Shoham Shmuel, Focosi Daniele, Franchini Massimo, Atamna Alaa
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy.
Expert Rev Hematol. 2025 Jan;18(1):39-46. doi: 10.1080/17474086.2024.2436973. Epub 2024 Dec 3.
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.
In this narrative review, which relied on a review of the PubMed and 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.
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.
新型冠状病毒肺炎（COVID-19）对血液系统恶性肿瘤免疫功能低下的患者来说仍是一项持续的挑战。这类患者出现并发症的风险增加，包括住院、呼吸衰竭、抗癌治疗延迟，甚至死亡。除了非药物干预措施外，这类患者的主要预防策略是接种疫苗和暴露前预防。
在这篇叙述性综述中，我们通过检索PubMed数据库（检索起始时间为2019年11月1日），总结了血液系统恶性肿瘤患者中COVID-19的流行病学情况、疫苗反应以及抗病毒药物作为预防用药的情况。免疫功能低下患者，尤其是淋巴细胞计数和功能异常的患者，接种疫苗的免疫反应欠佳，这是接种疫苗的一个局限性。预防用药方面，仅证实抗病毒单克隆抗体（mAbs）有效，但普通人群中出现耐药毒株是其局限性。
对于血液系统恶性肿瘤免疫功能低下的患者，我们建议按照美国疾病控制与预防中心（CDC）不断更新的建议进行疫苗接种，考虑使用抗病毒mAbs进行暴露前预防（前提是其对流行的病毒株有效），并进行快速诊断检测，以便在那些突破预防策略的患者中尽早进行治疗，预防COVID-19的严重并发症。
