Effectiveness of the BNT162b2mRNA COVID-19 vaccine in patients with hematological neoplasms in a nationwide mass vaccination setting

Abstract

Evidence regarding the effectiveness of covid-19 vaccine in patients with impaired immunity, is limited. Initial observations suggest a lower humoral response in these patients. We evaluated the relative effectiveness of the mRNA BNT162b2 vaccine in patients with hematological neoplasms compared to matched controls. Data on patients with hematological neoplasms after two vaccine doses were extracted and matched 1:1 with vaccinated controls. Subpopulation analyses focused on patients receiving therapy for the hematological neoplasm, patients without treatment who are only followed, and recipients of specific treatments. The analysis focused on covid-19 outcomes from day 7 through 43 following the second vaccine dose: Documented covid-19 infection by PCR; Symptomatic infection; Hospitalizations; Severe covid-19 disease and covid-19-related death. Of a population of 4.7 million insured people, 32,516 patients with hematological neoplasms were identified, of whom 5,017 were receiving therapy for an active disease. Vaccinated patients with hematological neoplasms, compared with vaccinated matched controls, had an increased risk of documented infections (RR 1.60, 95% confidence interval [CI] 1.12-2.37), symptomatic covid-19 (RR 1.72, 95% CI 1.05-2.85), covid-19 related hospitalizations (RR 3.13, 95% CI 1.68-7.08), severe covid-19 (RR 2.27, 95% CI 1.18-5.19) and covid-19 related death (RR 1.66, 95% CI 0.72-4.47). Limiting the analysis to patients on hematological treatments showed a higher increased risk. This analysis shows that vaccinated patients with hematological neoplasms, in particular patients on treatment, suffer from covid-19 outcomes more than vaccinated individuals with intact immune system. Ways to enhance covid-19 immunity in this patient population, such as additional doses, should be explored.

CD20-Targeted Therapy Ablates De Novo Antibody Response to Vaccination but Spares Preestablished Immunity

“…Patients in need of ongoing lymphoma treatment are prime candidates for passive immunization with monoclonal anti-SARS-CoV-2 antibodies, although vaccination should still be attempted as vaccine benefits may extend beyond neutralizing antibodies. Emerging evidence suggests that vaccinated patients with hematologic malignancies have greater risk of infection, hospitalization, and death compared to vaccinated controls (23,24). While rates of poor outcomes are much lower than seen in unvaccinated patients with hematologic malignancies, signaling the benefit of vaccination, layering of additional mitigation strategies is clearly needed.…”

SARS-CoV-2 breakthrough infections in vaccinated individuals: measurement, causes and impact

“…Moreover, there is evidence that, among vaccinated individuals, those with haematological neoplasms experience substantially higher rates of SARS-CoV-2 infection and/or severe COVID-19 (ref. 74 ).…”

Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer

“…There is now accumulating evidence for vaccine effectiveness against COVID-19 in patients with cancer. (58,182,(184)(185)(186)(187)194,(197)(198)(199)(200)(201)(202)(203)(204)(205)(206)(207)(208)(209)(210)(211)(212) In most patients with cancer, mRNA vaccination leads to seroconversion after the second dose, although antibody titers achieved tend to be inferior to non-cancer controls. (185)(186)(187)198,200,(207)(208)(209)(210)212) There is also emerging evidence that COVID-19 vaccines differ in antigenicity, for example mRNA-1273 (Moderna, Inc.) can generate higher median antibody titers than BNT162b2 (Pfizer and BioNTech).…”

“…(58,182,(184)(185)(186)(187)194,(197)(198)(199)(200)(201)(202)(203)(204)(205)(206)(207)(208)(209)(210)(211)(212) In most patients with cancer, mRNA vaccination leads to seroconversion after the second dose, although antibody titers achieved tend to be inferior to non-cancer controls. (185)(186)(187)198,200,(207)(208)(209)(210)212) There is also emerging evidence that COVID-19 vaccines differ in antigenicity, for example mRNA-1273 (Moderna, Inc.) can generate higher median antibody titers than BNT162b2 (Pfizer and BioNTech). (198,204,213) However, consistent with the observation that patients with hematologic malignancies mount limited immune responses to SARS-CoV-2 infection, (214) seroconversion following COVID-19 vaccination tends to be lower in this group.…”

“…(236)(237)(238) Vaccinated patients with hematological malignancies, in particular those on treatment, have a higher risk of severe COVID-19 outcomes than comparable vaccinated healthy people. (208) This has prompted the CDC to recommend an additional dose of an mRNA COVID-19 vaccine in moderately to severely immunocompromised people (https://www.cdc.gov/media/releases/2021/s0813-additional-mRNA-mrna-dose.html), and this may be especially important for patients with hematologic malignancies. (202,239) A phase 1 study in patients with solid tumors on active chemotherapy, examined the role of a third immunization.…”