Outcome of COVID-19 patients with haematological malignancies after the introduction of vaccination and monoclonal antibodies: results from the HM-COV 2.0 study

Abstract

Patients with haematological malignancies (HM) and SARS-CoV-2 infection present a higher risk of severe COVID-19 and mortality. The aim of the study was to investigate whether vaccination and monoclonal antibodies (mAbs) have modified the outcomes of HM patients with COVID-19. This is a single-centre retrospective study in HM patients hospitalized due to SARS-CoV-2 infection from March 2020 to April 2022. Patients were divided into PRE-V-mAb group (patients hospitalized before the introduction of vaccination and mAbs) and POST-V-mAb group (patients hospitalized after the use of vaccine and mAbs). A total of 126 patients were included (65 PRE-V-mAb and 61 POST-V-mAb). POST-V-mAb patients showed a significantly lower risk of intensive care unit (ICU) admission (8.2% vs. 27.7%, p = 0.005), shorter viral shedding [17 (IQR 10–28) vs. 24 days (IQR 15–50), p = 0.011] and shorter hospitalization length [13 (IQR 7–23) vs. 20 (IQR 14–41) days, p = 0.0003] compared to the PRE-V-mAb group. Nevertheless, both in-hospital and 30-day mortality rates did not significantly differ between the two groups (29.5% POST-V-mAb vs. 36.9% PRE-V-mAb and 21.3% POST-V-mAb vs. 29.2% PRE-V-mAb, respectively). At the multivariable analysis, an active malignancy (p = 0.042), a critical COVID-19 at admission (p = 0.025) and the need for high-level of oxygen support at respiratory worsening [either HFNC/CPAP (p = 0.022) or mechanical ventilation (p = 0.011)] were independently associated with in-hospital mortality. In the subgroup of POST-V-mAb patients, receiving therapy with mAbs was a protective factor (p = 0.033). Despite the new therapeutic and preventive strategies available, HM patients with COVID-19 disease represent an extremely vulnerable group with still high mortality rates.

Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit

“…Chronic steroid treatment was defined as the use of prednisone or its equivalent at a dosage of at least 0.5 mg/kg/day for a minimum of 30-days before admission. Immunodeficiency was defined as the presence of primitive or secondary immunodeficiency conditions (e.g., AIDS, active chemotherapy) [ 24 ].…”

Vaccinations in hematological patients in the era of target therapies: Lesson learnt from SARS-CoV-2

“…Hematological patients had an estimated COVID-19 related mortality of up to 35% during the initial pandemics waves [ 1 , 2 ], with different risk depending on disease status (2 fold risk in those with progressive disease), patients' characteristics (nearly 2 fold risk in those aged >60 years) and ongoing therapies (mortality rate ranging from 12% to 56% with different chemotherapy, targeted agents, or combination) [ 2 ]. In this setting, prioritized massive SARS-CoV2 vaccination contributed to decrease COVID-related morbidity and mortality to around 10-15% in more recent international reports [ [3] , [4] , [5] , [6] , [7] ], also varying with SARS-CoV-2 variants [ 7 ] and number of vaccine doses [ 6 ]. However, the efficacy and safety of SARS-CoV-2 vaccines in hematological patients might be different as compared to the general population, and little information was available about other vaccines such as those against capsulated bacteria, Influenza and hepatitis viruses, etc.…”