Prophylaxis Strategies for
SARS
‐
CoV
‐2 Infection in Adults With Hematological Malignancies in Saudi Arabia: Consensus Statements From the Working
Mubarak Al‐Mansour, Ayman Alhejazi, Manal Ahmed Alsaggaf, Hafiz Mosa Malhan, Riad El Fakih, Reyad Dada, Ghazi Saud Alotaibi, Reem S. Almaghrabi, Majid Alshamrani ABSTRACT
Background
Despite the end of the pandemic phase, patients with hematological malignancies (HMs) remain vulnerable to severe COVID‐19 infection and mortality. Prophylaxis strategies, including vaccination and monoclonal antibodies (mAbs) like AZD7442, are crucial for protection. In Saudi Arabia, the incidence of HMs has risen, emphasizing the need for locally adapted prophylaxis strategies.
Aims
This consensus provides recommendations for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection prophylaxis in adults with HMs in Saudi Arabia.
Methods
We employed a modified Delphi approach to develop recommendations for minimizing the risk of SARS‐CoV‐2 infection in patients with HMs. A multidisciplinary expert panel of hematologists, oncologists, and infectious disease specialists was formed. The Delphi process involved three voting rounds. Consensus was achieved if there was ≥ 80% agreement.
Results
The present consensus consists of 24 statements. The panel agreed that the currently recommended COVID‐19 vaccination is the frontline prophylactic strategy for SARS‐CoV‐2 prophylaxis or severe COVID‐19 in patients with HMs. They also agreed that patients with HMs should receive at least one booster dose of an updated COVID‐19 vaccine, and that vaccination should not delay scheduled treatment. With regard to patients in the high‐risk group, pre‐exposure long‐acting mAbs may be considered when activity against currently circulating SARS‐CoV‐2 variants has been demonstrated, and the agent is locally available and approved by the relevant regulatory authorities. The mAbs should be started, even if the patient is under treatment. In the case of vaccinated patients, the long‐acting mAbs should be administered at least 2 weeks after vaccination.
Conclusion
There is a need for tailored prophylactic strategies to protect high‐risk immunocompromised patients from COVID‐19. Key recommendations include the need for booster doses of the updated vaccines, according to national availability, and the use of long‐acting mAbs for pre‐exposure prophylaxis, only when activity against circulating variants has been demonstrated, and the product is locally available and approved by the relevant regulatory authority.