ABSTRACT
Background
Sotrovimab is an anti-spike neutralization monoclonal antibody (mAB) developed to reduce the risk of Coronavirus Disease 2019 (COVID-19) progression and advancement to hospitalization in high-risk patients. Currently, there is limited research describing the association of sotrovimab treatment in patients with hematologic malignancies (HM) and the predictive factors of hospitalization.
Methods
We performed an observational study of 156 consec utive cancer patients who received sotrovimab at Memorial Sloan Kettering Cancer Center in New York City during the BA.1 Omicron surge. We evaluated the demographic, clinical, and laboratory characteristics of the patients who had subsequent COVID-19-related hospitalization(s) compared to those who did not.
Results
Among the 156 study patients, seventeen (17, 11%) were hospitalized of which four were readmitted for COVID-19-related complications; three deaths were attributed to COVID-19. Results from multivariable logistic regression show significant factors associated with hospitalization include patients on anti-CD20 therapy (adjusted OR = 5.59, 95% CI (1.73 - 18.12), p = 0.004) and with relapse/refractory disease (adjusted OR = 5.69, 95% CI (1.69 - 19.16), p = 0.005). Additionally, whole-genome sequencing of SARS-CoV-2 detected high occurrences of mutations in the spike gene associated with treatment-related resistance longitudinal samples from 11 patients treate d with sotrovimab.
Conclusions
While sotrovimab is effective at reducing COVID-19 hospitalization and disease severity in HM patients when administered early, patients who received anti-CD20 antibodies showed substantial morbidity. Due to the high potential for resistance mutation to sotrovimab and increased morbidity in patients on anti-CD20 therapy, combination treatment should be explored to determine whether it provides added benefits compared to monotherapy.
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