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COVID mAbs
Protecting Patients With Hematologic Malignancies With COVID-19 mAbs

Released: May 15, 2024

Expiration: May 14, 2025

Mazyar Shadman
Mazyar Shadman, MD, MPH
Activity Information

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Key Takeaways
  • In the past, monoclonal antibody (mAb) prophylaxis significantly reduced the risk of severe COVID-19 in patients with compromised immune systems, who are unlikely to have optimal vaccine responses.
  • Next-generation COVID-19 monoclonal antibodies are expected to retain efficacy as the virus evolves, providing durable protection against emerging variants of concern.

As a hematologist and medical oncologist working at an academic center, I face numerous challenges while managing the care of patients with hematologic malignancies, particularly those with lymphoid malignancies such as chronic lymphocytic leukemia. My role also extends to caring for patients undergoing advanced therapies, including CAR T-cell therapy and stem cell transplantation, who are at an exceptionally high risk for severe infections such as COVID-19. This heightened vulnerability emphasizes the need for robust preventive measures, especially as these patients increasingly return to community interaction and social activities post pandemic.

COVID-19 mAbs as Prevention
Primary prevention, including vaccination, is fundamental in shielding our patients from COVID-19. However, the unique immunocompromised state of patients with hematologic cancer often leads to suboptimal vaccine responses. Thus, additional preventive strategies are crucial.

One of the most promising methods in this regard is the prophylactic administration of monoclonal antibodies against COVID-19. These antibodies are engineered to provide passive immunity by delivering effective antiviral agents directly to patients, offering immediate protection against the virus.

Monoclonal antibodies certainly have boosted the fight against COVID-19. Initially authorized under emergency use, these treatments substantially alleviated the burden of severe disease in high-risk groups, including older patients and those with chronic conditions. For patients whose immune systems are compromised by their disease or the aggressive treatments they undergo (such as patients with cancer), these antibodies are a vital shield against severe COVID-19, potentially averting disastrous outcomes associated with a SARS-CoV-2 infection.

However, a significant limitation of COVID-19 monoclonal antibodies as prophylaxis is viral immune escape. As the pandemic progressed, the emergence of new variants of concern rendered most of the previously available COVID-19 monoclonal antibodies ineffective. Thus, the development of a new generation of anti‒COVID-19 monoclonal antibodies is a monumental step forward.

The newer formulations combat a broader range of virus variants, ensuring that patients remain protected as the virus evolves. Pemivibart recently received emergency use authorization and others are in development and clinical trials. The significance of these advanced monoclonal antibodies cannot be overstated, particularly as people begin to reengage more fully with society. As social restrictions lift and interactions increase, so too does the risk of COVID-19 exposure. For people with cancer, any infection, especially one as severe as COVID-19, can lead to significant health complications, disrupt essential cancer treatments, and severely affect outcomes.

A Broader Shift
In my practice, I will advocate for the use of these monoclonal antibodies, when they are available, as a key component of our preventive strategy against COVID-19. This approach is about more than just avoiding infection—it is about ensuring that our patients can safely continue their cancer treatment, maintain their quality of life, and engage with their communities without the constant fear of COVID-19. This strategy offers dual benefits: It protects public health and supports individual health resilience.

Integrating monoclonal antibodies into our preventive toolkit also reflects a broader shift in how we manage the care of immunocompromised patients. It highlights the importance of innovation in medical treatments and the need for ongoing research and adaptation to meet new challenges. By leveraging these cutting-edge therapies, we not only protect our patients from immediate threats, but also help pave the way for more resilient healthcare systems capable of withstanding future pandemics.

The forthcoming generation of monoclonal antibodies represents a beacon of hope for patients with hematologic malignancies. As we navigate the complexities of COVID-19 in a postpandemic world, these treatments will be pivotal in safeguarding the most vulnerable populations, allowing them to live fuller and more secure lives despite ongoing viral threats. For healthcare professionals and patients alike, the continued development and deployment of such therapies are crucial for turning the tide against COVID-19 and enhancing overall disease management in the realm of oncology.

Join Me
To explore the potential promise of COVID-19 prevention in our vulnerable patients with cancer, I hope you will join me and my colleagues, Shmuel Shoham, MD, and Cynthia Nguyen, PharmD, BCIDP, at our May 31 symposium, “Caring for Patients With Cancer in a Post-COVID World: Expert Guidance on the Latest Data and Therapeutic Advances to Mitigate Infection Risk.” You can join us in person in Chicago or online.

Your Thoughts?
How do you intend to incorporate next-generation COVID-19 monoclonal antibodies into your preventive toolkit? Leave a comment to join the discussion.