Novel approaches for preventing COVID-19 infection in immunocompromised patients with hematologic malignancies

Introduction: COVID-19 is a continuing challenge for immunocompromised patients with hematological malignancies. Such patients are at increased risk for complications, including hospitalization, respiratory failure, delayed anti-cancer therapies, and even death. In addition to non-pharmacologic interventions, the main strategies for prevention in such patients are vaccination and pre-exposure prophylaxis. Areas covered: In this narrative review, which relied on a review of the PubMed and bioRxiv databases (starting 1 November 2019), we summarize the epidemiology of COVID-19 and vaccine responses in patients with hematological malignancies and the use of antiviral agents as prophylaxis. A limitation to vaccination is suboptimal immune responses in immunocompromised patients, particularly those with abnormalities in lymphocyte count and function. A limitation to prophylaxis, which has only been proven effective for antiviral monoclonal antibodies (mAbs), is the emergence of resistant strains in the general population. Expert opinion: For immunocompromised patients with hematological malignancies, we recommend vaccinations as guided by evolving US Centers for Disease Control and Prevention (CDC) recommendations, consideration of pre-exposure prophylaxis with antiviral mAbs, providing that they are effective against circulating viral strains, and rapid diagnostic testing linked to early therapy for the prevention of severe complications of COVID-19 in those who have broken through the prevention strategies.