Patients with hematologic malignancies who develop COVID-19 after vaccination remain at risk of death, but the risk is lower than before the availability of COVID-19 vaccines and novel treatments, according to the results of a registry study published in Blood.
The study included data from 1548 patients in the EPICOVIDEHA registry (ClinicalTrials.gov Identifier: NCT04733729) who had a hematologic malignancy, a minimum of 1 dose of a COVID-19 vaccine, and a COVID-19 diagnosis between January 2021 and March 2022.
Most patients (76.3%) had lymphoid malignancies, 20.8% had stable malignancies, and 23.6% had active disease at the time of COVID-19 diagnosis. The majority of patients (91.6%) had received at least 2 doses of a COVID-19 vaccine, primarily the mRNA-based vaccines.
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Of the sequenced cases (49%), most SARS-CoV-2 infections were the omicron variant (68.7%). A COVID-19-specific therapy was administered to 59% of patients.
In all, 9.8% of patients had critical COVID-19, 32.9% had severe COVID-19, 39% had mild COVID-19, and 18.3% had asymptomatic COVID-19.
The researchers previously reported that, prior to the availability of vaccines, the rate of severe or critical COVID-19 in a cohort of patients with hematologic malignancies was 63.8% (2425/3801). In the current cohort, the rate of severe or critical COVID-19 was 42.7%, a significant difference (P <.001).
The 30-day mortality rate was 9.2% in the current cohort, compared with 31.2% in the pre-vaccine cohort (P <.001).
Among the patients who died in the current cohort, the majority of deaths were due to COVID-19 (67.8%) or COVID-19 and progressive cancer (27.2%). Few patients (4.8%) died from progressive cancer alone or other reasons.
A higher risk of mortality was significantly associated with older age (hazard ratio [HR], 1.042; 95% CI, 1.024-1.061; P <.001), active malignancy (HR, 1.981; 95% CI, 1.305-3.008; P =.001), and the presence of 2 or more comorbidities (HR, 1.503; 95% CI, 1.050-2.229; P =.027).
The use of monoclonal antibodies alone (HR, 0.155; 95% CI, 0.077-0.313; P <.001) or with antivirals (HR, 0.407; 95% CI, 0.206-0.803; P =.010) was significantly associated with a lower risk of death.
“[O]ur survey has shown that vaccination and novel COVID-19 treatments have brought significant improvements in terms of mortality in HMs [hematologic malignancies],” the researchers concluded.
Reference
Pagano L, Salmanton-García J, Marchesi F, et al. Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: Results from EPICOVIDEHA survey. Blood. Published online September 20, 2022. doi:10.1182/blood.2022017257
