Early administration of SARS‐CoV‐2 monoclonal antibody reduces the risk of mortality in hematologic malignancy and hematopoietic cell transplant patients with COVID‐19

Abstract

AbstractBackgroundData on severe acute respiratory distress syndrome coronavirus 2 monoclonal antibody (SARS‐CoV‐2‐specific mAb) use in hematologic malignancy and hematopoietic cell transplantation (HM/HCT) patients are limited. Here, we describe our experience with the use of casirivimab–imdevimab or bamlanivimab for the treatment of coronavirus disease 2019 (COVID‐19) in HM/HCT patients.MethodsThis was a retrospective chart review at the University of Miami Hospital and Sylvester Comprehensive Cancer Center for HM/HCT patients with COVID‐19 who received casirivimab–imdevimab or bamlanivimab from November 21, 2020, to September 30, 2021. Outcomes measured were mortality, hospital admission, and infusion reaction to SARS‐CoV‐2‐specific mAbs.ResultsWe identified 59 HM/HCT patients with mild to moderate COVID‐19 who received casirivimab–imdevimab or bamlanivimab. Median age was 57 years (interquartile range [IQR]: 45–65). Among the 59 patients, 25 (42%) received cellular therapy: 14 (24%) had undergone allogeneic HCT, nine (15%) autologous HCT, and two (3%) received chimeric antigen receptor T‐cell therapy. The median time from COVID‐19 symptom onset to SARS‐CoV‐2‐specific mAb administration was 4 (IQR: 3–6) days. Forty‐six (78%) patients received SARS‐CoV‐2‐specific mAbs as outpatients and 13 (22%) patients received SARS‐CoV‐2‐specific mAbs during hospitalization. Among patients who received SARS‐CoV‐2‐specific mAbs as outpatients, only four (9%) visited the emergency department at days 10, 11, 15, and 35 after SARS‐CoV‐2‐specific mAb administration. None of these four patients required hospital admission. Among the hospitalized patients, five (38%) were admitted to the hospital with neutropenic fever, four (31%) were already hospitalized for transplantation and cellular therapy, three (23%) were admitted for monitoring of COVID‐19 symptoms, and one (8%) was admitted with acute kidney injury. Three hospitalized patients (23%) died at 14, 35, and 59 days after SARS‐CoV‐2‐specific mAb administration; two of these three deaths were attributed to COVID‐19 infection. One patient developed an immediate infusion reaction to bamlanivimab, and no infusion reactions were reported to casirivimab–imdevimab use.ConclusionDuring the alpha and delta variant surges, early administration of bamlanivimab or casirivimab–imdevimab prevented hospitalization and death when given in the outpatient setting. Among patients who received mAbs at or after hospital admission, the risk of COVID‐19 disease progression and death remains significant. Larger studies of the use of mAb therapy to treat COVID‐19 in this population are needed. image