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Baratè C, Scortechini I, Ciofini S, Picardi P, Angeletti I, Loscocco F, Sanna A, Isidori A, Sportoletti P. Management of infections for patient treated with ibrutinib in clinical practice. Front Oncol 2024; 14:1428464. [PMID: 39319061 PMCID: PMC11420164 DOI: 10.3389/fonc.2024.1428464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/23/2024] [Indexed: 09/26/2024] Open
Abstract
Ibrutinib, a highly effective inhibitor of the Bruton tyrosine kinase, has significantly transformed the therapeutic approach in chronic lymphocytic leukemia (CLL). Despite these advancements, the disease continues to be characterized by immune dysfunction and increased susceptibility to infections, with mortality rates from infections showing no significant improvement over the past few decades. Therefore, timely prevention, recognition, and treatment of infections remains an important aspect of the standard management of a patient with CLL. A panel of hematologists with expertise in CLL met to discuss existing literature and clinical insights for the management of infectious in CLL undergoing ibrutinib treatment. Despite not being a fully comprehensive review on the topic, this work provides a set of practical recommendations that can serve as a guide to healthcare professionals who manage these patients in their daily clinical practice.
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Affiliation(s)
- Claudia Baratè
- Oncology Department, Hematology and Bone Marrow Transplant Unit, Pisa, Italy
| | - Ilaria Scortechini
- Clinic of Hematology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Sara Ciofini
- Department of Cell Therapies, Hematology Unit, Senese Hospital and University, Siena, Italy
| | - Paola Picardi
- Hematology and Cellular Therapy, Mazzoni Hospital, Ascoli Piceno, Italy
| | | | - Federica Loscocco
- Hematology and Stem Cell Transplant Center, Azienda Sanitaria Territoriale (AST) Pesaro and Urbino, Pesaro, Italy
| | - Alessandro Sanna
- Hematology Unit, Azienda Ospedaliera Universitaria (AOU) Careggi, Florence, Italy
| | - Alessandro Isidori
- Hematology and Stem Cell Transplant Center, Azienda Sanitaria Territoriale (AST) Pesaro and Urbino, Pesaro, Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncology Research (CREO), University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
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Guarnera L, Tiravanti I, Guiducci A, Coppola L, Marinoni M, Nunzi A, Laureana R, Cardillo L, Esposito F, Secchi R, Buzzatti E, Paterno G, Pupo L, Sarmati L, Gattei V, Venditti A, Postorino M, Del Principe MI. Prophylaxis with Tixagevimab/Cilgavimab in chronic lymphocytic leukaemia, a case control study. Ann Hematol 2024; 103:3831-3833. [PMID: 39026027 DOI: 10.1007/s00277-024-05815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/22/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Luca Guarnera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Translational Hematology & Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 44114, USA
| | - Ilaria Tiravanti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Arianna Guiducci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Coppola
- Clinical Infectious Diseases, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Marinoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Nunzi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Laureana
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Cardillo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabiana Esposito
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Secchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Buzzatti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giovangiacinto Paterno
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Livio Pupo
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Adriano Venditti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - Massimiliano Postorino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Ilaria Del Principe
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
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3
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De Filippi R, Marcacci G, Amelio S, Becchimanzi C, Pinto A. Patients with multiple myeloma infected with COVID-19 during autologous stem cell transplantation. Infect Agent Cancer 2024; 19:38. [PMID: 39135101 PMCID: PMC11318344 DOI: 10.1186/s13027-024-00603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024] Open
Abstract
Despite the global vaccination campaigns, certain patient groups remain highly vulnerable to SARS-CoV-2 and are at high risk for unfavorable COVID-19 outcomes. As previously shown by our group and a more recent report by Chang Su and coworkers, patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT) represent one of such high-risk populations. This is due to the underlying disease-related immunodeficiency, suboptimal response to vaccines, heavy exposure to dexamethasone, and the use of high-dose melphalan prior to the ASCT procedure. Contracting SARS-CoV-2 and developing COVID-19 during the ASCT procedure remain high-risk events for these patients. It is then crucial to maintain and implement all appropriate strategies to prevent COVID-19 breakthroughs in this clinical setting. This might include targeted pre- and post-exposure prophylaxis with monoclonal antibodies, based on the circulation and prevalence of different SARS-CoV-2 variants/subvariants, and the prompt use of antivirals if, despite prophylaxis, MM patients develop COVID-19 during the transplantation procedure. We emphasize the importance of regularly monitoring MM patients for SARS-CoV-2 infection at all stages of the ASCT procedure. This is crucial to promptly implement measures to reduce the risk of unfavorable COVID-19 outcomes during the current post-pandemic phase.
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Affiliation(s)
- Rosaria De Filippi
- Department of Clinical Medicine and Surgery, Università degli Studi Federico II, Naples, Italy
| | - Gianpaolo Marcacci
- Hematology-Oncology and Stem-Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I-80131, Italy
| | - Sabrina Amelio
- Hematology-Oncology and Stem-Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I-80131, Italy
| | - Cristina Becchimanzi
- Hematology-Oncology and Stem-Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I-80131, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem-Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I-80131, Italy.
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4
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Gai X, Sun X, Liu B, Yan W, Sheng Z, Zhou Q, Sun Y. Efficacy of Combination of Antiviral Therapy With Neutralizing Monoclonal Antibodies for Recurrent Persistent SARS-CoV-2 Pneumonia in Patients With Lymphoma. BIOMED RESEARCH INTERNATIONAL 2024; 2024:8182887. [PMID: 39140001 PMCID: PMC11321881 DOI: 10.1155/2024/8182887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/18/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024]
Abstract
Despite the potential of neutralizing antibodies in the management of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), clinical research on its efficacy in Chinese patients remains limited. This study is aimed at investigating the therapeutic effect of combination of antiviral therapy with neutralizing monoclonal antibodies for recurrent persistent SARS-CoV-2 pneumonia in patients with lymphoma complicated by B cell depletion. A prospective study was conducted on Chinese patients who were treated with antiviral nirmatrelvir/ritonavir therapy and the neutralizing antibody tixagevimab-cilgavimab (tix-cil). The primary outcome was the rate of recurrent SARS-CoV-2 infection. Five patients with lymphoma experienced recurrent SARS-CoV-2 pneumonia and received tix-cil treatment. All patients had a history of CD20 monoclonal antibody use within the year preceding SARS-CoV-2 infection, and two patients also had a history of Bruton's tyrosine kinase (BTK) inhibitor use. These patients had notably low lymphocyte counts and exhibited near depletion of B cells. All five patients tested negative for serum SARS-CoV-2 IgG and IgM antibodies. None of the patients developed reinfection with SARS-CoV-2 pneumonia after antiviral and tix-cil treatment during the 6-month follow-up period. In conclusion, the administration of antiviral and SARS-CoV-2-neutralizing antibodies showed encouraging therapeutic efficacy against SARS-CoV-2 pneumonia in patients with lymphoma complicated by B cell depletion, along with the potential preventive effect of neutralizing antibodies for up to 6 months.
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Affiliation(s)
- Xiaoyan Gai
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Xiaoyan Sun
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Beibei Liu
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Wei Yan
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Zikang Sheng
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Qingtao Zhou
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
| | - Yongchang Sun
- Department of Pulmonary and Critical Care Medicine Peking University Third Hospital, Beijing 100083, China
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5
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Vergori A, Matusali G, Cimini E, Bordi L, Borrelli P, Lanini S, Palazzi R, Paulicelli J, Mariotti D, Mazzotta V, Notari S, Casetti R, Francalancia M, Rosati S, D’Abramo A, Mija C, Mencarini P, Milozzi E, Caraffa E, Sica S, Metafuni E, Sorà F, Rago A, Siniscalchi A, Abruzzese E, Garzia M, Luzi G, Battistini R, Prosperini L, Cingolani A, Girardi E, Maggi F, Antinori A. Real World Use of Tixagevimab/Cilgavimab Pre-Exposure Prophylaxis of COVID-19 in Immunocompromised Individuals: Data from the OCTOPUS Study. Vaccines (Basel) 2024; 12:784. [PMID: 39066422 PMCID: PMC11281604 DOI: 10.3390/vaccines12070784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Objective. We aimed to report the real-world use and outcomes over time in immunocompromised individuals receiving tixagevimab/cilgavimab (T/C) pre-exposure prophylaxis (PrEP). Methods. This observational study included participants who received T/C PrEP, categorized into three groups: (i) No COVID-19 (NoC), i.e., participants who never had COVID-19; (ii) Hybrids (H), i.e., participants who had COVID-19 before PrEP; and (iii) Break-through Infections (BTIs), i.e., participants who had COVID-19 after PrEP. The study measured several immune markers at the administration of T/C (T0) at 3 (T1), 6 (T2), and 9 (T3) months afterward. These markers included: anti-receptor-binding domain (RBD) IgG antibodies; BA.5-neutralizing antibodies (nAbs); mucosal IgG; and T cell immunity. The incidence rate ratios for BTIs were analyzed using a Poisson regression model. Results. A total of 231 participants with a median age of 63 years (IQR 54.0-73.0). were included. Among these, 84% had hematological diseases and received a median of three vaccine doses. N = 72 participants belonged to the NoC group, N = 103 to the H group, and n = 56 to the BTI group (24%), with most BTIs being mild/moderate. The incidence rate (IR) of BTIs was 4.2 per 100 patient-months (95% CI 3.2-5.4), with no associated risk factors identified. There was a significant increase in anti-RBD IgG levels 3 months after the T/C administration in all groups, followed by a decline at 6 months, whereas at the same time points, geometric mean titers (GMTs) of anti-BA.5 nAbs were low for all groups and were around or below the detection threshold. No significant changes were observed in IFN-γ levels. The mucosal immune response was observed only 3 months after the PrEP administration. Conclusion. We provided a real-world experience model on the clinical efficacy of T/C PrEP in preventing severe COVID-19 during the Omicron wave through a comprehensive virological and immunological study. While waiting for the arrival of new monoclonal antibodies that can effectively neutralize the most recent variants, T/C PrEP remains the only viable strategy in the available armamentarium today to prevent COVID-19 complications in an extremely fragile population with suboptimal immune responses to COVID-19 vaccines.
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Affiliation(s)
- Alessandra Vergori
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.L.); (J.P.); (V.M.); (A.A.)
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Eleonora Cimini
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (E.C.); (S.N.); (R.C.)
| | - Licia Bordi
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Paola Borrelli
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University “G. D’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy;
| | - Simone Lanini
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.L.); (J.P.); (V.M.); (A.A.)
- Clinica Malattie Infettive, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Roberta Palazzi
- Accettazione e Teleconsulto Rete Regionale Malattie Infettive, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Jessica Paulicelli
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.L.); (J.P.); (V.M.); (A.A.)
| | - Davide Mariotti
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Valentina Mazzotta
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.L.); (J.P.); (V.M.); (A.A.)
| | - Stefania Notari
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (E.C.); (S.N.); (R.C.)
| | - Rita Casetti
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (E.C.); (S.N.); (R.C.)
| | - Massimo Francalancia
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Silvia Rosati
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases “L.Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.R.); (A.D.)
| | - Alessandra D’Abramo
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases “L.Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.R.); (A.D.)
| | - Cosmina Mija
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Paola Mencarini
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Eugenia Milozzi
- Epatology Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Emanuela Caraffa
- Severe and Immune-Depression Associated Infectious Diseases Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy;
| | - Simona Sica
- Imaging Diagnostics Departmenti, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00184 Rome, Italy; (S.S.); (E.M.); (F.S.)
| | - Elisabetta Metafuni
- Imaging Diagnostics Departmenti, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00184 Rome, Italy; (S.S.); (E.M.); (F.S.)
| | - Federica Sorà
- Imaging Diagnostics Departmenti, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00184 Rome, Italy; (S.S.); (E.M.); (F.S.)
| | - Angela Rago
- UOSD Ematologia ASL Roma 1, San Filippo Neri Hospital, 00135 Rome, Italy; (A.R.); (A.S.)
| | - Agostina Siniscalchi
- UOSD Ematologia ASL Roma 1, San Filippo Neri Hospital, 00135 Rome, Italy; (A.R.); (A.S.)
| | | | - Mariagrazia Garzia
- UOC Ematologia e Trapianto di Cellule Staminali, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.G.); (G.L.); (R.B.)
| | - Giovanni Luzi
- UOC Ematologia e Trapianto di Cellule Staminali, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.G.); (G.L.); (R.B.)
| | - Roberta Battistini
- UOC Ematologia e Trapianto di Cellule Staminali, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.G.); (G.L.); (R.B.)
| | - Luca Prosperini
- UOC Neurologia e Neurofisiopatologia, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | | | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases “L. Spallanzani”, IRCCS, 00184 Rome, Italy;
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (G.M.); (L.B.); (D.M.); (M.F.); (C.M.); (F.M.)
| | - Andrea Antinori
- Viral Immunodeficiencies Unit, National Institute for Infectious Diseases “L. Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00149 Rome, Italy; (S.L.); (J.P.); (V.M.); (A.A.)
- Clinical Department and Research Direction, National Institute for Infectious Diseases “L. Spallanzani”, IRCCS, 00184 Rome, Italy
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Taniguchi T, Homma T, Tamai Y, Arita Y, Fujiwara M, Kuroishi N, Sugiyama K, Kanazu S, Maruyama A. Clinical characteristics and COVID-19-related outcomes of immunocompromised patients receiving tixagevimab/cilgavimab pre-exposure prophylaxis in Japan. J Infect Chemother 2024:S1341-321X(24)00185-5. [PMID: 38986842 DOI: 10.1016/j.jiac.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/06/2024] [Accepted: 07/06/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Tixagevimab/cilgavimab is a cocktail of two long-acting monoclonal antibodies approved for pre-exposure prophylaxis (PrEP) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection (cause of coronavirus disease 2019 [COVID-19]) in immunocompromised (IC) or high-risk patients. We investigated the patient characteristics and clinical outcomes of IC patients administered tixagevimab/cilgavimab for PrEP in real-world use in Japan. METHODS This observational study used anonymous secondary data from Real-World Data Co., Ltd. for IC patients aged ≥12 years administered tixagevimab/cilgavimab between September 2022 and September 2023. We analyzed the baseline characteristics and event-rates of COVID-19-related clinical outcomes within 6 months of administration. RESULTS Data were analyzed for 397 IC patients. About half (53.4 %) were male and the median age was 71.0 (interquartile range 61.0, 77.0) years. Malignancy (97.2 %), cardiovascular disease (71.3 %), and diabetes (66.5 %) were frequent comorbidities. Systemic corticosteroids and immunosuppressants were prescribed to 87.4 % and 24.9 %, respectively. The two most common target clinical conditions were active therapy for hematologic malignancies (88.2 %) and treatment with B cell-depleting therapies (57.4 %). The event-rates per 100 person-months (95 % confidence interval; number) for medically attended COVID-19, COVID-19 hospitalization, in-hospital mortality due to COVID-19, and all-cause death were 4.14 (3.06-5.48; n = 49), 1.74 (1.09-2.64; n = 22), 0.07 (0.00-0.42; n = 1), and 0.60 (0.26-1.17; n = 8), respectively. CONCLUSION This is the first report using a multicenter database to describe the clinical characteristics and COVID-19-related outcomes of IC patients administered with tixagevimab/cilgavimab in real-world settings in Japan. This cohort of IC patients who received tixagevimab/cilgavimab included many elderly patients with comorbidities.
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Affiliation(s)
| | - Tomoyuki Homma
- Vaccines & Immune Therapies, Medical Department, AstraZeneca K.K., Osaka, Japan.
| | - Yoichi Tamai
- Evidence & Observational Research, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Yoshifumi Arita
- Evidence & Observational Research, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Masakazu Fujiwara
- Evidence & Observational Research, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Naho Kuroishi
- Vaccines & Immune Therapies, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Keiji Sugiyama
- Vaccines & Immune Therapies, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Shinichi Kanazu
- Vaccines & Immune Therapies, Medical Department, AstraZeneca K.K., Osaka, Japan
| | - Atsushi Maruyama
- Vaccines & Immune Therapies, Medical Department, AstraZeneca K.K., Osaka, Japan
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7
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Lalle E, Mazzotta V, Sberna G, Fabeni L, Garbuglia AR, Mastrorosa I, D’Abramo A, Nicastri E, Girardi E, Antinori A, Maggi F, Bordi L. Saliva Is a Sensitive and Accessible Sample Both for SARS-CoV-2 Detection and for the Evaluation of Treatment Effectiveness in Follow-Up Studies. Viruses 2024; 16:1040. [PMID: 39066203 PMCID: PMC11281700 DOI: 10.3390/v16071040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Despite emerging evidence indicating that molecular SARS-CoV-2 tests performed on saliva have diagnostic sensitivity and specificity comparable to those observed with nasopharyngeal swabs (NPSs), most in vivo follow-up studies on the efficacy of drugs against SARS-CoV-2 have been performed on NPSs, not considering saliva as a possible alternative matrix. For this reason, in this study, we used, in parallel, saliva and NPS samples for the detection of SARS-CoV-2 by real-time RT-PCR in patients receiving Tixagevimab/Cilgavimab, Nirmatrelvir/Ritonavir, or Sotrovimab as a treatment against SARS-CoV-2. Our results showed a good correlation between the NPS and saliva samples for each drug; moreover, comparable changes in the cycle threshold (Ct) levels in saliva and NPSs were observed both 7 days and 30 days after treatment, thus confirming that the saliva represents a good matrix for in vivo follow-up studies verifying the effectiveness of treatments against SARS-CoV-2.
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Affiliation(s)
- Eleonora Lalle
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Valentina Mazzotta
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy (I.M.)
| | - Giuseppe Sberna
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Lavinia Fabeni
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Ilaria Mastrorosa
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy (I.M.)
| | - Alessandra D’Abramo
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy (I.M.)
| | - Emanuele Nicastri
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy (I.M.)
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Andrea Antinori
- Clinical and Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy (I.M.)
| | - Fabrizio Maggi
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
| | - Licia Bordi
- Laboratory of Virology and Biosafety Laboratories, National Institute for Infectious Diseases Lazzaro Spallanzani—IRCCS, 00149 Rome, Italy
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8
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Dick JK, Hicks D, Krishna VD, Sangala JA, Zandstra BT, Baehr C, Verbeek JS, Cragg MS, Cheeran MCJ, Pravetoni M, Hart GT. ACE2 decoy Fc-fusions and bi-specific killer engager (BiKEs) require Fc engagement for in vivo efficacy against SARS-CoV-2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.20.599956. [PMID: 38948747 PMCID: PMC11212978 DOI: 10.1101/2024.06.20.599956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
SARS-CoV-2 virus has continued to evolve over time necessitating the adaptation of vaccines to maintain efficacy. Monoclonal antibodies (mAbs) against SARS-CoV-2 were a key line of defense for unvaccinated or immunocompromised individuals. However, these mAbs are now ineffective against current SARS-CoV-2 variants. Here, we tested three aspects of αSARS-CoV-2 therapeutics. First, we tested whether Fc engagement is necessary for in vivo clearance of SARS-CoV-2. Secondly, we tested bi-specific killer engagers (BiKEs) that simultaneously engage SARS-CoV-2 and a specific Fc receptor. Benefits of these engagers include the ease of manufacturing, stability, more cell-specific targeting, and high affinity binding to Fc receptors. Using both mAbs and BiKEs, we found that both neutralization and Fc receptor engagement were necessary for effective SARS-CoV-2 clearance. Thirdly, due to ACE2 being necessary for viral entry, ACE2 will maintain binding to SARS-CoV-2 despite viral evolution. Therefore, we used an ACE2 decoy Fc-fusion or BiKE, instead of an anti-SARS-CoV-2 antibody sequence, as a potential therapeutic that would withstand viral evolution. We found that the ACE2 decoy approach also required Fc receptor engagement and, unlike traditional neutralizing antibodies against specific variants, enabled the clearance of two distinct SARS-CoV-2 variants. These data show the importance of Fc engagement for mAbs, the utility of BiKEs as therapies for infectious disease, and the in vivo effectiveness of the ACE2 decoy approach. With further studies, we predict combining neutralization, the cellular response, and this ACE2 decoy approach will benefit individuals with ineffective antibody levels. Abbreviations ACE2, scFv, mAb, BiKE, COVID-19, Fc, CD16, CD32b, CD64, d.p.i. Key points With equal dosing, both neutralization and Fc engagement are necessary for the optimal efficacy of in vivo antibodies and bi-specific killer engagers (BiKEs) against SARS-CoV-2. BiKEs can clear SARS-CoV-2 virus and protect against severe infection in the hACE2-K18 mouse model. ACE2 decoys as part of Fc-fusions or BiKEs provide in vivo clearance of two disparate SARS-CoV-2 variants.
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9
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Reimann P, Petzer V, Mündlein A, Hartmann B, Severgnini L, Winkler A, Lang T, Huynh M, Gasser K, Rüger J, Atzl M, Mink S, Fraunberger P, Schmidt S, Steiner N, Griesmacher A, Gunsilius E, Nachbaur D, Willenbacher W, Wolf D, Winder T, Benda MA. Efficacy and safety of tixagevimab/cilgavimab as passive immunisation against COVID-19 infections in patients with hematological malignancies. Ann Hematol 2024; 103:2123-2131. [PMID: 38436671 DOI: 10.1007/s00277-024-05671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Monoclonal antibodies, as tixagevimab/cilgavimab, have been introduced as prophylaxis against COVID-19 infections in high-risk populations. However, data on efficacy are limited. This study investigates efficacy and tolerability of tixagevimab/cilgavimab in hematological patients under real-life conditions. Tixagevimab/cilgavimab was administered to 155 hematological patients (March-August 2022) at two Austrian centres. S/RBD-antibody assessments were performed before (T0), four weeks (T1), and six months (T2) after application. Side effects, the occurrence of COVID-19 infections, and the course of S/RBD-antibody titres were analysed retrospectively in relation to clinical variables. 155 hematological patients, who refused tixagevimab/cilgavimab, were included as a control group to compare the frequency of COVID-19 infections. Of all immunised patients (52.3% males; 91% triple vaccinated), 25.8% had a COVID-19 breakthrough infection (76% mild) compared to 43.9% in the control group. Patients with chronic lymphocytic leukaemia (CLL)/lymphoma were at highest risk of a COVID-19 infection (OR = 2.21; 95% CI 1.05-4.65; p = 0.037). After immunisation, a steep increase in median antibody levels (1193.4BAU/ml, IQR 0-2318.94) was observed in 67.8%, followed by a rapid decrease between T1 and T2 (465.95BAU/ml, IQR 0-1900.65.3) with the greatest declines in CLL/lymphoma (848.7BAU/ml, IQR 0-1949.6, p = 0.026). Side-effects occurred in 21.2% (CTCAE I/II). These real-world data indicate that S/RBD antibodies respond rapidly after passive immunisation in all hematological patients without safety concerns. Given the rapid decline in S/RBD antibodies, early booster immunisations should be considered for future scenarios in this vulnerable group.
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Affiliation(s)
- Patrick Reimann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Verena Petzer
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Axel Mündlein
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
| | - Bernd Hartmann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Luciano Severgnini
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Alex Winkler
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Theresia Lang
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Minh Huynh
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Klaus Gasser
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Julia Rüger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Michele Atzl
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Stefan Schmidt
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Normann Steiner
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Med. and Chem. Laboratory Diagnostics (ZIMCL) With Interdisciplinary Hematological Competence Centre (IHK), Medical University Innsbruck, Innsbruck, Austria
| | - Eberhard Gunsilius
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - David Nachbaur
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
- Syndena,GmbH Connect to Cure, Innsbruck, Austria
| | - Dominik Wolf
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- University of Zurich, Zurich, Switzerland
| | - Magdalena Anna Benda
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
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10
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Merli M, Costantini A, Tafuri S, Bavaro DF, Minoia C, Meli E, Luminari S, Gini G. Management of vaccinations in patients with non-Hodgkin lymphoma. Br J Haematol 2024; 204:1617-1634. [PMID: 38532527 DOI: 10.1111/bjh.19422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
Vaccinations are fundamental tools in preventing infectious diseases, especially in immunocompromised patients like those affected by non-Hodgkin lymphomas (NHLs). The COVID-19 pandemic made clinicians increasingly aware of the importance of vaccinations in preventing potential life-threatening SARS-CoV-2-related complications in NHL patients. However, several studies have confirmed a significant reduction in vaccine-induced immune responses after anti-CD20 monoclonal antibody treatment, thus underscoring the need for refined immunization strategies in NHL patients. In this review, we summarize the existing data about COVID-19 and other vaccine's efficacy in patients with NHL and propose multidisciplinary team-based recommendations for the management of vaccines in this specific group of patients.
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Affiliation(s)
- Michele Merli
- Division of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Costantini
- Clinical Immunology Unit, Azienda Ospedaliero Universitaria delle Marche - Università Politecnica delle Marche, Ancona, Italy
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Carla Minoia
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Erika Meli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Guido Gini
- Clinic of Hematology, Azienda Ospedaliero Universitaria Delle Marche - Università Politecnica Delle Marche, Ancona, Italy
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11
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Salmanton-García J, Marchesi F, Farina F, Weinbergerová B, Itri F, Dávila-Valls J, Martín-Pérez S, Glenthøj A, Hersby DS, Gomes da Silva M, Nunes Rodrigues R, López-García A, Córdoba R, Bilgin YM, Falces-Romero I, El-Ashwah S, Emarah Z, Besson C, Kohn M, Van Doesum J, Ammatuna E, Marchetti M, Labrador J, Zambrotta GPM, Verga L, Jaksic O, Nucci M, Piukovics K, Cabirta-Touzón A, Jiménez M, Arellano E, Espigado I, Blennow O, Nordlander A, Meers S, van Praet J, Aiello TF, Garcia-Vidal C, Fracchiolla N, Sciumè M, Seval GC, Žák P, Buquicchio C, Tascini C, Gräfe SK, Schönlein M, Adžić-Vukičević T, Bonuomo V, Cattaneo C, Nizamuddin S, Čerňan M, Plantefeve G, Prin R, Szotkovski T, Collins GP, Dargenio M, Petzer V, Wolf D, Čolović N, Prezioso L, Valković T, Passamonti F, Méndez GA, Sili U, Vena A, Bavastro M, Limongelli A, Duarte RF, Ledoux MP, Cvetanoski M, Stojanoski Z, Machado M, Batinić J, Magliano G, Biernat MM, Pantić N, Poulsen CB, Cuccaro A, Del Principe MI, Kulasekararaj A, Ormazabal-Vélez I, Busca A, Demirkan F, Ijaz M, Klimko N, Stoma I, Khostelidi S, Fernández N, Omrani AS, Bergantim R, De Jonge N, Fouquet G, Navrátil M, Abu-Zeinah G, Samarkos M, Maertens J, De Ramón C, Guidetti A, Magyari F, González-López TJ, Lahmer T, Finizio O, Ali N, Pinczés LI, Lavilla-Rubira E, Romano A, Merelli M, Delia M, Calbacho M, Meletiadis J, Antić D, Hernández-Rivas JÁ, Marques de Almeida J, Al-Khabori M, Hoenigl M, Tisi MC, Khanna N, Barać A, Eisa N, Di Blasi R, Liévin R, Miranda-Castillo C, Bahr NC, Lamure S, Papa MV, Yahya A, Aujayeb A, Novák J, Erben N, Fernández-Galán M, Ribera-Santa Susana JM, Rinaldi I, Fazzi R, Piedimonte M, Duléry R, Gonzaga Y, Soto-Silva A, Sapienza G, Serris A, Drgoňa Ľ, Groh A, Serrano L, Gavriilaki E, Tragiannidis A, Prattes J, Coppola N, Otašević V, Mladenović M, Mitrović M, Mišković B, Jindra P, Zompi S, Sacchi MV, Krekeler C, Infante MS, García-Bordallo D, Çolak GM, Mayer J, Nygaard M, Hanáková M, Ráčil Z, Bonanni M, Koehler P, Rahimli L, Cornely OA, Pagano L. Decoding the historical tale: COVID-19 impact on haematological malignancy patients-EPICOVIDEHA insights from 2020 to 2022. EClinicalMedicine 2024; 71:102553. [PMID: 38533127 PMCID: PMC10963230 DOI: 10.1016/j.eclinm.2024.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Background The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020-2022). Findings The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding Not applicable.
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Affiliation(s)
- Jon Salmanton-García
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Barbora Weinbergerová
- Masaryk University and University Hospital Brno - Department of Internal Medicine, Hematology and Oncology, Brno, Czech Republic
| | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | | | | | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | | | - Alberto López-García
- Fundación Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Raúl Córdoba
- Fundación Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | | | - Iker Falces-Romero
- Microbiology and Parasitology Department, University Hospital La Paz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
- King Abdullah Medical City, Makkah, Saudi Arabia
| | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France
- Université Paris-Saclay, UVSQ, Inserm, Équipe “Exposome et Hérédité”, CESP, Villejuif, France
| | - Milena Kohn
- Centre Hospitalier de Versailles, Le Chesnay, France
- Université Paris-Saclay, UVSQ, Inserm, Équipe “Exposome et Hérédité”, CESP, Villejuif, France
| | | | | | - Monia Marchetti
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy
- Università Milano-Bicocca, Milan, Italy
| | | | - Marcio Nucci
- Department of Internal Medicine, Federal University of Rio de Janeiro and Grupo Oncoclinicas, Rio de Janeiro, Brazil
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Alba Cabirta-Touzón
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Moraima Jiménez
- Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jens van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Summiya Nizamuddin
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Martin Čerňan
- University Hospital Olomouc, Olomouc, Czech Republic
| | - Gaëtan Plantefeve
- Head ICU and CRC, Centre Hospitalier Victor DUPOUY, Argenteuil, France
| | - Romane Prin
- CRA from CRC Centre Hospitalier Victor DUPOUY, Argenteuil, France
| | | | | | | | - Verena Petzer
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | | | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Croatia
- Faculty of Medicine and Faculty of Health Studies of University of Rijeka, Rijeka, Croatia
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | | | | | | | | | | | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josip Batinić
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
- Faculty of Medicine University of Zagreb, Zagreb, Croatia
| | | | | | - Nikola Pantić
- University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
- National Cancer Institute, Fondazione ‘G. Pascale’, IRCCS, Hematology-Oncology and Stem Cell Transplantation Unit, Naples, Italy
| | | | - Austin Kulasekararaj
- Department of Hematological Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Fatih Demirkan
- Dokuz Eylul University, Division of Hematology, Izmir, Turkey
| | - Marriyam Ijaz
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nikolai Klimko
- North-Western State Medical University Named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Igor Stoma
- Gomel State Medical University, Gomel, Belarus
| | - Sofya Khostelidi
- North-Western State Medical University Named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Nick De Jonge
- Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | | | | | | | - Michail Samarkos
- Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Anna Guidetti
- University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Ferenc Magyari
- Division of Hematology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Tobias Lahmer
- Medizinische Klinik II, Klinikum Rechts der Isar, TU München, Munich, Germany
| | | | | | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, Bari, Italy
| | | | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Darko Antić
- University Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Clinical Mycology, Department of Internal Medicine, Medical University of Graz, Austria
- BioTechMed, Graz, Austria
| | | | - Nina Khanna
- University Hospital of Basel, Basel, Switzerland
| | | | - Noha Eisa
- Aseer Central Hospital, Abha, Saudi Arabia
- Oncology Center Mansoura University, Mansoura, Egypt
| | | | | | | | - Nathan C. Bahr
- University of Kansas Medical Center, Kansas City, United States
| | - Sylvain Lamure
- Department of Clinical Hematology, Montpellier University Hospital, IGMM UMR5535 CNRS, University of Montpellier, Montpellier, France
| | | | - Ayel Yahya
- Aseer Central Hospital, Abha, Saudi Arabia
| | | | - Jan Novák
- University Hospital of Královské Vinohrady, Prague, Czech Republic
| | - Nurettin Erben
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | | | - Rita Fazzi
- Hematology and Stem Cell Transplant Unit, Osperadiela University Pisana Company, Pisa, Italy
| | | | - Rémy Duléry
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Inserm UMRs 938, Paris, France
| | - Yung Gonzaga
- Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | - Andrés Soto-Silva
- Faculty of Medicine, University of Chile. Infectious Diseases Unity, Salvador Hospital of Santiago, Santiago de Chile, Chile
| | - Giuseppe Sapienza
- Azienda Ospedaliera “Ospedali Riuniti Villa Sofia-Cervello”, Palermo, Italy
| | | | - Ľuboš Drgoňa
- Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ana Groh
- Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Eleni Gavriilaki
- General Hospital of Thessaloniki “George Papanikolaou”, Thessaloniki, Greece
| | | | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania, Naples, Italy
| | | | | | | | - Bojana Mišković
- Center for Radiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Pavel Jindra
- University Hospital Pilsen, Pilsen, Czech Republic
| | - Sofia Zompi
- Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy
| | - Maria Vittoria Sacchi
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carolin Krekeler
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | | | | | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Jiří Mayer
- Masaryk University and University Hospital Brno - Department of Internal Medicine, Hematology and Oncology, Brno, Czech Republic
| | | | - Michaela Hanáková
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Matteo Bonanni
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Qian H, Yang X, Zhang T, Zou P, Zhang Y, Tian W, Mao Z, Wei J. Improving the safety of CAR-T-cell therapy: The risk and prevention of viral infection for patients with relapsed or refractory B-cell lymphoma undergoing CAR-T-cell therapy. Am J Hematol 2024; 99:662-678. [PMID: 38197307 DOI: 10.1002/ajh.27198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy, an innovative immunotherapeutic against relapsed/refractory B-cell lymphoma, faces challenges due to frequent viral infections. Despite this, a comprehensive review addressing risk assessment, surveillance, and treatment management is notably absent. This review elucidates immune response compromises during viral infections in CAR-T recipients, collates susceptibility risk factors, and deliberates on preventive strategies. In the post-pandemic era, marked by the Omicron variant, new and severe threats to CAR-T therapy emerge, necessitating exploration of preventive and treatment measures for COVID-19. Overall, the review provides recommendations for viral infection prophylaxis and management, enhancing CAR-T product safety and recipient survival.
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Affiliation(s)
- Hu Qian
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingcheng Yang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Zhang
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Ping Zou
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Tian
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Zekai Mao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
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13
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Hayashino K, Seike K, Fujiwara K, Kondo K, Matsubara C, Terao T, Kitamura W, Kamoi C, Fujiwara H, Asada N, Nishimori H, Ennishi D, Fujii K, Fujii N, Matsuoka KI, Maeda Y. Chimeric antigen receptor T-cell therapy after COVID-19 in refractory high-grade B-cell lymphoma. Int J Hematol 2024; 119:459-464. [PMID: 38349446 PMCID: PMC10960909 DOI: 10.1007/s12185-024-03711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 03/24/2024]
Abstract
Although chimeric antigen receptor T-cell (CAR-T) therapies have dramatically improved the outcomes of relapsed/refractory B-cell malignancies, recipients suffer from severe humoral immunodeficiencies. Furthermore, patients with coronavirus disease 2019 (COVID-19) have a poor prognosis, as noted in several case reports of recipients who had COVID-19 before the infusion. We report the case of a 70-year-old woman who developed COVID-19 immediately before CAR-T therapy for high-grade B-cell lymphoma. She received Tixagevimab-Cilgavimab chemotherapy and radiation therapy but never achieved remission. She was transferred to our hospital for CAR-T therapy, but developed COVID-19. Her symptoms were mild and she was treated with long-term molnupiravir. On day 28 post-infection, lymphodepleting chemotherapy was restarted after a negative polymerase chain reaction (PCR) test was confirmed. The patient did not experience recurrence of COVID-19 symptoms or severe cytokine release syndrome. Based on the analysis and comparison of the previous reports with this case, we believe that CAR-T therapy should be postponed until a negative PCR test is confirmed. In addition, Tixagevimab-Cilgavimab and long term direct-acting antiviral agent treatment can be effective prophylaxis for severe COVID-19 and shortening the duration of infection.
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Affiliation(s)
- Kenta Hayashino
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Keisuke Seike
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan.
| | - Kanako Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Kaho Kondo
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Chisato Matsubara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Toshiki Terao
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Chihiro Kamoi
- Division of Blood Transfusion, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Daisuke Ennishi
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Keiko Fujii
- Division of Clinical Laboratory, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
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14
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Demel I, Skopal D, Šafránková E, Rozsívalová P, Jindra P, Šrámek J, Turková A, Vydra J, Labská K, Vedrová J, Čerňan M, Szotkowski T, Móciková H, Hynková L, Šušol O, Kováčová I, Belada D, Hájek R. 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; 103:981-992. [PMID: 38092996 PMCID: PMC10866774 DOI: 10.1007/s00277-023-05572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/28/2023] [Indexed: 02/15/2024]
Abstract
Despite lower virulence, the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) still poses a relevant threat for immunocompromised patients. A retrospective multicentric study was conducted to evaluate the efficacy of pre-exposure prophylaxis with tixagevimab/cilgavimab (Evusheld) with a 6-month follow-up for preventing severe COVID-19 in adult patients with hematology malignancy. Among the 606 patients in the cohort, 96 (16%) contracted COVID-19 with a median of 98.5 days after Evusheld administration. A total of 75% of patients had asymptomatic or mild severity of COVID-19, while just 25% of patients with SARS-CoV-2 positivity had to be hospitalized. Two patients (2%) died directly, and one patient (1%) in association with COVID-19. Eight patients (1.3%) of every cohort experienced adverse events related to Evusheld, mostly grade 1 and of reversible character. It was found that complete vaccination status or positive seroconversion was not associated with lower risk of COVID-19 infection. Previous treatment with an anti-CD20 monoclonal antibody was associated with higher rates of COVID-19, while previous treatment with anti-CD38 monoclonal antibody was not, as was the case for recipients of hematopoietic stem cell transplantation or CAR-T cell therapy. Presence of other comorbidities was not associated with more severe COVID-19. The results support the growing evidence for Evusheld's efficacy against severe COVID-19 in patients with hematology malignancies.
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Affiliation(s)
- Ivo Demel
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic.
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - David Skopal
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Eliška Šafránková
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Petra Rozsívalová
- Hospital Pharmacy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Pavel Jindra
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jiří Šrámek
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
- Department of Histology and Embryology, Faculty of Medicine, Pilsen, Czech Republic
| | - Adéla Turková
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Vydra
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Klára Labská
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Jana Vedrová
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Martin Čerňan
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Tomáš Szotkowski
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Heidi Móciková
- Department of Internal Medicine and Haematology, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lenka Hynková
- Department of Internal Medicine and Haematology, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ondrej Šušol
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ingrid Kováčová
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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15
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Salvini M, Grossi PA, Cacioppo A, Merli M, Pellegrini G, Brociner M, Passamonti F. Efficacy of Tixagevimab-Cilgavimab as Immunoprophylaxis in Patients With Hematologic Cancer. JAMA Oncol 2024; 10:405-407. [PMID: 38270961 PMCID: PMC10811587 DOI: 10.1001/jamaoncol.2023.6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/04/2023] [Indexed: 01/26/2024]
Abstract
This cohort study compares outcomes for patients with hematologic malignant tumors who prophylactically received tixagevimab-cilgavimab against SARS-CoV-2 with those who did not.
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Affiliation(s)
- Marco Salvini
- ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Paolo Antonio Grossi
- ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Michele Merli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giacomo Pellegrini
- ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Marco Brociner
- ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesco Passamonti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano, Milano, Italy
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16
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Gidari A, Sabbatini S, Bastianelli S, Pierucci S, Busti C, Svizzeretto E, Tommasi A, Pallotto C, Schiaroli E, Francisci D. Tixagevimab/Cilgavimab: Still a Valid Prophylaxis against COVID-19 New Variants? Viruses 2024; 16:354. [PMID: 38543720 PMCID: PMC10975286 DOI: 10.3390/v16030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND this study aims to evaluate the efficacy of tixagevimab/cilgavimab (Evusheld™) against various SARS-CoV-2 variants, including newer Omicron sublineages, in an immunocompromised cohort and in vitro. STUDY DESIGN Conducted in Italy, this research involves immunocompromised patients who received Evusheld. It evaluates serum neutralization activity against different SARS-CoV-2 strains (20A.EU1, BA.5, BQ.1, XBB.1.5, XBB.1.16, and EG.5) before (T0), after 14 (T1), and after 30 (T2) days from the tixagevimab/cilgavimab injection. Furthermore, the in vitro activity of Evusheld against SARS-CoV-2 VOCs was evaluated. RESULTS The cohort was composed of 72 immunocompromised patients. The serum neutralizing activity of tixagevimab/cilgavimab-treated patients was notably lower against newer variants such as BQ.1, XBB.1.5, XBB.1.16, and EG.5. Then, the in vitro study detailed specific EC50 values to quantify the activity of tixagevimab/cilgavimab against various SARS-CoV-2 VOCs. Newer variants like BQ.1 and XBB.1.5 exhibited notably lower neutralization, underscoring the challenges in effectively countering the evolving virus. Interestingly, tixagevimab/cilgavimab maintained reduced but still valid activity against EG.5 with an EC50 of 189 ng/mL and Cmax/EC90 of 110.7. CONCLUSIONS Tixagevimab/cilgavimab efficacy wanes against novel subvariants. This underscores the critical need for ongoing adaptation and vigilance in prophylactic strategies to effectively counter the dynamic and unpredictable nature of the COVID-19 pandemic.
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Affiliation(s)
- Anna Gidari
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Samuele Sabbatini
- Department of Medicine and Surgery, Medical Microbiology Section, University of Perugia, 06123 Perugia, Italy;
| | - Sabrina Bastianelli
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Sara Pierucci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Chiara Busti
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Elisabetta Svizzeretto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Andrea Tommasi
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Carlo Pallotto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Elisabetta Schiaroli
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, “Santa Maria della Misericordia” Hospital, University of Perugia, 06132 Perugia, Italy; (S.B.); (S.P.); (C.B.); (E.S.); (A.T.); (C.P.); (E.S.); (D.F.)
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17
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Duminuco A, Nardo A, Orofino A, Giunta G, Conticello C, Del Fabro V, Chiarenza A, Parisi MS, Figuera A, Leotta S, Milone G, Cupri A, Cambria D, Di Raimondo F, Romano A, Palumbo GA. Efficacy and safety of tixagevimab-cilgavimab versus SARS-CoV-2 breakthrough infection in the hematological conditions. Cancer 2024; 130:41-50. [PMID: 37658645 DOI: 10.1002/cncr.35005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Managing SARS-CoV-2 infection in frail and immunosuppressed patients still represents an open challenge, but, starting from the phase 3 PROVENT study, prophylaxis with tixagevimab-cilgavimab has improved the approach in this category of patients, guaranteeing a better outcome and inferior mortality. Real-life data in a heterogeneous cohort are few. METHODS The aim of this study is to evaluate the benefit of prophylaxis with tixagevimab-cilgavimab in a cohort of 202 patients affected by different hematological diseases (lymphoproliferative, myeloproliferative, autoimmune, patients recently receiving a bone marrow transplant), active (with ongoing treatment), or in watch-and-wait strategy, followed in our center, during a median follow-up of 249 (45-325) days. RESULTS An incidence of 44 breakthrough infections (21.8%) is reported, with no treatment-related adverse effects. Age ≥70 years, ongoing treatment (above all with monoclonal antibodies), baseline lymphoproliferative disorders, and prior virus exposure are identified as risk factors related to subsequent infection (p < 0.05). Moreover, the incidence is higher in low/nonresponse to prior vaccination (p = .002). Patients treated with tixagevimab-cilgavimab had a mild course of the infection and a reduction of the duration compared with preprophylaxis infection (11 vs. 15 days, p < .001). The concurrent treatment with anti-CD20 monoclonal antibodies and B-non-Hodgkin lymphoma still confers a higher duration of infection despite prophylaxis. No deaths attributable to the infection occurred. CONCLUSION Prophylaxis treatment seems to be a valid and safe strategy, although not preventing breakthrough infection, but the severe complications associated with the infection and the possible delays in administering lifesaving therapies from long positivity.
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Affiliation(s)
- Andrea Duminuco
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Antonella Nardo
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Alessandra Orofino
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Giuliana Giunta
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Concetta Conticello
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Vittorio Del Fabro
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Annalisa Chiarenza
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Marina S Parisi
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Amalia Figuera
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Salvatore Leotta
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Giuseppe Milone
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Alessandra Cupri
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Daniela Cambria
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia University of Catania, Catania, Italy
| | - Alessandra Romano
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia University of Catania, Catania, Italy
| | - Giuseppe A Palumbo
- Division of Hematology and BMT Unit, A.O.U. Policlinico G.Rodolico-San Marco, Catania, Italy
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate G.F. Ingrassia, University of Catania, Catania, Italy
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18
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Kawashima I, Hyuga H, Nakadate A, Matsuura M, Sakamoto Y, Suzuki J, Kumagai T, Suzuki M, Koshiishi M, Yamamoto T, Nakajima K, Tanaka M, Kirito K. Pre-exposure prophylaxis with tixagevimab/cilgavimab for coronavirus disease 2019 (COVID-19) during the Omicron BA.5 wave at a single institution in Japan. Int J Hematol 2023; 118:731-736. [PMID: 37747583 DOI: 10.1007/s12185-023-03663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
Pre-exposure prophylaxis with tixagevimab/cilgavimab was considered a useful strategy to protect immunocompromised patients from COVID-19 based on the phase 3 PROVENT trial conducted between November 2020 and March 2021. However, after late 2021, the dominant substrains of COVID-19 changed to Omicron substrains, which showed resistance to tixagevimab/cilgavimab. Therefore, it is important to re-evaluate the real-world efficacy of tixagevimab/cilgavimab for the prevention of COVID-19 in the Omicron era. To this end, we retrospectively evaluated the efficacy and safety of tixagevimab/cilgavimab prophylaxis for COVID-19 during the Omicron BA.5 wave in Japan. A total of 240 consecutive patients with hematologic malignancies received tixagevimab/cilgavimab at our institution from October 18, 2022, to January 31, 2023. Among them, the cumulative incidence of COVID-19 at 90 days was 6.4%. A total of 10/14 (71.4%) had mild infection, and 4/14 (28.5%) had severe infection. No patient died due to COVID-19. Adverse events consisted of deep vein thrombosis in 2 patients. Our analysis indicated that pre-exposure prophylaxis with tixagevimab/cilgavimab might have clinical effectiveness in reducing the severity of COVID-19 in Japanese HM patients, even in the Omicron BA.5 surge. It also suggested that tixagevimab/cilgavimab may be associated with cardiovascular complications.
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Affiliation(s)
- Ichiro Kawashima
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Hideto Hyuga
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Ayato Nakadate
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Minori Matsuura
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Yuma Sakamoto
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Jun Suzuki
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Takuma Kumagai
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Megumi Suzuki
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Megumi Koshiishi
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Takeo Yamamoto
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Kei Nakajima
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Masaru Tanaka
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, 1110, Shimokato, Chuo-City, Yamanashi-Ken, 409-3898, Japan.
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19
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Assanto GM, Totaro M, Poggiali R, Delli Paoli A, Annechini G, D'Elia GM, Aji F, Petrucci L, Fazio F, Del Giudice I, Martelli M, Micozzi A, Gentile G. Impact of Sars-CoV-2 Prophylaxis with Tixagevimab-Cilgavimab in High-Risk Patients with B-Cell Malignancies: A Single-Center Retrospective Study. Mediterr J Hematol Infect Dis 2023; 15:e2023061. [PMID: 38028390 PMCID: PMC10631717 DOI: 10.4084/mjhid.2023.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Severe Acute Respiratory Syndrome CoronaVirus‐2 (SARS‐CoV‐2) infection can result in different clinical manifestations (COVID-19), starting from asymptomatic disease to life threatening respiratory insufficiency. Onco-haematologic patients are at higher risk to develop severe COVID-19. In particular, patients affected by lymphoproliferative diseases, given the impaired cell-mediated and antibody-mediated immunity and treatment toxicity, develop more often a symptomatic and a more serious disease of Covid-19. Various therapeutic and prophylactic agents are being used against COVID‐19 such as antiviral drugs, vaccines and antiviral S‐protein monoclonal antibodies. Pre-exposure prophylaxis with AZD442/Evusheld (tixagevimab-cilgavimab) may be a complementary strategy to decrease the incidence or severity of COVID-19 for patients with B-cell malignancies. Tixagevimab-cilgavimab is a combination of two monoclonal antibodies that bind SARS-CoV-2 spike protein and inhibits the attachment to the surface of cells, preventing viral entry in the cell and COVID-19 development. In the setting of hematology real-life, few data are available on the impact of pre-exposure prophylaxis, given the multiple factors involved in the clinical behavior of SARS-CoV-2 . Our aim was to evaluate the clinical benefit and the safety of this strategy at our center.
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Affiliation(s)
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Rebecca Poggiali
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Adele Delli Paoli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gianna Maria D'Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesco Aji
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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20
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Gelibter S, Pirro F, Saraceno L, Susani E, Moioli MC, Puoti M, Agostoni EC, Protti A. Tixagevimab and cilgavimab use in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder during anti-CD20 treatment: A single-center experience. J Neuroimmunol 2023; 383:578199. [PMID: 37717427 DOI: 10.1016/j.jneuroim.2023.578199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND B-cell-depleting treatments, such as ocrelizumab and rituximab (anti-CD20), reduce humoral response to SARS-CoV-2 in people with Multiple Sclerosis (pwMS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) and are associated with an increased risk of a more severe course of COVID-19 disease. The combination of tixagevimab and cilgavimab was authorized for COVID-19 prevention in immunocompromised subjects at high risk of severe COVID-19 disease, including patients treated with anti-CD20. Few real-world studies are available regarding the use of tixagevimab/cilgavimab in pwMS/NMOSD. In the present study, we describe the use of tixagevimab/cilgavimab for SARS-CoV-2 pre-exposure prophylaxis in a cohort of pwMS and NMOSD, treated with ocrelizumab and rituximab respectively. METHODS 26 subjects were treated with tixagevimab/cilgavimab, while we used 18 patients as the control group. We collected clinical data at baseline in all patients and during scheduled follow up evaluations. SARS-CoV-2 serological status pre- and post-tixagevimab/cilgavimab treatment was available for 10 patients. RESULTS We observed no adverse events following tixagevimab/cilgavimab treatment. Post-tixagevimab/cilgavimab anti-Spike-1-RBD IgG were significantly higher when compared to baseline values. No difference was found when comparing the percentage of COVID-19 infections between groups. All patients infected with SARS-CoV-2 had mild disease which did not require hospitalization. In patients treated with tixagevimab/cilgavimab, the rate of infection among patients exposed to SARS-CoV-2 was lower, without reaching statistical significance. We observed a significantly longer negativization time in the treated group. CONCLUSIONS Our results are not consistent with what was observed in the registration trial and some more recent studies. We did not observe a difference in COVID-19 incidence nor in disease severity in MS and NMOSD between treated and untreated patients. Our different results may be partially explained by the change in SARS-CoV-2 variants epidemiology (i.e. reduced efficacy of tixagevimab and cilgavimab against the currently dominant variants) as well as different patient selection included in the trial and different dose of tixagevimab/cilgavimab used in other studies. The present report provides a real-life experience with tixagevimab/cilgavimab in pwMS and NMOSD treated with anti-CD20, with findings that are in line with the current SARS-CoV-2 epidemiology and the recent evidence regarding SARS-CoV-2 variants. Our results warrant further research to best treat patients in the present and future pandemic scenario.
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Affiliation(s)
- Stefano Gelibter
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Fiammetta Pirro
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Saraceno
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Susani
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Cristina Moioli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Protti
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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21
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Harel R, Itchaki G. COVID-19 in Patients with Chronic Lymphocytic Leukemia: What Have We Learned? Acta Haematol 2023; 147:60-72. [PMID: 37820599 PMCID: PMC11251671 DOI: 10.1159/000534540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is a prevalent hematological malignancy (HM) characterized by inherent immunodeficiency, which is further pronounced by disease-directed therapy. The COVID-19 pandemic has had devastating outcomes, and although its impact has diminished over time, it continues to be a cause of significant morbidity and mortality, particularly among immunodeficient patients. SUMMARY In this review, we describe mechanisms of immune dysfunction in CLL in relation to COVID-19, provide an overview of the clinical outcomes of the disease in this patient population, and identify risk factors associated with severe morbidity and mortality. Additionally, we acknowledge the influence of the rapidly evolving landscape of new disease variants. The review further delineates the humoral and cellular responses to vaccination and their clinical efficacy in preventing COVID-19 in CLL patients. Moreover, we explore potential approaches to enhance these immune responses. Pre- and post-exposure prophylaxis strategies are discussed, along with description of common agents in the treatment of the disease in both outpatient and inpatient setting. Throughout the review, we emphasize the interplay between novel therapies for CLL and COVID-19 outcomes, prevention, and treatment and describe the impact of COVID-19 on the utilization of these novel agents. This information has the potential to guide clinical decision making in the management CLL patients. KEY MESSAGES CLL patients are at risk for severe COVID-19 infection. Vaccinations and COVID-19 directed therapy have improved outcomes in patients with CLL, yet clinical challenges persist.
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Affiliation(s)
- Reut Harel
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Gilad Itchaki
- Hematology, Meir Medical Center, Kefar Sava, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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22
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Callegari C, Lazzarotto D, Soravia A, Mutti M, Lauzzana P, Peghin M, Cordella S, Fanin R, Candoni A. Reduced prophylactic effect of tixagevimab-cilgavimab in patients with hematological malignancies and without antibody response after SARS-COV-2 vaccination. Eur J Haematol 2023; 111:668-670. [PMID: 37461815 DOI: 10.1111/ejh.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Chiara Callegari
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Davide Lazzarotto
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alessandra Soravia
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martina Mutti
- Division of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Lauzzana
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Stefano Cordella
- Division of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Division of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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23
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Ntanasis-Stathopoulos I, Filippatos C, Gavriatopoulou M, Malandrakis P, Eleutherakis-Papaiakovou E, Spiliopoulou V, Syrigou RE, Theodorakakou F, Fotiou D, Migkou M, Roussou M, Kastritis E, Dimopoulos MA, Terpos E. Tixagevimab/Cilgavimab as Pre-Exposure Prophylaxis against COVID-19 for Multiple Myeloma Patients: A Prospective Study in the Omicron Era. Diseases 2023; 11:123. [PMID: 37754319 PMCID: PMC10529256 DOI: 10.3390/diseases11030123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Background: tixagevimab/cilgavimab, distributed under the name "Evusheld", was the first available pre-exposure prophylaxis for COVID-19 other than vaccination. It received an EUA from the FDA after sufficient trial data showed efficacy in preventing SARS-CoV-2 infections and subsequent severe disease. Its potential benefits for high-risk immunocompromised patients generated a lot of interest. Individuals with multiple myeloma fall into this category, as they are characterized by attenuated immune responses and, in some cases, vaccines have limited efficacy. Methods: this single-center, prospective study included consecutive patients with multiple myeloma. All individuals were considered high-risk for COVID-19 due to their underlying disease. Baseline demographic and clinical characteristics, as well as data regarding COVID-19 infection and antibodies, were collected. Patients were administered two intramuscular 150 mg doses of Evusheld and were monitored during the follow-up period. Results: one hundred and eleven multiple myeloma patients were included in this analysis, with a median age of 64 years (range 58-69) and fifty-three were females (47.7%). Fourteen patients (12.6%) had a prior history of COVID-19 and all patients were vaccinated with either three or four doses of mRNA-based vaccines. An increase was observed in the median neutralizing-antibody levels before and after tixagevimab/cilgavimab administration, from 92.6% to 97.3%. The high levels were sustainable, with a median neutralizing-antibody level of 95.4% at 3 months post Evusheld administration. Overall, nine patients (8.1%) were diagnosed with COVID-19 during the follow-up period, at a median of 31 days. There were no SARS-CoV-2- infection-related hospitalizations or deaths. The monoclonal antibody combination was well tolerated, with no infusion-related reactions or major adverse events, and pain at the injection site only was reported by 33 patients (30%). Conclusions: tixagevimab/cilgavimab (Evusheld) seemed beneficial for patients with multiple myeloma, who presented high neutralizing-antibody levels and a low incidence of COVID-19 during the initial Omicron wave. No new safety concerns emerged. However, novel combinations of monoclonal antibodies against the new circulating variants of SARS-CoV-2 are deemed necessary in view of the emergence of immune tolerance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (C.F.)
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24
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Haraguchi M, Yamamoto H, Watanabe O, Sakoh T, Ishida K, Ogura S, Katoh-Morishima M, Taya Y, Nishida A, Kaji D, Takagi S, Yamamoto G, Uchida N, Araoka H. Incidence of breakthrough COVID-19 in patients with hematological disorders who received pre-exposure prophylaxis with tixagevimab-cilgavimab: a retrospective study in Japan. Bone Marrow Transplant 2023; 58:1051-1053. [PMID: 37330600 PMCID: PMC10471491 DOI: 10.1038/s41409-023-02019-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Mizuki Haraguchi
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan.
| | | | - Otoya Watanabe
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Takashi Sakoh
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Keiko Ishida
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Sho Ogura
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | | | - Yuki Taya
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kaji
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | | | - Go Yamamoto
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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25
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Kamboj M, Laracy JC, Usiak S, Babady NE, Yan J, Seo SK. Outcomes of hematologic malignancy patients with SARS-CoV-2 breakthrough infections after tixagevimab-cilgavimab during community transmission of monoclonal antibody resistant variants. J Infect 2023; 87:282-285. [PMID: 37451364 DOI: 10.1016/j.jinf.2023.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Mini Kamboj
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Justin C Laracy
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Shauna Usiak
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Esther Babady
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judy Yan
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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26
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Funakoshi Y, Yakushijin K, Ohji G, Matsutani T, Hojo W, Sakai H, Matsumoto S, Watanabe M, Kitao A, Saito Y, Kawamoto S, Yamamoto K, Koyama T, Nagatani Y, Kimbara S, Imamura Y, Kiyota N, Ito M, Minami H. Response to mRNA SARS-CoV-2 vaccination evaluated by B-cell receptor repertoire after tixagevimab/cilgavimab administration. Br J Haematol 2023; 202:504-516. [PMID: 37349876 DOI: 10.1111/bjh.18932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
The use of anti-SARS-CoV-2 antibody products like tixagevimab/cilgavimab represents an important strategy to protect immunocompromised patients with haematological malignancies from COVID-19. Although patients who receive these agents should still be vaccinated, the use of tixagevimab/cilgavimab can mask the production of anti-spike antibody after vaccination, making it hard to assess vaccine response. We have newly established a quantification method to assess the response to SARS-CoV-2 vaccination at the mRNA level using B-cell receptor (BCR) repertoire assay and the Coronavirus Antibody Database (CoV-AbDab). Repeated blood samples before and after vaccination were analysed for the BCR repertoire, and BCR sequences were searched in the database. We analysed the number and percentage frequency of matched sequences. We found that the number of matched sequences increased 2 weeks after the first vaccination and quickly decreased. Meanwhile, the number of matched sequences more rapidly increased after the second vaccination. These results show that the postvaccine immune response can be assessed at the mRNA level by analysing the fluctuation in matching sequences. Finally, BCR repertoire analysis with CoV-AbDab clearly demonstrated the response to mRNA SARS-CoV-2 vaccination even after tixagevimab/cilgavimab administration in haematological malignancy patients who underwent allogeneic haematopoietic stem cell transplantation.
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Affiliation(s)
- Yohei Funakoshi
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Goh Ohji
- Division of Infection Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Takaji Matsutani
- Research & Development Department, Repertoire Genesis Inc., Ibaraki, Japan
| | | | | | - Sakuya Matsumoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Marika Watanabe
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Akihito Kitao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Yasuyuki Saito
- Division of Molecular and Cellular Signaling, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinichiro Kawamoto
- Department of Transfusion Medicine and Cell Therapy, Kobe University Hospital, Kobe, Japan
| | - Katsuya Yamamoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Taiji Koyama
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Nagatani
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Shiro Kimbara
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Mitsuhiro Ito
- Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
- Cancer Center, Kobe University Hospital, Kobe, Japan
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Gargiulo E, Teglgaard RS, Faitová T, Niemann CU. Immune Dysfunction and Infection - Interaction between CLL and Treatment: A Reflection on Current Treatment Paradigms and Unmet Needs. Acta Haematol 2023; 147:84-98. [PMID: 37497921 DOI: 10.1159/000533234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is a hematological malignancy characterized by immune dysfunction, which significantly contributes to increased morbidity and mortality due to infections. SUMMARY Advancement in therapeutic strategies based on combination chemoimmunotherapy and targeted treatment have increased life expectancy for patients affected by CLL. However, mortality and morbidity due to infection showed no improvement over the last decades. Although therapy options are highly efficient in targeting leukemic cells, several studies highlighted the interactions of different treatments with the tumor microenvironment immune components, significantly impacting their clinical efficacy and fostering increased risk of infections. KEY MESSAGES Given the profound immune dysfunction caused by CLL itself, treatment can thus represent a double-edged sword. Thus, it is essential to increase our understanding and awareness on how conventional therapies affect the disease-microenvironment-infection axis to ensure the best personalized strategy for each patient. This requires careful consideration of the advantages and disadvantages of efficient treatments, whether chemoimmunotherapy or targeted combinations, leading to risk of infectious complications. To this regard, our machine learning-based algorithm CLL Treatment-Infection Model, currently implemented into the local electronic health record system for Eastern Denmark, aims at early identification of patients at high risk of serious infections (PreVent-ACaLL; NCT03868722). We here review strategies for management of immune dysfunction and infections in CLL.
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Affiliation(s)
- Ernesto Gargiulo
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Infectious Diseases, PERSIMUNE, Rigshospitalet, Copenhagen, Denmark
| | | | - Tereza Faitová
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Johnson S, McDonnell JC, Fernandez JM. Efficacy of Tixagevimab and Cilgavimab Against SARS-CoV-2 Infections in Patients with Inborn Errors of Immunity. J Clin Immunol 2023; 43:865-868. [PMID: 36862321 PMCID: PMC9978277 DOI: 10.1007/s10875-023-01457-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/17/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Sarah Johnson
- Department of Allergy and Clinical Immunology, Cleveland Clinic Foundation, Cleveland, OH USA
| | - John C. McDonnell
- Center for Pediatric Allergy and Immunology, Cleveland Clinic Foundation, Cleveland, OH USA
| | - James M. Fernandez
- Department of Allergy and Clinical Immunology, Cleveland Clinic Foundation, Cleveland, OH USA
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29
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Davis JA, Granger K, Sakowski A, Goodwin S, Herbst A, Smith D, Hendrickson L, Nachar VR. Dual target dilemma: navigating epcoritamab vs. glofitamab in relapsed refractory diffuse large B-cell lymphoma. Expert Rev Hematol 2023; 16:915-918. [PMID: 37982732 DOI: 10.1080/17474086.2023.2285978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Affiliation(s)
- James A Davis
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Katelynn Granger
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Alex Sakowski
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Sara Goodwin
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Amanda Herbst
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Deidra Smith
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Lindsey Hendrickson
- Department of Malignant Hematology and Bone Marrow Transplant, The Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Victoria R Nachar
- Department of Pharmacy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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30
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Xue E, Scorpio G, Ruggeri A, Clerici D, Farina F, Campodonico E, Acerbis A, Fiore P, Bruno A, Carrabba MG, Peccatori J, Greco R, Lupo Stanghellini MT, Ciceri F, Corti C. Impact of tixagevimab/cilgavimab prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplants and CAR T-cell therapy: A single center experience. Curr Res Transl Med 2023; 71:103402. [PMID: 37399601 PMCID: PMC10299847 DOI: 10.1016/j.retram.2023.103402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Elisabetta Xue
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy.
| | - Gianluca Scorpio
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | - Daniela Clerici
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | - Francesca Farina
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | - Edoardo Campodonico
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Acerbis
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Fiore
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Bruno
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Matteo G Carrabba
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy
| | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Consuelo Corti
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milan, Italy.
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Angotzi F, Petrella M, Berno T, Binotto G, Bonetto G, Branca A, Carraro M, Cavaretta CA, Cellini A, D’Amore F, Forlani L, Gianesello I, Gurrieri C, Imbergamo S, Lessi F, Maroccia A, Mazzetto F, Pavan L, Pezone S, Piazza F, Pravato S, Ruocco V, Scapinello G, Vianello F, Zambello R, Zatta I, Zoletto S, Padoan A, Trentin L, Visentin A. Tixagevimab/Cilgavimab as pre-exposure prophylaxis against SARS-CoV-2 in patients with hematological malignancies. Front Oncol 2023; 13:1212752. [PMID: 37427126 PMCID: PMC10324575 DOI: 10.3389/fonc.2023.1212752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
The approved combination of Tixagevimab/Cilgavimab has been shown to decrease the rate of symptomatic SARS-CoV-2 infection in patients at increased risk of inadequate response to vaccination. However, Tixagevimab/Cilgavimab was tested in a few studies that included patients with hematological malignancies, even if this population has shown an increased risk of unfavorable outcomes following infection (with high rates of hospitalization, intensive care unit admission, and mortality) and poor significant immunization following vaccines. We performed a real-life prospective cohort study to evaluate the rate of SARS-CoV-2 infection following pre-exposure prophylaxis with Tixagevimab/Cilgavimab in anti-spike seronegative patients compared to a cohort of seropositive patients who were observed or received a fourth vaccine dose. We recruited 103 patients with a mean age of 67 years: 35 (34%) received Tixagevimab/Cilgavimab and were followed from March 17, 2022, until November 15, 2022. After a median follow-up of 4.24 months, the 3-month cumulative incidence of infection was 20% versus 12% in the Tixagevimab/Cilgavimab and observation/vaccine groups respectively (HR 1.57; 95% CI: 0.65-3.56; p = 0.34). In this study, we report our experience with Tixagevimab/Cilgavimab and a tailored approach to SARS-CoV-2 infection prevention in patients with hematological malignancies during the SARS-CoV-2 omicron surge.
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Affiliation(s)
- Francesco Angotzi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Petrella
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Giorgia Bonetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Branca
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Carraro
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Chiara Adele Cavaretta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Alessandro Cellini
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabio D’Amore
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Forlani
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ilaria Gianesello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Carmela Gurrieri
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Silvia Imbergamo
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Lessi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Maroccia
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Mazzetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Pavan
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Sara Pezone
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Stefano Pravato
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Valeria Ruocco
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Greta Scapinello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ivan Zatta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Simone Zoletto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Integrated Diagnostic Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
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33
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Touret F, Martin-Blondel G, de Lamballerie X, Dupont A, Izopet J, Mentré F, Kamar N, Autran B, Paintaud G, Caillard S, Richez C, Couzi L, Xhaard A, Marjanovic Z, Avouac J, Jacquet C, Anglicheau D, Cheminant M, Yazdanpanah Y, N'Guyen S, Terrier B, Gottenberg JE, Besson C, Letrou S, Kali S, Angoulvant D, Barthélémy K, Priet S, Nurtop E, Sanchez VP, Tardivon C, Blancho G, Le Bourgeois A, Lévy V. Low to undetectable Omicron BQ.1.1 neutralization by patient's sera a month after initiation of AZD7442 600 mg. J Infect 2023; 86:e126-e129. [PMID: 36750165 DOI: 10.1016/j.jinf.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Franck Touret
- Unité des Virus Émergents, INSERM-1207, IRD-190, Aix-Marseille University, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse & Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, France
| | | | - Axelle Dupont
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France; Centre d'Investigation clinique-Epidémiologie Clinique 1425, Inserm, Hôpital Bichat, Paris, France; Department of Epidemiology Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Jacques Izopet
- CHU Toulouse, Hôpital Purpan, Laboratoire de Virologie, National Reference Center for Hepatitis E, 31300 Toulouse, France; Inserm UMR 1291, CNRS UMR5051, Université Toulouse III, 31000 Toulouse, France
| | - France Mentré
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France; Centre d'Investigation clinique-Epidémiologie Clinique 1425, Inserm, Hôpital Bichat, Paris, France; Department of Epidemiology Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil 31059 Toulouse, France
| | - Brigitte Autran
- Sorbonne-Université, Cimi-Paris, Inserm U1135, CNRS ERL8255, UPMC CR7, Team "NK and T Cell Immunity, Infections and Cancer", Paris, France
| | - Gilles Paintaud
- Université de Tours, EA4245 Transplantation, Immunology and Inflammation, Tours, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, 67000 Strasbourg, France; Inserm UMR S1109 Labex Transplantex, Fédération de Médecine Translationnelle, Strasbourg University, Strasbourg, France
| | - Christophe Richez
- Hôpital Pellegrin, CHU de Bordeaux, Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares (RESO), UMR-CNRS 5164, Université de Bordeaux, Bordeaux, France
| | - Lionel Couzi
- Nephrologie-Transplantation-Dialyse, CHU Bordeaux, Bordeaux, France; CNRS-UMR 5164 Immuno ConcEpT, Université de Bordeaux, Bordeaux, France
| | - Aliénor Xhaard
- Service d'hématologie greffe Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France
| | - Zora Marjanovic
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Jerome Avouac
- Université de Paris Service de Rhumatologie, Hôpital Cochin, AP-HP, CUP 27 rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Caroline Jacquet
- Service d'Hématologie, CHRU Nancy, Hôpitaux Brabois, Vandoeuvre les Nancy, France
| | - Dany Anglicheau
- Department of Nephrology and kidney transplantation, Necker Hospital, APHP and Université de Paris Cité, Paris, France
| | - Morgane Cheminant
- Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, F-75015, Université de Paris Cité, Paris, France
| | | | - Stéphanie N'Guyen
- Sorbonne université, Groupe Hospitalier Pitié-Salpêtrière APHP, Service d'Hématologie clinique, Pavillon Georges Heuyer, 47-83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France; Sorbonne Université, Inserm CNRS 1135 "NK and T Cell Immunity, Virus and Cancer", Centre d'Immunologie et des Pathologies Infectieuses (CIMI), UPMC UMRS CR7-Inserm U1135-CNRS ERL 8255, faculté de Médecine Sorbonne Université, Site Pitié-Salpêtrière, 91 boulevard de l'Hôpital, 75013 Paris, France
| | - Benjamin Terrier
- Assistance Publique-Hôpitaux de Paris, Département de Médecine Interne, Centre de Référence National pour les maladies auto-immunes systémiques rares, Hôpital Cochin Paris, Université Paris, France
| | - Jacques Eric Gottenberg
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; CNR RESO, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; Laboratoire d'Immunopathologie et de Chimie Thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, Strasbourg, France
| | - Caroline Besson
- Université Paris-Saclay, UVSQ, CESP-INSERM1018, CH de Versailles, 78150, Le Chesnay, France
| | - Sophie Letrou
- Département d'Épidémiologie, Biostatistique et Recherche Clinique Unité de Recherche Clinique Paris Nord APHP, Nord - Université Paris Cité Hôpital Bichat - Claude-Bernard 46 rue Henri Huchard, 75877 Paris Cedex 18, France
| | - Sabrina Kali
- Clinical Research Department, ANRS|Emerging infectious disease, PariSanté Campus, 2 rue d'Oradour-sur-Glane, 75015 Paris, France
| | - Denis Angoulvant
- Service de Cardiologie, CHRU de Tours & EA4245 Transplantation Immunologie et Inflammation, Université de Tours, F37000 Tours, France
| | - Karine Barthélémy
- Unité des Virus Émergents, INSERM-1207, IRD-190, Aix-Marseille University, France
| | - Stéphane Priet
- Unité des Virus Émergents, INSERM-1207, IRD-190, Aix-Marseille University, France
| | - Elif Nurtop
- Unité des Virus Émergents, INSERM-1207, IRD-190, Aix-Marseille University, France
| | | | - Coralie Tardivon
- Department of Epidemiology Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France; Centre d'Investigation clinique-Epidémiologie Clinique 1425, Inserm, Hôpital Bichat, Paris, France
| | - Gilles Blancho
- Institut de Transplantation- Urologie - Néphrologie (ITUN) Hôtel Dieu - CHU de Nantes, 30 bd Jean-Monnet, 44093 Nantes, France
| | - Amandine Le Bourgeois
- Service d'hématologie clinique, CHU Nantes, 1 place Alexis Ricordeau, 44000 Nantes, France
| | - Vincent Lévy
- Département de Recherche Clinique, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord and CRESS INSERM U1153, ECSTRRA Team, Paris, France.
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Leyfman Y, Emmanuel N, Menon GP, Joshi M, Wilkerson WB, Cappelli J, Erick TK, Park CH, Sharma P. Cancer and COVID-19: unravelling the immunological interplay with a review of promising therapies against severe SARS-CoV-2 for cancer patients. J Hematol Oncol 2023; 16:39. [PMID: 37055774 PMCID: PMC10100631 DOI: 10.1186/s13045-023-01432-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023] Open
Abstract
Cancer patients, due to their immunocompromised status, are at an increased risk for severe SARS-CoV-2 infection. Since severe SARS-CoV-2 infection causes multiple organ damage through IL-6-mediated inflammation while stimulating hypoxia, and malignancy promotes hypoxia-induced cellular metabolic alterations leading to cell death, we propose a mechanistic interplay between both conditions that results in an upregulation of IL-6 secretion resulting in enhanced cytokine production and systemic injury. Hypoxia mediated by both conditions results in cell necrosis, dysregulation of oxidative phosphorylation, and mitochondrial dysfunction. This produces free radicals and cytokines that result in systemic inflammatory injury. Hypoxia also catalyzes the breakdown of COX-1 and 2 resulting in bronchoconstriction and pulmonary edema, which further exacerbates tissue hypoxia. Given this disease model, therapeutic options are currently being studied against severe SARS-COV-2. In this study, we review several promising therapies against severe disease supported by clinical trial evidence-including Allocetra, monoclonal antibodies (Tixagevimab-Cilgavimab), peginterferon lambda, Baricitinib, Remdesivir, Sarilumab, Tocilizumab, Anakinra, Bevacizumab, exosomes, and mesenchymal stem cells. Due to the virus's rapid adaptive evolution and diverse symptomatic manifestation, the use of combination therapies offers a promising approach to decrease systemic injury. By investing in such targeted interventions, cases of severe SARS-CoV-2 should decrease along with its associated long-term sequelae and thereby allow cancer patients to resume their treatments.
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Affiliation(s)
- Yan Leyfman
- Icahn School of Medicine at Mount Sinai South Nassau, Rockville Centre, NY, USA
| | - Nancy Emmanuel
- Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | | | | | | | | | - Pushpa Sharma
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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35
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Marchesi F, Salmanton-García J, Buquicchio C, Itri F, Besson C, Dávila-Valls J, Martín-Pérez S, Fianchi L, Rahimli L, Tarantini G, Grifoni FI, Sciume M, Labrador J, Cordoba R, López-García A, Fracchiolla NS, Farina F, Ammatuna E, Cingolani A, García-Bordallo D, Gräfe SK, Bilgin YM, Dargenio M, González-López TJ, Guidetti A, Lahmer T, Lavilla-Rubira E, Méndez GA, Prezioso L, Schönlein M, Van Doesum J, Wolf D, Hersby DS, Magyari F, Van Praet J, Petzer V, Tascini C, Falces-Romero I, Glenthøj A, Cornely OA, Pagano L. Passive pre-exposure immunization by tixagevimab/cilgavimab in patients with hematological malignancy and COVID-19: matched-paired analysis in the EPICOVIDEHA registry. J Hematol Oncol 2023; 16:32. [PMID: 37005697 PMCID: PMC10066993 DOI: 10.1186/s13045-023-01423-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/12/2023] [Indexed: 04/04/2023] Open
Abstract
Only few studies have analyzed the efficacy of tixagevimab/cilgavimab to prevent severe Coronavirus disease 2019 (COVID-19) and related complications in hematologic malignancies (HM) patients. Here, we report cases of breakthrough COVID-19 after prophylactic tixagevimab/cilgavimab from the EPICOVIDEHA registry). We identified 47 patients that had received prophylaxis with tixagevimab/cilgavimab in the EPICOVIDEHA registry. Lymphoproliferative disorders (44/47, 93.6%) were the main underlying HM. SARS-CoV-2 strains were genotyped in 7 (14.9%) cases only, and all belonged to the omicron variant. Forty (85.1%) patients had received vaccinations prior to tixagevimab/cilgavimab, the majority of them with at least two doses. Eleven (23.4%) patients had a mild SARS-CoV-2 infection, 21 (44.7%) a moderate infection, while 8 (17.0%) had severe infection and 2 (4.3%) critical. Thirty-six (76.6%) patients were treated, either with monoclonal antibodies, antivirals, corticosteroids, or with combination schemes. Overall, 10 (21.3%) were admitted to a hospital. Among these, two (4.3%) were transferred to intensive care unit and one (2.1%) of them died. Our data seem to show that the use of tixagevimab/cilgavimab may lead to a COVID-19 severity reduction in HM patients; however, further studies should incorporate further HM patients to confirm the best drug administration strategies in immunocompromised patients.
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Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jon Salmanton-García
- Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMMUniversity Hospital Cologne, Faculty of Medicine), University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | | | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France
- UVSQ, Inserm, Équipe "Exposome Et Hérédité", CESP, Université Paris-Saclay, Villejuif, France
| | | | | | - Luana Fianchi
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Laman Rahimli
- Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Federica Irene Grifoni
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariarita Sciume
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de La Salud, Universidad Isabel I, Burgos, Spain
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | | | | | | | - Antonella Cingolani
- Dipartimento Di Sicurezza E Bioetica, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | | | - Stefanie K Gräfe
- Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | | | - Anna Guidetti
- University of Milan and Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Tobias Lahmer
- Medizinische Klinik II, Klinikum Rechts Der Isar, TU München, Munich, Germany
| | | | | | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Dominik Wolf
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ferenc Magyari
- Division of Haematology, Institution of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Jens Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Verena Petzer
- Department of Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Oliver A Cornely
- Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
- Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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Duminuco A, Romano A, Leotta D, La Spina E, Cambria D, Bulla A, Del Fabro V, Tibullo D, Giallongo C, Palumbo GA, Conticello C, Di Raimondo F. Clinical outcome of SARS-CoV-2 infections occurring in multiple myeloma patients after vaccination and prophylaxis with tixagevimab/cilgavimab. Front Oncol 2023; 13:1157610. [PMID: 37064138 PMCID: PMC10090508 DOI: 10.3389/fonc.2023.1157610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionPatients with multiple myeloma (MM) frequently reported immune impairment with an increased risk for infection-related mortality. We aimed to evaluate the immune response in MM patients vaccinated for SARS-CoV-2 during active treatment.MethodsWe enrolled 158 patients affected by active MM or smoldering MM (SMM) and 40 healthy subjects. All subjects received 2 or 3 doses of the BNT162b2 (Pfizer/BioNTech) vaccine, and the anti-spike IgG values were evaluated after every dose. We applied the Propensity Score Matching (PSM) as a consequence of the limited sample size and its heterogeneity to adjust for differences in baseline clinical variables between MM patients who achieved or not a vaccine response after 2 or 3 doses.ResultsAt 30 days from the second dose, the median antibodies level in MM was 25.2 AU/mL, lower than in SMM and in the control group. The same results were confirmed after the third dose, with lower median anti-spike IgG levels in MM, compared to SMM and control group. Following PSM, lack of response to SARS-CoV-2 complete vaccination plus boost was associated with age more than 70 years old and use of high-dose of steroids. We failed to identify an association between specific treatment types and reduced vaccine response. The use of prophylaxis with tixagevimab/cilgavimab for 40 non-responder patients after 3 doses of vaccine has proven to be an effective and safe approach in reducing the risk of serious illness in the event of a breakthrough SARS-CoV-2 infection, faced with a mild symptomatic course, and in providing protection instead of long-term humoral immune vaccine responses. Following PSM, only the high-risk cytogenetic abnormalities were associated with an increased risk of developing a breakthrough SARS-CoV-2 infection.ConclusionMonitoring the immune response is fundamental in MM patients that remain highly vulnerable to SARS-CoV-2 despite the vaccine. The use of prophylaxis with tixagevimab/cilgavimab can guarantee better protection from the severe form of the disease.
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Affiliation(s)
- Andrea Duminuco
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Alessandra Romano
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, Catania, Italy
- *Correspondence: Alessandra Romano,
| | - Dario Leotta
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Enrico La Spina
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Daniela Cambria
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Anna Bulla
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Vittorio Del Fabro
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Daniele Tibullo
- Dipartimento di Scienze Biomediche e Biotecnologie Avanzate, University of Catania, Catania, Italy
| | - Cesarina Giallongo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Giuseppe A. Palumbo
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Concetta Conticello
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Francesco Di Raimondo
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, Catania, Italy
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Mauro FR, Visentin A, Giannarelli D, Molinari MC, Proietti G, Petrella M, Angotzi F, Pepe S, Trentin L, Baroncelli S, Giombini E, Meschi S, Maggi F, Focosi D. Pre-exposure prophylaxis with tixagevimab/cilgavimab in patients with chronic lymphocytic leukaemia treated with targeted agents. Br J Haematol 2023; 201:564-567. [PMID: 36810731 DOI: 10.1111/bjh.18701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Diana Giannarelli
- Design and Analysis of Clinical Trials Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria C Molinari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Proietti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Petrella
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Sara Pepe
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Emanuela Giombini
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Silvia Meschi
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
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Granger K, Gaffney KJ, Davis JA. Newly approved and forthcoming T-cell-redirecting bispecific antibodies for the treatment of relapsed/refractory multiple myeloma. J Oncol Pharm Pract 2023; 29:722-726. [PMID: 36775940 DOI: 10.1177/10781552231154809] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE Summarize the background, clinical trials, and place in therapy for the newly Food and Drug Administration (FDA) approved and forthcoming bispecific antibodies for relapsed/refractory (R/R) multiple myeloma. DATA SOURCES A search of the PubMed database was conducted using the following search terms: B-cell maturation antigen (BCMA), teclistamab, myeloma, BsAbs, GPRC5D, and bispecific. Ongoing clinical trials as well as abstracts from ASH and ASCO evaluating the efficacy and safety of novel agents were evaluated. Prescribing information was also reviewed. SUMMARY For patients with R/R multiple myeloma who have failed available therapies, treatment options are limited and survival is short. The FDA recently approved teclistamab, a T-cell-redirecting bispecific antibody, in patients with R/R multiple myeloma who have failed four prior lines of therapy. Teclistamab targets both CD3 expressed on T-cells and BCMA expressed on the surface of myeloma cells, mediating T-cell activation and lysis of plasma cells that express BCMA. Accelerated approval was granted based upon the results of the MajesTEC-1 study, which showed a durable response in a high proportion of heavily pretreated patients. Teclistamab is the first bispecific antibody approved for use in patients with multiple myeloma and the fourth approved agent targeting BCMA. Additional T-cell redirecting bispecific antibodies for use in multiple myeloma are also currently being studied. CONCLUSION Teclistamab is the newest agent granted FDA approval for use in R/R multiple myeloma and represents a promising new option for patients. Ongoing trials are investigating teclistamab and other novel bispecific antibodies in the upfront and R/R setting.
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Affiliation(s)
- Katelynn Granger
- Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Gaffney
- Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
| | - James A Davis
- Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
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Jakimovski D, Eckert SP, Mirmosayyeb O, Thapa S, Pennington P, Hojnacki D, Weinstock-Guttman B. Tixagevimab and Cilgavimab (Evusheld™) Prophylaxis Prevents Breakthrough COVID-19 Infections in Immunosuppressed Population: 6-Month Prospective Study. Vaccines (Basel) 2023; 11:vaccines11020350. [PMID: 36851227 PMCID: PMC9963629 DOI: 10.3390/vaccines11020350] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Persons with neuroinflammatory diseases (pwNID) treated with potent immunosuppressives are at risk of severe COVID-19 outcomes and reduced vaccine seroconversion. We aimed at determining the real-world efficacy of tixagevimab and cilgavimab (Evusheld™) in immunosuppressed pwNID in preventing breakthrough COVID-19 infections. METHODS 31 immunosuppressed pwNID were followed for 6 months after administration of tixagevimab and cilgavimab as a prophylactic COVID-19 medication (January 2022-July 2022). Only pwNID treated with anti-CD20 monoclonal antibodies and sphingosine-1-phosphate modulators were considered eligible for the study. A control group of 126 immunosuppressed pwNID (38 seropositive and 88 seronegative after SARS-CoV-2 vaccination) were included. Breakthrough COVID-19 infections rate and their severity was determined over the follow-up. RESULTS The pwNID treated with tixagevimab and cilgavimab had more comorbidities when compared with the total and seronegative pwNID control group (54.8% vs. 30.2% vs. 27.3%, p = 0.02 and p = 0.005, respectively). After a 6-month follow-up, significantly lower numbers of pwNID treated with tixagevimab and cilgavimab had breakthrough COVID-19 when compared with the control pwNID group (6.5% vs. 34.1%, p = 0.002) and seronegative control pwNID group (6.5% vs. 38.6%, p < 0.001). All COVID-19 infections in Evusheld-treated pwNID were mild, whereas 9/43 COVID-19 infections in the control group were moderate/severe. No side effects to tixagevimab and cilgavimab were recorded. CONCLUSION In pwNID treated with immunosuppressive therapies, tixagevimab and cilgavimab (Evusheld™) significantly reduced the numbers and severity of breakthrough COVID-19 infections during the Omicron (BA.2-BA.5 variants) wave.
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Affiliation(s)
- Dejan Jakimovski
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
- Buffalo Neuroimaging Analysis Center (BNAC), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
- Correspondence:
| | - Svetlana P. Eckert
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
| | - Omid Mirmosayyeb
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
| | - Sangharsha Thapa
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
| | - Penny Pennington
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center for Treatment and Research (JMSCTR), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14202, USA
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COVID-19 prophylaxis: half-full or half-empty glass? Blood 2023; 141:130-132. [PMID: 36633884 PMCID: PMC9906282 DOI: 10.1182/blood.2022018858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Bordat J, Maury S, Leclerc M. Allogeneic hematopoietic stem cell transplantation in the COVID-19 era. Front Immunol 2023; 14:1100468. [PMID: 36911678 PMCID: PMC9993088 DOI: 10.3389/fimmu.2023.1100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) recipients are especially vulnerable to coronavirus disease 19 (COVID-19), because of their profound immunodeficiency. Indeed, the first pandemic wave was marked by a high mortality rate in this population. Factors increasing immunodepression such as older age, immunosuppressive treatments or a short delay between transplant and infection appear to worsen the prognosis. Many changes in clinical practice had to be implemented in order to limit this risk, including postponing of transplant for non-malignant diseases, preference for local rather than international donations and for peripheral blood as stem cell source, and the widespread use of cryopreservation. The great revolution in the COVID-19 pandemic came from the development of mRNA vaccines that have shown to be able to prevent severe forms of the disease. More than 75% of allo-HSCT recipients develop seroconversion after 2 doses of vaccine. Multiple studies have identified lymphopenia, exposure to immunosuppressive or anti-CD20 therapies, and a short post-transplant period as factors associated with a poor response to vaccination. The use of repeated injections of the vaccine, including a third dose, not only improves the seroconversion rate but also intensifies the immune response, both in B cells and T cells. Vaccines are an effective and well-tolerated method in this high-risk population. Some studies investigated the possibility of immune protection being transferred from a vaccinated donor to a recipient, with encouraging initial results. However, dynamic mutations and immune escape of the virus can lead to breakthrough infections with new variants in vaccinated individuals and still represent a threat of severe disease in allo-HSCT recipients. New challenges include the need to adapt vaccine protection to emerging variants.
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Affiliation(s)
- Jonathan Bordat
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France
| | - Sébastien Maury
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France.,Institut Mondor de Recherche Biomédicale, équipe Immunorégulation et Biothérapies, INSERM U955, Créteil, France.,Faculté de Médecine, Paris-Est Créteil University, Créteil, France
| | - Mathieu Leclerc
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France.,Institut Mondor de Recherche Biomédicale, équipe Immunorégulation et Biothérapies, INSERM U955, Créteil, France.,Faculté de Médecine, Paris-Est Créteil University, Créteil, France
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Akinosoglou K, Rigopoulos EA, Kaiafa G, Daios S, Karlafti E, Ztriva E, Polychronopoulos G, Gogos C, Savopoulos C. Tixagevimab/Cilgavimab in SARS-CoV-2 Prophylaxis and Therapy: A Comprehensive Review of Clinical Experience. Viruses 2022; 15:118. [PMID: 36680160 PMCID: PMC9866621 DOI: 10.3390/v15010118] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Effective treatments and vaccines against COVID-19 used in clinical practice have made a positive impact on controlling the spread of the pandemic, where they are available. Nevertheless, even if fully vaccinated, immunocompromised patients still remain at high risk of adverse outcomes. This has driven the largely expanding field of monoclonal antibodies, with variable results. Tixagevimab/Cilgavimab (AZD7442), a long-acting antibody combination that inhibits the attachment of the SARS-CoV-2 spike protein to the surface of cells, has proved promising in reducing the incidence of symptomatic COVID-19 or death in high-risk individuals without major adverse events when given as prophylaxis, as well as early treatment. Real-world data confirm the antibody combination's prophylaxis efficacy in lowering the incidence, hospitalization, and mortality associated with COVID-19 in solid organ transplant recipients, patients with immune-mediated inflammatory diseases and hematological malignancies, and patients in B-cell-depleting therapies. Data suggest a difference in neutralization efficiency between the SARS-CoV-2 subtypes in favor of the BA.2 over the BA.1. In treating COVID-19, AZD7442 showed a significant reduction in severe COVID-19 cases and mortality when given early in the course of disease, and within 5 days of symptom onset, without being associated with severe adverse events, even when it is used in addition to standard care. The possibility of the development of spike-protein mutations that resist monoclonal antibodies has been reported; therefore, increased vigilance is required in view of the evolving variants. AZD7442 may be a powerful ally in preventing COVID-19 and the mortality associated with it in high-risk individuals. Further research is required to include more high-risk groups and assess the concerns limiting its use, along the SARS-CoV-2 evolutionary trajectory.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, Medical School, University of Patras, 26504 Rio, Greece
| | | | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stylianos Daios
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleftheria Ztriva
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Polychronopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, Medical School, University of Patras, 26504 Rio, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Alhumaid S, Al Mutair A, Alali J, Al Dossary N, Albattat SH, Al HajjiMohammed SM, Almuaiweed FS, AlZaid MR, Alomran MJ, Alqurini ZS, Alsultan AA, Alhajji TS, Alshaikhnasir SM, Al motared A, Al mutared KM, Hajissa K, Rabaan AA. Efficacy and Safety of Tixagevimab/Cilgavimab to Prevent COVID-19 (Pre-Exposure Prophylaxis): A Systematic Review and Meta-Analysis. Diseases 2022; 10:118. [PMID: 36547204 PMCID: PMC9777759 DOI: 10.3390/diseases10040118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Tixagevimab/cilgavimab (TGM/CGM) are neutralizing monoclonal antibodies (mAbs) directed against different epitopes of the receptor-binding domain of the SARS-CoV-2 spike protein that have been considered as pre-exposure prophylaxis (PrEP). Objectives: This study seeks to assess the efficacy and safety of TGM/CGM to prevent COVID-19 in patients at high risk for breakthrough and severe SARS-CoV-2 infection who never benefited maximally from SARS-CoV-2 vaccination and for those who have a contraindication to SARS-CoV-2 vaccines. Design: This study is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Methods: Electronic databases (PubMed, CINAHL, Embase, medRxiv, ProQuest, Wiley online library, Medline, and Nature) were searched from 1 December 2021 to 30 November 2022 in the English language using the following keywords alone or in combination: 2019-nCoV, 2019 novel coronavirus, COVID-19, coronavirus disease 2019, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, tixagevimab, cilgavimab, combination, monoclonal, passive, immunization, antibody, efficacy, clinical trial, cohort, pre-exposure, prophylaxis, and prevention. We included studies in moderate to severe immunocompromised adults (aged ≥18 years) and children (aged ≥12 years) who cannot be vaccinated against COVID-19 or may have an inadequate response to SARS-CoV-2 vaccination. The effect sizes of the outcome of measures were pooled with 95% confidence intervals (CIs) and risk ratios (RRs). Results: Of the 76 papers that were identified, 30 articles were included in the qualitative analysis and 13 articles were included in the quantitative analysis (23 cohorts, 5 case series, 1 care report, and 1 randomized clinical trial). Studies involving 27,932 patients with high risk for breakthrough and severe COVID-19 that reported use of TGM/CGM combination were analyzed (all were adults (100%), 62.8% were men, and patients were mainly immunocompromised (66.6%)). The patients’ ages ranged from 19.7 years to 79.8 years across studies. TGM/CGM use was associated with lower COVID-19-related hospitalization rate (0.54% vs. 1.2%, p = 0.27), lower ICU admission rate (0.6% vs. 5.2%, p = 0.68), lower mortality rate (0.2% vs. 1.2%, p = 0.67), higher neutralization of COVID-19 Omicron variant rate (12.9% vs. 6%, p = 0.60), lower proportion of patients who needed oxygen therapy (8% vs. 41.2%, p = 0.27), lower RT-PCR SARS-CoV-2 positivity rate (2.1% vs. 5.8%, p < 0.01), lower proportion of patients who had severe COVID-19 (0% vs. 0.5%, p = 0.79), lower proportion of patients who had symptomatic COVID-19 (1.8% vs. 6%, p = 0.22), and higher adverse effects rate (11.1% vs. 10.7%, p = 0.0066) than no treatment or other alternative treatment in the prevention of COVID-19. Conclusion: For PrEP, TGM/CGM-based treatment can be associated with a better clinical outcome than no treatment or other alternative treatment. However, more randomized control trials are warranted to confirm our findings and investigate the efficacy and safety of TGM/CGM to prevent COVID-19 in patients at risk for breakthrough or severe SARS-CoV-2 infection.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
- Department of Nursing, Prince Sultan Military College, Dharan 34313, Saudi Arabia
| | - Jalal Alali
- Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Ministry of Health, Al-Ahsa 36358, Saudi Arabia
| | - Sami Hussain Albattat
- Division of Haematology and Oncology, Pediatric Department, Maternity and Children Hospital, Ministry of Health, Al-Ahsa 36422, Saudi Arabia
| | | | - Fatimah Saad Almuaiweed
- Pharmacy Department, Aljafr General Hospital, Ministry of Health, Al-Ahsa 7110, Saudi Arabia
| | - Maryam Radhi AlZaid
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Ministry of Health, Al-Ahsa 36424, Saudi Arabia
| | | | - Zainab Sabri Alqurini
- Pharmacy Department, Prince Sultan Cardiac Center, Ministry of Health, Al-Ahsa 36441, Saudi Arabia
| | - Ahmed Abduljalil Alsultan
- Pharmacy Department, Maternity and Children Hospital, Ministry of Health, Dammam 32253, Saudi Arabia
| | - Thamer Saeed Alhajji
- Pharmacy Department, Maternity and Children Hospital, Ministry of Health, Dammam 32253, Saudi Arabia
| | | | - Ali Al motared
- Pharmacy Department, Eradah Complex and Mental Health, Ministry of Health, Najran 66248, Saudi Arabia
| | - Koblan M. Al mutared
- Administration of Pharmaceutical Care, Ministry of Health, Najran 66255, Saudi Arabia
| | - Khalid Hajissa
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health/Nutrition, The University of Haripur, Haripur 22620, Pakistan
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