Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies

Abstract

Patients with hematologic malignancies have both an increased risk for SARS-CoV2 infections and higher morbidity/mortality. They have lower seroconversion rates post-vaccination, potentially leading to inferior COVID-19 outcomes, despite vaccination. We consequently evaluated the clinical outcomes of COVID-19 infections in 243 vaccinated and 175 unvaccinated patients with hematologic malignancies. Hospitalization rates were lower in the vaccinated group when compared to the unvaccinated group (31.3% vs 52.6%, p≤0.001). However, the rates of COVID-associated death were similar at 7.0% and 8.6% in vaccinated and unvaccinated patients, respectively (p=0.61). By univariate logistic regression, females (odds ratio (OR) 2.77, p=0.01), older patients (OR 1.03, p=0.02), and individuals with higher modified Charlson Co-morbidity Index scores (OR 1.32, p=0.003) were at a higher risk of death from COVID-19 infections. To account for the non-randomized nature of COVID-19 vaccination status, a propensity score weighting approach was utilized. In the final propensity weighted model, vaccination status was not significantly associated with the risk of death from COVID-19 infections (OR 0.70, p=0.36) but associated with the risk of hospitalizations (OR 0.38, p<0.001). The predicted benefit of vaccination was an absolute decrease in the probability of death and hospitalization from COVID-19 infections by 2.3% and 22.9%, respectively. In conclusion, COVID-19 vaccination status in patients with hematologic malignancies was associated with a decreased risk of hospitalization but not associated with a decreased risk of death from COVID-19 infections in the pre-Omicron era. Protective strategies, in addition to immunization, are warranted in this vulnerable patient population.

Initial Efficacy of the COVID-19 mRNA Vaccine Booster and Subsequent Breakthrough Omicron Variant Infection in Patients with B-Cell Non-Hodgkin’s Lymphoma: A Single-Center Cohort Study

“…Additionally, it was not possible to compare the results with those of a group of unvaccinated patients. In the pre-Omicron era, Chien KS et al showed that, compared with unvaccinated patients, vaccinated patients with hematologic malignancies were associated with a reduced risk of hospitalization due to COVID-19 infection [ 34 ]. Data on COVID-19 Omicron variant infections in patients with B-NHL are still lacking, and additional data with a larger patient pool are needed.…”

Risk factors and outcomes of COVID‐19 in adult patients with hematological malignancies: A single‐center study showing lower than expected rates of hospitalization and mortality

“…20 Notably, a recently published study comparing COVID-19-related outcomes in vaccinated versus nonvaccinated patients with HM, showed that vaccination status was not significantly associated with a decreased risk of death. 34 Concerns regarding the future emergence of more virulent or vaccineresistant strains have also been raised. 25 Hence, there is still a need to better understand the risk factors for adverse COVID-19-related outcomes in patients with HM, regardless of vaccination status and the current landscape of strains, and to optimize preventive strategies.…”

“…Studies showing limited responses of patients with HM to vaccination further underscore the vulnerability of this patient population 20 . Notably, a recently published study comparing COVID‐19‐related outcomes in vaccinated versus nonvaccinated patients with HM, showed that vaccination status was not significantly associated with a decreased risk of death 34 . Concerns regarding the future emergence of more virulent or vaccine‐resistant strains have also been raised 25 .…”

Inactivated Vaccine Dosage and Serum IgG Levels Correlate with Persistent COVID-19 Infection in Hematologic Malignancy Patients During the Omicron Surge in China

“…The accumulating body of evidence robustly advocates for the widespread immunization of oncological patients as a crucial tactic in diminishing COVID-19-related morbidity and mortality [31][32][33][34]. Before the emergence of the Omicron variant, research by Chien et al [35] found that vaccination (≥ 2 doses) in HM patients signi cantly reduced hospitalization risk compared to those who were unvaccinated. Azar JH et al [36] observed that B cell-targeting therapies mainly affect the generation of new antibodies rather than existing ones, bolstering the case for mRNA vaccination prior to cancer therapy.…”