“Vaccines and monoclonal antibodies remain unavailable for some of the deadliest viruses in patients with haematolgical malignancies”
Patients with haematological malignancies are particularly vulnerable to respiratory infections, yet treatment and prevention options for many common viruses remain inadequate. At ESCMID Global 2025, Dr Jon Salmanton-García (University of Cologne, Germany) presented real-world findings from the EPICODE-ID registry, highlighting the disproportionate impact of viruses like RSV and metapneumovirus in this high-risk group. With limited vaccines and no effective antivirals for several key pathogens, his work underscores the need for expanded prophylactic and therapeutic strategies. In this interview, Dr. Salmanton-García shares key insights from his research and discusses why real-world data are critical to improving care for immunocompromised patients.
Q1. Patients with haematological malignancies are particularly susceptible to respiratory infections. What are the current unmet needs for prevention and treatments?
Patients with haematological malignancies face a high risk of respiratory infections, and there are several unmet needs in both prevention and treatment. In terms of prevention, two main areas stand out: vaccines and monoclonal antibodies. While vaccines are available for SARS-CoV-2, influenza and more recently for respiratory syncytial virus (RSV), there are still no approved vaccines for other significant pathogens such as metapneumovirus and parainfluenza virus, both of which are associated with high mortality in this population. The situation is similar for monoclonal antibodies – although there was some success with agents targeting SARS-CoV-2, their efficacy has been limited by the rapid emergence of resistant viral variants. For other respiratory viruses, monoclonal antibody options remain largely absent.
Regarding treatment, antiviral therapies such as remdesivir and nirmatrelvir–ritonavir are available for SARS-CoV-2, with molnupiravir also approved in some countries. For influenza, oseltamivir remains a standard option. However, for RSV, metapneumovirus, parainfluenza and rhinovirus, no effective antiviral treatments currently exist. This leaves patients vulnerable to complications and hospitalization, increasing their risk of nosocomial infections. From both a clinical and economic perspective, advances in prophylaxis and treatment are urgently needed to reduce morbidity, mortality and healthcare costs in this vulnerable group.
Q2. You have presented in this area at ESCMID Global 2025, please can you summarize the key takeaways from your studies?
Our studies are observational in nature and based on real-world data. While clinical trials remain essential for controlling variables and generating robust evidence, real-world data provide valuable insight into how treatments and infections behave outside controlled settings. This kind of evidence is increasingly recognized by academia, hospitals and industry as a necessary complement to clinical trial findings.
At EPICODE-ID, we do not direct participating investigators on how to manage their patients. Instead, they treat according to local practice, and we collect data retrospectively. This allows us to analyse outcomes from multiple perspectives – such as hospital admissions, associations with specific antivirals or differences in mortality rates between viral pathogens.
At the congress, we presented three posters: one focused on metapneumovirus, one on RSV and one offering a broader overview of rare and very rare viral infections. In the RSV and metapneumovirus posters, we also compared these viruses to influenza and SARS-CoV-2 – pathogens for which vaccines and treatments are available. This contrast is particularly relevant, as RSV and metapneumovirus currently lack effective prophylactic and therapeutic options. We also explored seasonality – for example, RSV and influenza peak together in winter, while metapneumovirus tends to emerge in spring.
About Jon Salmanton-García
Dr Jon Salmanton-García holds a PhD in Health Sciences from the University of Cologne and has published numerous scientific articles while presenting his work at national and international congresses. He serves as the scientific coordinator of the EPICOVIDEHA registry, which investigates respiratory viral infections in hematological patients, and leads the Diagnostic and Treatment Capacity of Invasive Fungal Infections initiative. Additionally, he has held leadership roles in European medical associations, contributing to advances in infection management for vulnerable populations.
Interviewer: Caroline Markham
Disclosure: Jon Salmanton-García disclosures grant/research support from AstraZeneca. He is a member of the Advisory Board Pfizer. He has received honoraria/honorarium from Menarini. He is a Speaker’s Bureau participant with Gilead, Pfizer and AstraZeneca.
Cite: #ESCMIDGlobal2025: Dr Jon Salmanton-García on addressing respiratory virus risks in haematological malignancies. touchINFECTIOUS DISEASES. April xxx, 2025
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