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Observational Study
. 2023 Apr 17;76(8):1476-1482.
doi: 10.1093/cid/ciac916.

Predictors of Coronavirus Disease 2019 Hospitalization After Sotrovimab in Patients With Hematologic Malignancy During the BA.1 Omicron Surge

Judy Yan  1 , Samantha N Steiger  2 , Rich Kodama  3 , Jerome Fender  1   4 , Carrie Tan  2 , Justin Laracy  1   3   5 , Nina Cohen  2 , Tracy McMillen  6 , Krupa Jani  6 , Elizabeth V Robilotti  1   3   5 , N Esther Babady  6 , Susan K Seo  3   5 , Mini Kamboj  1   3   5
Affiliations
Observational Study

Predictors of Coronavirus Disease 2019 Hospitalization After Sotrovimab in Patients With Hematologic Malignancy During the BA.1 Omicron Surge

Judy Yan et al. Clin Infect Dis. .

Abstract

Background: Sotrovimab is an anti-spike neutralization monoclonal antibody 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 malignancy and the predictive factors of hospitalization.

Methods: We performed an observational study of 156 consecutive 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, 17 (11%) were hospitalized, of whom 4 were readmitted for COVID-19-related complications; 3 deaths were attributed to COVID-19. Results from multivariable logistic regression show that significant factors associated with hospitalization include patients on anti-CD20 therapy (adjusted odds ratio [aOR], 5.59 [95% confidence interval {CI}, 1.73-18.12]; P = .004) and with relapse/refractory disease (aOR, 5.69 [95% CI, 1.69-19.16]; P = .005). Additionally, whole genome sequencing of severe acute respiratory syndrome coronavirus 2 detected high occurrences of mutations in the spike gene associated with treatment-related resistance longitudinal samples from 11 patients treated with sotrovimab.

Conclusions: While sotrovimab is effective at reducing COVID-19 hospitalization and disease severity in patients with hematologic malignancy 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.

Keywords: COVID-19; SARS-CoV-2; hematologic malignancy; monoclonal antibodies.

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Conflict of interest statement

Potential conflicts of interest. E. V. R. has received consulting fees from Replimune. N. E. B. is on the advisory board at Bio-Rad Molecular, Agena Diagnostics, and ArcBio/Canta. S. K. S. has an investigator-initiated grant from Merck. M. K. has acted as a consultant for Regeneron (participation on data and safety monitoring board or advisory board) and has received speaker’s fees from WebMD/Medscape. J. L. reports a Global HIV Implementation Science Research Training Grant under the National Institute of Allergy and Infectious Diseases (grant number T32AI114398), unrelated to this work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Various spike protein mutations associated with resistance identified following receipt of sotrovimab in 11 patients, including 8 hospitalized cases and 2 persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. *Patient had a coronavirus disease 2019–related hospitalization after receipt of sotrovimab. ‡Patient had a persistent SARS-CoV-2 infection.
See this image and copyright information in PMC

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