Prof. Iwona Hus: Covid-19 pre-exposure prophylaxis will allow the treatment of patients at risk to be continued

Which groups of haematological and haematooncological patients are particularly at risk of developing severe course of Covid-19?

Patients with haematological neoplasms are a large group of patients with various types of cancer. Cancers of the lymphatic system in particular are associated with greater immunodeficiency. Their immunosuppressive therapy increases the risk of a severe course of Covid-19. Patients with chronic lymphocytic leukemia are primarily at risk, especially those who are treated with anti-CD20 monoclonal antibodies or Bruton kinase inhibitors and CAR-T therapy. The second group includes acute leukemia patients who also have immune disorders associated with the disease and receive high-dose chemotherapy. The third group consists of people undergoing hematopoietic cell transplantation, both autogenous and allogeneic.

How effective is the Covid-19 vaccine in these people?

Unfortunately, the effectiveness in these groups is much lower than in healthy people. Studies assessing primarily the humoral response showed that, for example, in chronic lymphocytic leukemia, it was only 50 percent. It's very little. We also know that within 12 months after treatment with anti-CD20 monoclonal antibodies there is a very small chance of obtaining a response, and yet patients sometimes take such treatment for two years. In turn, treatment with Bruton's kinase inhibitors is continuous. Although we vaccinate everyone, such patients have little chance of getting a satisfactory answer.

Is there any other solution for them to build resistance to SARS-CoV-2 virus?

This is pre-exposure prophylaxis. It could help reduce the risk of Covid-19 disease, but also allow treatment to continue. Their disease causes a break in the treatment of the underlying disease, and in those at risk, the infection may persist for a long time. This can have a very negative effect on the prognosis. The use of pre-exposure prophylaxis would significantly increase the chances of receiving treatment in these patients without interruptions due to infection?

How long does immunity last after such prophylaxis?

According to the Summary of Product Characteristics, this prophylaxis lasts for approximately six months. Initial practice data show that it can be up to eight months. I would like to apply such prophylaxis to a large proportion of my patients.

Thanks for the interview.