Chronic lymphocytic leukaemia (CLL) is a common lymphoid malignancy affecting older adults. CLL patients are immunocompromised by the disease itself and by several of its therapies. It has now been shown that many CLL patients do not mount an antibody response following COVID-19 vaccination and are therefore at risk of COVID-19 infection. Furthermore, patients with hematologic malignancies are known to be at increased risk of severe infection if they do acquire COVID-19 infection. The purpose of this trial is to document evidence of passive immunity to COVID-19 infection after EVUSHELD administration with serologic and neutralization assays at multiple post administration time points in patients with no response to standard of care vaccination to COVID-19. This trial will include a single dose of EVUSHELD to be administered, with a 1-year follow-up period, comprising of 8 health status visits. Blood samples will be taken at screening, baseline and at multiple health status visits over the course of the year for various antibody testing and analysis. T cell reactivity to COVID-19 epitopes will be studied at baseline and again monthly for 3 months in any participants that become infected with COVID-19.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
EVUSHELD is a combination of 2 monoclonal antibodies (mAbs), Tixagevimab and Cilgavimab. The single dose, is to be administered intramuscular, each mAb sequentially into the deltoid
Sunnybrook Health Sciences Cente
Toronto, Ontario, Canada
Passive Immunity
The primary study objective is to confer passive immunity to CLL patients, so the primary outcome measurement is the proportion of of participants after EVUSHELD administration with anti-spike antibodies above the minimal level set as a standard for convalescent serum or 210 u/ml using the Roche assay
Time frame: 12 months
Surrogate Viral Neutralization Assay
Serum neutralization using a surrogate viral neutralization assay levels (representing levels of EVUSHELD) at months 1-6, 9 and 12 to document longevity of protection following one-time administration of the product.
Time frame: 12 months
Pseudo- Viral Naturalization Assay
Serum neutralization with a pseudo-typed viral-like particle (pseudo-virus) neutralization assay will be completed using samples obtained from 50% of participants (i.e. 25) within each treatment group at baseline and five post treatment time points. These results will be modeled over the course of the study.
Time frame: 12 months
Pharmacokinetic Assessments
Serum pharmacokinetic levels of antibodies to the COVID-19 RBD epitope at the baseline visit and visits 1, 3, 5, 7, and 8 to provide additional supportive data documenting longevity of protection following one-time administration of the product (in a subset of patients)
Time frame: 12 months
COVID-19 Infection (antibodies)
COVID-19 infection as documented by evidence of antibodies to the nucleocapsid (NC) protein
Time frame: 12 months
COVID-19 Infection (RAT/PCR)
COVID-19 infection documented by PCR or RAT.
Time frame: 12 months
Symptomatic COVID-19 infection
Symptomatic COVID-19 infection and outcomes as documented by participant clinical symptomatology and status (hospital admission, ICU admission, or death) at conclusion of the trial
Time frame: 12 months
Safety of EVUSHELD
Safety will be evaluated at each clinical visit and will include the documentation of; any changes in grade/seriousness or severity of baseline medical history, body temperature, blood pressure, oxygen saturation, heart rate, pulse, and review of symptoms, toxicities at monthly time points. Toxicities will be graded according to the NCI Common Terminology Criteria for Adverse Events, version 5.0 (NCI CTCAE, v5.0).
Time frame: 12 months
Baseline T cell responses to COVID-19 as a potential predictor of breakthrough COVID-19 infections
T cell responses at baseline will be evaluated by COVID-19-specific LEGEND-plex cytokine detection with stratification according to participant treatment group to help understand mechanisms of viral escape in participants who do become infected with COVID after EVUSHELD administration.
Time frame: 12 months
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