Patients with haematological malignancies (HM) are particularly vulnerable to severe outcomes from COVID-19, with mortality rates reaching up to 34% in this patient group following COVID-19 infection (1). Although COVID-19 vaccines have been widely effective in reducing severe outcomes in the general population, patients with haematological malignancies often have limited immune responses to vaccination, even after multiple doses (2–6). Therefore, monoclonal antibodies (mAbs) used as pre-exposure prophylaxis (PrEP) have emerged as a vital preventive measure, providing added protection where vaccines alone fall short (3,7–9).
Our qualitative study explored the experiences of five haemato-oncologists in Germany working with this vulnerable group. Our aim was to identify key insights on implementation, challenges, and potential areas for improvement related to using mAbs as COVID PrEP. We found that large hospitals with greater resources and infrastructure, were better equipped to administer these preventive treatments. In contrast, smaller, office-based practices often lacked the necessary resources and clinician expertise and often referred patients to larger institutions.
The findings highlight the importance of streamlined guidelines, enhanced healthcare resources, knowledge sharing among healthcare professionals and targeted education for clinicians working in smaller practices to improve COVID PrEP adoption across all settings. These insights could shape future policies and best practice, helping to protect immunocompromised patients during future pandemics by ensuring they have access to lifesaving preventive measures.
The findings of this work were presented at the European Society for Immunodeficiencies (ESID) conference, held in October 2023 in Marseille, France.
The poster can accessed here . This study was funded by AstraZeneca.
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com
1. Vijenthira A, Gong IY, Fox TA, Booth S, Cook G, Fattizzo B, et al. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood. 2020 Dec 17;136(25):2881–92.
2. Reimann P, Petzer V, Mündlein A, Hartmann B, Severgnini L, Winkler A, et al. Efficacy and safety of tixagevimab/cilgavimab as passive immunisation against COVID-19 infections in patients with hematological malignancies. Ann Hematol [Internet]. 2024 Mar 2 [cited 2024 Mar 5]; Available from: https://doi.org/10.1007/s00277-024-05671-6
3. Glhoom S, Fergany A, El-Araby D, Abdelkhalek AA, Gomaa A, Zayed EO, et al. The efficacy of tixagevimab/cilgavimab (Evusheld) in prophylaxis and treatment of COVID-19 in immunocompromised patients: a systematic review and meta-analysis. Eur J Med Res. 2024 Jan 5;29:27.
4. Severe COVID-19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales – The Lancet [Internet]. [cited 2024 Mar 14]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01656-7/fulltext
5. Barnes E, Goodyear CS, Willicombe M, Gaskell C, Siebert S, I de Silva T, et al. SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease. Nat Med. 2023 Jul;29(7):1760–74.
6. Riccardi N, Falcone M, Yahav D. Vaccination for SARS-CoV-2 in Hematological Patients. Acta Haematol. 2022 May;145(3):257–66.
7. Cowan J, Amson A, Christofides A, Chagla Z. Monoclonal antibodies as COVID-19 prophylaxis therapy in immunocompromised patient populations. Int J Infect Dis. 2023 Sep;134:228–38.
8. Fomina DS, Lebedkina MS, Iliukhina AA, Kovyrshina AV, Shelkov AY, Andreev SS, et al. Real-world clinical effectiveness of Tixagevimab/Cilgavimab and Regdanvimab monoclonal antibodies for COVID-19 treatment in Omicron variant-dominant period. Front Immunol. 2023 Oct 20;14:1259725.
9. Demel I, Skopal D, Šafránková E, Rozsívalová P, Jindra P, Šrámek J, et al. Effectiveness of tixagevimab/cilgavimab in patients with hematological malignancies as a pre-exposure prophylaxis to prevent severe COVID-19: a Czech retrospective multicenter study. Ann Hematol. 2024;103(3):981–92.
Article by Enyal Lani November 2024