Keynote Presentation: Laboratory Assessment of Covid-19 Immunity in Patients with a Cancer Diagnosis: Alpha to Omicron

The COVID-19 pandemic has taken a dramatic toll worldwide. Its impact possibly has been the most palpable amongst uniquely vulnerable groups of patients, such as patients with a cancer diagnosis whose outcomes suffered in addition as a result of disrupted healthcare services. Imminent need for knowledge as to best means to protect patients with a cancer diagnosis remains an acute need with new variants and waves. This keynote talk will address knowledge obtained since the start of the pandemic as to the impact of COVID-19 and in particular immunity against COVID-19.  Adverse outcomes in the face of COVID-19 clearly highlight the notable impact of a cancer diagnosis and even more prominently that of advanced age, frailty, co-morbidities as well as certain malignancy types, such as hematological malignancies and thoracic cancers. While case fatality rates have dropped significantly during the Omicron crisis, these key predictors remain pertinent to identify patients with a worse prognosis. Robust efforts have been undertaken to understand correlates of immunity amongst patients with a malignant diagnosis and demonstrate generally robust immune response to COVID-19 infections as well as COVID-19 vaccines with the exception of definable subsets of patients with high levels of baseline immune suppression, such as B-cell malignancies or following receipt of highly immune suppressive therapies, in particular anti-CD20 monoclonal antibody therapy, CAR-T cell therapy and stem cell transplantation. Booster vaccinations can enhance detectable immunity in general as well as amongst some of the most immune suppressed patients, however further need remains for alternate strategies, such as anti-COVID-19 antibody therapy for stronger protection. Immune correlates of vaccine response, including serological testing, neutralization assay and T cell assays provide surrogate markers of immune response and might be helpful for risk assessment and patient enrichment for clinical studies.

Learning Objectives:

1. Discuss risk factors for poor outcomes amongst patients with a cancer diagnosis and COVID-19.

2. Discuss measures of immunity post-COVID-19 infection and following COVID-19 vaccinations.

3. Discuss emerging strategies, such as booster vaccinations and prophylactic antibody therapies to enhance anti-COVID-19 immunity amongst the most immune suppressed.