Adults and adolescents with hematologic malignancies, low anti-S IgG (<260 BAU/ml), at high risk of severe COVID-19
Care Setting
Hospitalized hematology department; compassionate use program
Key Highlights
Tixagevimab-cilgavimab shows ~12-fold decreased neutralizing activity against Omicron but retains partial efficacy.
In a retrospective study of 13 patients with hematologic malignancies and Omicron infection, asymptomatic patients treated early with tixagevimab-cilgavimab did not progress to severe COVID-19.
Symptomatic patients requiring oxygen had mixed outcomes; some recovered with tixagevimab-cilgavimab ± steroids, while others experienced prolonged disease or death.
Guideline-Based Recommendations
Diagnosis
Confirm Omicron SARS-CoV-2 infection by type-specific multiplex RT-PCR assay.
Assess anti-S IgG levels to identify weak or absent vaccine response (<260 BAU/ml).
Management
Administer intravenous tixagevimab-cilgavimab 300–300 mg for treatment in high-risk patients with low anti-S IgG.
Consider steroids (dexamethasone or prednisolone) and tocilizumab for inflammatory syndrome.
Early treatment in asymptomatic or mild cases may prevent progression to severe disease.
Monitoring & Follow-up
Monitor clinical symptoms and oxygen requirements closely.
Perform follow-up serological assessment to evaluate anti-S IgG increase post-treatment.
Watch for prolonged viral shedding and late respiratory deterioration.
Risks
Potential for treatment failure and progression to severe COVID-19 in symptomatic patients despite therapy.
High mortality risk remains in hospitalized patients with hematologic malignancies and Omicron infection.
Patient & Prescribing Data
Patients with hematologic malignancies infected with Omicron SARS-CoV-2, low anti-S IgG, including vaccinated and unvaccinated individuals.
Tixagevimab-cilgavimab increases anti-S IgG levels; early administration in asymptomatic patients prevents severe disease; symptomatic patients may require additional therapies.
Clinical Best Practices
Screen patients with hematologic malignancies for SARS-CoV-2 infection and antibody levels promptly.
Initiate tixagevimab-cilgavimab treatment early in asymptomatic or mild cases to prevent progression.
Use adjunctive steroids or immunomodulators in patients with inflammatory syndrome.
Monitor patients for delayed respiratory worsening and consider additional treatments such as convalescent plasma if needed.
Resume chemotherapy promptly in patients recovering from mild or asymptomatic COVID-19 after treatment.
by Armelle Otiniano, Zoe van de Wyngaert, Eolia Brissot, Rémy Dulery, Joel Gozlan, Anne Daguenel, Yasmine Abi Aad, Laure Ricard, Nicolas Stocker, Anne Banet, Agnes Bonnin, Tamim Alsuliman, Zora Marjanovic, Aurélie Schnuriger, Paul Coppo, Ollivier Legrand, Karine Lacombe, Mohamad Mohty, Florent Malard
