How to Provide the Needed Protection from COVID-19 to Patients with Hematologic Malignancies

Abstract

Patients with hematologic malignancies are particularly vulnerable to COVID-19 infections, and upon a pooled data analysis of 24 publications, there is evidence that they have suboptimal antibody responses to COVID-19 vaccination and boosters. To provide them the needed additional protection from COVID-19, it is imperative to achieve a 100% full immunization rate in health care workers and adult caretakers, and to foster research to test higher doses and repeated rounds of COVID-19 vaccines and the use of passive immune prophylaxis and therapy.

Figure 1.

Rates of anti–SARS-CoV-2 spike protein IgG antibody seroconversion of patients with different histologies of hematologic malignancies compared with healthy subjects. The size of the round symbol is proportional to the number of subjects in each group. The healthy subject group is an overlay of the concurrent control groups from nine of the series. ALL/AML, acute lymphoblastic leukemia/acute myeloid leukemia; CLL, chronic lymphoblastic leukemia; CML/MPD, chronic myelogenous leukemia/myeloproliferative diseases; MDS, myelodysplastic syndromes; MM, multiple myeloma; NHL, non-Hodgkin lymphoma; WM, Waldenstrom macroglobulinemia.

Figure 2.

Full vaccination in the majority of potential contacts of a patient with a hematologic malignancy with low anti–SARS-CoV-2 spike protein IgG serologic responses to COVID-19 vaccination would prevent the spread of SARS-CoV-2. A, A population of patients with suboptimal immunity to SARS-CoV-2, with some persons not vaccinated (pink, both adults and children), some persons with decreased antibody levels after vaccination (light blue), some persons without face masks with different levels of immunity to the virus, a person with COVID-19 (red), and a person with a hematologic malignancy without ability to mount full protection to COVID-19 despite vaccination (purple, in the center). In this setting, the SARS-CoV-2 virus can make its way from the infected person to the vulnerable patient with a hematologic malignancy without seroconversion after full COVID-19 vaccination. B, An alternate scenario, where all caregivers and health care workers taking care of a patient with hematologic malignancy are fully immune to COVID-19 and cannot pass the virus to the vulnerable patient with a hematologic malignancy. The only people without immunity to the SARS-CoV-2 virus in this scenario are children under the age of 12 and the person with the hematologic malignancy.