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Successful early use of anti‐SARS‐CoV‐2 monoclonal neutralizing antibodies in SARS‐CoV‐2 infected hematological patients – A Czech multicenter experience

Authors
  • Weinbergerová, Barbora1, 2
  • Demel, Ivo3, 4
  • Víšek, Benjamin5
  • Válka, Jan6
  • Čerňan, Martin7
  • Jindra, Pavel8
  • Novák, Jan9
  • Stejskal, Lukáš10
  • Kovácsová, Flóra1, 2
  • Kabut, Tomáš1, 2
  • Szotkowski, Tomáš7
  • Hájek, Roman3, 4
  • Žák, Pavel5
  • Cetkovský, Petr6
  • Král, Zdeněk1, 2
  • Mayer, Jiří1, 2
  • 1 Masaryk University, Czech Republic , (Czechia)
  • 2 University Hospital Brno, Czech Republic , (Czechia)
  • 3 University Hospital Ostrava, Czech Republic , (Czechia)
  • 4 Faculty of Medicine, University of Ostrava, Czech Republic , (Czechia)
  • 5 University Hospital Hradec Kralove, Czech Republic , (Czechia)
  • 6 Institute of Hematology and Blood Transfusion, Czech Republic , (Czechia)
  • 7 Palacký University Olomouc and University Hospital Olomouc, Czech Republic , (Czechia)
  • 8 University Hospital Pilsen, Czech Republic , (Czechia)
  • 9 Charles University, Czech Republic , (Czechia)
  • 10 Silesian Hospital in Opava, Czech Republic , (Czechia)
Type
Published Article
Journal
Hematological Oncology
Publisher
Wiley (John Wiley & Sons)
Publication Date
Feb 17, 2022
Volume
40
Issue
2
Pages
280–286
Identifiers
DOI: 10.1002/hon.2974
PMID: 35120267
PMCID: PMC9015292
Source
PubMed Central
Keywords
Disciplines
  • Letters to the Editor
License
Unknown
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Abstract

COVID‐19 significantly impairs survival rates among hematological patients when compared to the general population. Our prospective multicentre project analyzed early administration of anti‐SARS‐CoV‐2 spike protein neutralizing monoclonal antibodies (NmAbs) – bamlanivimab (72%) and casirivimab/imdevimab (28%) – efficacy among hematological patients with early‐stage COVID‐19. Mortality rate was compared to a control cohort of 575 SARS‐CoV‐2 positive hematological patients untreated with any specific anti‐COVID‐19 therapy. 88 hematological patients with lymphomas, acute leukemias, and myeloma as their most frequent underlying diagnoses (72%) were evaluated with a 97 days median follow‐up after NmAb administration. One third of patients (32%) were treated with an anti‐CD20 monoclonal antibody before COVID‐19 diagnosis. Median time between first COVID‐19 symptom and NmAb administration was 2 days. When administering NmAb, 29%, 57%, 11%, 2%, and 1% of our patients had asymptomatic, mild, moderate, severe, and critical degrees of COVID‐19, respectively. 80% of baseline asymptomatic patients remained asymptomatic following NmAb administration. Median duration of COVID‐19 symptoms after NmAb administration was 2.5 days. Progression to severe/critical COVID‐19 occurred among a total of 17% (15/88) of our cases and numerically higher with bamlanivimab versus casirivimab/imdevimab (21% vs. 8%; p  = 0.215), and myelomas (29%), lymphomas (17%) and acute leukemias (18%), respectively. During final follow‐up, nine deaths (10%) were recorded ‐ all after bamlanivimab ( p  = 0.056) with 8% attributed to COVID‐19. Regarding “remdesivir/convalescent plasma naïve” patients, COVID‐19 mortality rates were significantly lower in our NmAbs treated cohort compared to the control cohort of untreated SARS‐CoV‐2 positive hematological patients (6% vs. 16%, p  = 0.020), respectively. Our study validated the safety and efficacy of NmAbs early use among hematological patients with newly diagnosed early‐stage COVID‐19 in terms of alleviating infection course and decreasing mortality. Results confirmed a more positive effect of a casirivimab/imdevimab combination versus bamlanivimab monotherapy.

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