PB2591: REAL WORLD DATA OF THE MANAGEMENT (TREATMENT AND PREVENTION OF COVID-19 DISEASE) IN PATIENTS WITH HEMATOLOGICAL DISEASES DURING THE PANDEMIC

Abstract Topic: 30. Infections in hematology (incl. supportive care/therapy)

Background: Comorbidities play an important role in the severity and progression of COVID-19 disease. Patients with hematological diseases represent a special high-risk group. The majority has impaired response to SARS-CoV-2 vaccination. Treatment with monoclonal antibodies causes immunosuppression. Patients undergoing hemopoietic stem cells transplantation or CAR T-cells therapy are at high risk of severe COVID-19 disease.

Aims: Presentation of the experience from the daily clinical practice (Real World Data) in the management (treatment and prevention of COVID-19 disease) of hematological patients during the pandemic.

Methods: We present 57 patients with hematological diseases, who either got sick with COVID-19 (40/57), or received prophylaxis with the combination of monoclonal antibodies tixagevimab/cilgavimab (Evusheld ® ) (17/57) between 11/2020-12/2022. In the group of patients who got sick, patients had median age 68.5 years, 15(45%) were male. 25(76%) had hematological malignancy [Diffuse Large B Cell Lymphoma (DLBCL) 8(24%), Multiple Myeloma 6(18%), CLL 6(18%)], one patient had received CAR T-cells, non-Malignant hematological diseases had 8(24%) patients. All patients were treated according to the appropriate guidelines of each pandemic wave. Since 8/2022, when Evusheld ® was available in Greece for prophylaxis against COVID-19 disease, 17(29.8%) eligible patients received Evusheld® im. Patients had median age 67.3 years (range: 53-83 years), 11 (64.7%) were male, one patient had Thrombotic Thrombocytopenic Purpura, 5 DLBCL, 1 DLBCL and had been treated with CAR T-cells, 5 CLL, 4 Multiple Myeloma and one had Waldeström macroglobulinemia.

Results: 6 (15%) patients who had COVID-19 disease at the beginning of the pandemic died after hospitalization in the COVID clinic. Οne patient had R/R Multiple Myeloma, two R/R DLBCL, and 3 Myelodysplastic Syndrome in transformation to Acute Leukemia. All of them were under advanced-line immunochemotherapy for their refractory or relapsed disease, had comorbidities and were elderly. When vaccination against SARS-CoV-2 was available, everyone was vaccinated. When vaccinated patients had COVID-19 disease, 13(32,5%) of them received remdesivir (Veklury ® ) i.v. and although some fell seriously ill, eventually, they recovered. 15(37,5%) were treated with nirmatrelvir/ritonavir (Paxlovid ® ) p.o, none required hospitalization and they all recovered. Regarding the 17 patients who received prophylaxis with Evusheld ® , no one got sick with COVID-19 disease during the six-month follow-up after administration.

Summary/Conclusion: Real World Data reporting the outcomes of the management of patients with hematological diseases remains a topic of great interest, including the use of the novel and specialized prophylaxis and treatments against COVID-19 in this high-risk group. Our findings were consistent with those of the international literature. Before vaccination availability and antiviral treatments, mortality was high in hematological patients. Vaccination remains the mainstay strategy to prevent severe COVID-19. Remdesivir’s (Veklury ® ) administration reduced in-hospital mortality, while Evusheld ® effectively prevented COVID-19 disease. Nowadays, nirmatrelvir/ritonavir (Paxlovid ® ) is used as first-line therapy for non hospitalized patients. Prompt administration to hematological patients reduces hospitalization and mortality rates. With the novel agents that are available in our armentarium against COVID-19 disease, therapies for hematological diseases can be continued uninterrupted.

Keywords: COVID-19, CAR-T, Multiple myeloma, DLBCL