Breakthrough COVID-19 in vaccinated patients with hematologic malignancies

TY - JOUR

T1 - Breakthrough COVID-19 in vaccinated patients with hematologic malignancies

T2 - results from EPICOVIDEHA survey

AU - Pagano, Livio

AU - Salmanton-García, Jon

AU - Marchesi, Francesco

AU - Blennow, Ola

AU - Gomes da Silva, Maria

AU - Glenthøj, Andreas

AU - van Doesum, Jaap A

AU - Bilgin, Yavuz M

AU - Lopez-Garcia, Alberto

AU - Itri, Federico

AU - Nunes Rodrigues, Raquel

AU - Weinbergerová, Barbora

AU - Farina, Francesca

AU - Dragonetti, Giulia

AU - Berg Venemyr, Caroline

AU - Van Praet, Jens

AU - Jaksic, Ozren

AU - Valkovic, Toni

AU - Falces-Romero, Iker

AU - Martin-Perez, Sonia

AU - Jiménez, Moraima

AU - Davila-Valls, Julio

AU - Schonlein, Martin

AU - Ammatuna, Emanuele

AU - Meers, Stef

AU - Delia, Mario

AU - Stojanoski, Zlate

AU - Nordlander, Anna

AU - Lahmer, Tobias

AU - Pinczés, László Imre

AU - Buquicchio, Caterina

AU - Piukovics, Klára

AU - Ormazabal-Velez, Irati

AU - Fracchiolla, Nicola Stefano

AU - Samarkos, Michail

AU - Mendez, Gustavo-Adolfo

AU - Hernández-Rivas, José-Ángel

AU - Espigado, Ildefonso

AU - Cernan, Martin

AU - Petzer, Verena

AU - Lamure, Sylvain

AU - Di Blasi, Roberta

AU - Marques de Almeida, Joyce

AU - Dargenio, Michelina

AU - Biernat, Monika Maria

AU - Sciumè, Mariarita

AU - de Ramón, Cristina

AU - De Jonge, Nick Alexander

AU - Batinic, Josip

AU - Aujayeb, Avinash

AU - Marchetti, Monia

AU - Fouquet, Guillemette

AU - Fernández Escalada, Noemi

AU - Zambrotta, Giovanni Paolo Maria

AU - Sacchi, Maria Vittoria

AU - Guidetti, Anna

AU - Demirken, Fatih

AU - Prezioso, Lucia

AU - Racil, Zdenek

AU - Nucci, Marcio

AU - Mladenovic, Miloš

AU - Lievin, Raphaël

AU - Hanakova, Michaela

AU - Grafe, Stefanie K

AU - Sili, Uluhan

AU - Machado, Marina

AU - Cattaneo, Chiara

AU - Adzic-Vukicevic, Tatjana

AU - Verga, Luisa

AU - Labrador, Jorge

AU - Rahimli, Laman

AU - Bonanni, Matteo

AU - Passamonti, Francesco

AU - Pagliuca, Antonio

AU - Corradini, Paolo

AU - Hoenigl, Martin

AU - Koehler, Philipp

AU - Busca, Alessandro

AU - Cornely, Oliver A

AU - EPICOVIDEHA Survey members

N1 - Copyright © 2022 American Society of Hematology.

PY - 2022/12/29

Y1 - 2022/12/29

N2 - Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P < .001), active HM (P < .001), and severe and critical COVID-19 (P = .007 and P < .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P < .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P < .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals.

AB - Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P < .001), active HM (P < .001), and severe and critical COVID-19 (P = .007 and P < .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P < .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P < .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals.

U2 - 10.1182/blood.2022017257

DO - 10.1182/blood.2022017257

M3 - SCORING: Journal article

C2 - 36126318

VL - 140

SP - 2773

EP - 2787

JO - BLOOD

JF - BLOOD

SN - 0006-4971

IS - 26

ER -