POTENTIALS OF EMERGENT PROPHYLACTICS OF NEW CORONAVIRUS INFECTION COVID-19 IN HEMATOLOGICAL PATIENTS
Original research article
Published September 2, 2023
Keywords
SARS-CoV-2
COVID-19
antibodies
COVID-19
antibodies
How to Cite
Ignateva E. V., Kazakov S. P., Rukavitsyn O. A. POTENTIALS OF EMERGENT PROPHYLACTICS OF NEW CORONAVIRUS INFECTION COVID-19 IN HEMATOLOGICAL PATIENTS // Kremlin Medicine Journal. 2023. VOL. № 3. С. 39-44.
Abstract
Introduction. The new COVID-19 coronavirus infection makes treatment of patients with hematological pathologies more complicated, as well as worsens their prognosis. Therefore, pre-contact emergent prevention is important in this group of patients, for which the preparation of recombinant human monoclonal antibodies (AB) of IgGIk class Tixagevimab + Cilgavimab (Evusheld) has been approved. Purpose. To study AB dynamics and duration to SARS-CoV-2 after Tixagevimab + Cilgavimab administration in patients with hematological pathologies, to determine the level of IgG class protective antibodies to SARS-CoV-2 S-protein and AB sufficient level to prevent COVID-19 infection. Materials and methods. 44 patients with hematological diseases, who were treated in the hospital, were prescribed Evusheld as COVID-19 emergent protective agent. Out of these 44 patients, 29 (65.9%) had lymphomas, 11 (25%) – multiple myelomas, and 4 (9.1%) – acute leukemia. AB of IgG class to SARS-CoV-2 S-protein (quantitative method, BAU/ml) and AB of IgM class to SARS-CoV-2 S-and N-proteins (semi-quantitative method, coefficient of positivity) were studied. Results and discussion. The studied parameters were analyzed before Evusheld administration , on days 3–7 and in 1, 3 and 6 months after it. Patients were divided into three groups depending on the protective AB level before Evusheld administration: first- AB of IgG class to SARS-CoV-2 S-protein less than 150 BAU/ml (36.4% of patients); second – sufficient level of protective antibodies from 150 to 550 BAU/ml ( 27.3% of patients ); third – AB of IgG class to SARS-CoV-2 S-protein more than 550 BAU/ml (36.4% of patients). The researchers found out that patients who survived COVID-19 or were vaccinated within six months have a higher level of IgG-class AB to SARS-CoV-2 S-protein. In the first month after preparation administration, 93.75% of patients had AB to SARS-CoV-2 IgG more than 2000 BAU/ml. The decrease of AB level was registered in three months after Evusheld administration. 7 (15.9%) patients fell ill with COVID-19 within one – two months after administration of the studied preparation. The overall mortality rate in the trial group was 18%. Conclusion. Administration of the combined preparation Tixagevimab + Cilgavimab decreases the incidence of new corona virus infection in hematological patients. A proper immune response in hematological patients is achievable at the level of protective AB of IgG-class to S-protein more than 550 BAU/ml. Patients who survived new corona virus infection or who were vaccinated within six months have higher level of protective antibodies. Therefore, before Tixagevimab + Cilgavimab administration, it is necessary to assess the level of IgG-class AB to S-protein. After administration of combined Tixagevimab + Cilgavimab preparation, the level of IgG-class AB to S-protein should be monitored every three months.References
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4. Zinchenko A.V. et al. СOVID-19 in a hematological hospital, course and outcomes // Hematology. Transfustology. Eastern Europe. – 2021. – V. 7. – №. 2. – P. 131–141. In Russian. doi: 10.34883/PI.2021.7.2.001.
5. Vijenthira A. et al. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients // Blood. – 2020. – V. 136. – №. 25. – С. 2881–2892. doi: 10.1182/blood.2020008824.
6. Pagano L. et al. COVID-19 in vaccinated adult patients with hematological malignancies: preliminary results from EPICOVIDEHA // Blood. – 2022. – V. 139. – №. 10. – P. 1588-1592. doi: 10.1182/blood.2021014124
7. Stuver R. et al. Activity of AZD7442 (tixagevimab-cilgavimab) against Omicron SARS-CoV-2 in patients with hematologic malignancies // Cancer Cell. – 2022. – V. 40. – №. 6. – P. 590–591. doi: 10.1016 /j.ccell.2022.05.007.
8. Feng S. et al. Correlates of protection against symptomatic and asymptomatic SARS-CoV-2 infection // Nat. Med. – 2021. – V. 27. – №. 11. – P. 2032–2040. DOI: 10.1038/s41591-021-01540-1.
9. SARS-CoV-2 IgG II Quantitative Reagents for ARCHITECT (SARS-CoV-2 IgG II Quant Reagent Kit) – Abbott test kit instructions, December 2020.
10. Kazakov S. P. et al. Evaluation of effectiveness of humoral immune response after vaccination with «CoviVaс». Medical alphabet. – 2022. – V. 1. – №. 6. – P. 18–24. In Russian. doi: 10.33667/2078-5631-2022-6-18-24.
11. Agletdinov E.F. The results of the study of cellular immunity of a patient with COVID-19 and a convalescent, promising laboratory technologies for assessing the quality of circulating antibodies to SARS-CoV-2 (report) 10/19/2021 // «Laboratory support of a new coronavirus infection» VII Russian Congress on Laboratory Medicine, 19–21 October 2021, Moscow. In Russian.
12. Levin M.J. et al. Intramuscular AZD7442 (tixagevimab–cilgavimab) for prevention of COVID-19 // N. Engl. J. Med . – 2022. – V. 386. – №. 23. – P. 2188–2200. doi: 10.1056/NEJMoa2116620.
13. Kazakov S.P. Vaccines against a new coronavirus infection: mechanisms of action, the possibility of their use in oncohematological patients (Chapter 1). P. 4–26 // Management of patients with oncohematological profile during the COVID-19 pandemic: Guide / Ed. academician RAS I.V. Poddubnaya. – M.: Econ-Inform, 2022. – 140 p. In Russian.
14. Komissarov A.A. et al. Boosting of the SARS-CoV-2–Specific Immune Response after Vaccination with Single-Dose Sputnik Light Vaccine // J. Immunol. – 2022. – V. 208. – №. 5. – P. 1139–1145. doi: 10.4049/jimmunol.2101052.
15. Piñana J.L. et al. SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders // J. Hematol. Oncol. – 2022. – V. 15. – №. 1. – P. 54. doi: 10.1186/s13045-022-01275-7.
16. Haggenburg S. et al. SARS-CoV-2 vaccine-induced humoral and cellular immunity in patients with hematologic malignancies // Seminars in Hematology. – WB Saunders, 2022. – V. 59. – №. 4. – P. 192–197. doi: 10.1053/j.seminhematol.2022.11.001.