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Pagano, L; Salmanton-García, J; Marchesi, F; Blennow, O; Gomes, da, Silva, M; Glenthøj, A; van, Doesum, J; Bilgin, YM; López-García, A; Itri, F; Nunes, Rodrigues, R; Weinbergerová, B; Farina, F; Dragonetti, G; Berg, Venemyr, C; van, Praet, J; Jaksic, O; Valković, T; Falces-Romero, I; Martín-Pérez, S; Jiménez, M; Dávila-Valls, J; Schönlein, M; Ammatuna, E; Meers, S; Delia, M; Stojanoski, Z; Nordlander, A; Lahmer, T; Imre, Pinczés, L; Buquicchio, C; Piukovics, K; Ormazabal-Vélez, I; Fracchiolla, N; Samarkos, M; Méndez, GA; Hernández-Rivas, JÁ; Espigado, I; Cernan, M; Petzer, V; Lamure, S; di, Blasi, R; Marques, de, Almedia, J; Dargenio, M; Biernat, MM; Sciumè, M; de, Ramón, C; de, Jonge, N; Batinić, J; Aujayeb, A; Marchetti, M; Fouquet, G; Fernández, N; Zambrotta, G; Sacchi, MV; Guidetti, A; Demirkan, F; Prezioso, L; Ráčil, Z; Nucci, M; Mladenović, M; Liévin, R; Hanáková, M; Gräfe, S; Sili, U; Machado, M; Cattaneo, C; Adžić-Vukičević, T; Verga, L; Labrador, J; Rahimli, L; Bonanni, M; Passamonti, F; Pagliuca, A; Corradini, P; Hoenigl, M; Koehler, P; Busca, A; Cornely, OA.
Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey.
Blood. 2022; 140(26):2773-2787 Doi: 10.1182/blood.2022017257 [OPEN ACCESS]
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Hönigl Martin

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Abstract:

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.

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Adult - administration & dosage

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COVID-19 - epidemiology, prevention & control

SARS-CoV-2 - administration & dosage

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Hematologic Neoplasms - complications, therapy

Antibodies, Monoclonal - administration & dosage

Antiviral Agents - administration & dosage

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