Antiviral and Monoclonal Antibody Combination Therapy in Haematological Patients in the Omicron Era

Immunocompromised (IC) patients are at higher risk for persistent and/or severe SARS-CoV-2 infection caused by different viral variants, with a high case-fatality ratio.1,2 The first persistent SARS-CoV-2 infection (5 months) was reported in 2020 in an IC patient with a long persistence of SARS-CoV-2,3 immediately followed by further reports.2,4 Indeed, the impairment of the immune system changes the natural history of COVID-19. However, no consensus exists on clinical management of IC COVID-19 patients.5 Several reports emphasize the clinical relevance of a combination therapy between small-molecule antivirals (AV) and anti-spike monoclonal antibodies (MoAbs) both in early and prolonged COVID-19 clinical management.6,7 In 2022, tixagevimab/cilgavimab (T/C) MoAb fixed combination was introduced as early therapy for outpatient with COVID-19.8 We describe here a single-center case series of 22 IC COVID-19 in patients with hematological disorders (HD) treated with a combined therapy based on tixagevimab/cilgavimab (T/C) plus small-molecule antivirals (AV), between April 1, 2022, and November 30, 2022.