TY - JOUR
T1 - Breakthrough COVID-19 in vaccinated patients with hematologic malignancies
T2 - results from the EPICOVIDEHA survey
AU - Pagano, Livio
AU - Salmanton-García, Jon
AU - Marchesi, Francesco
AU - Blennow, Ola
AU - Gomes da Silva, Maria
AU - Glenthøj, Andreas
AU - van Doesum, Jaap A
AU - Bilgin, Yavuz M
AU - Lopez-Garcia, Alberto
AU - Itri, Federico
AU - Nunes Rodrigues, Raquel
AU - Weinbergerová, Barbora
AU - Farina, Francesca
AU - Dragonetti, Giulia
AU - Berg Venemyr, Caroline
AU - Van Praet, Jens
AU - Jaksic, Ozren
AU - Valkovic, Toni
AU - Falces-Romero, Iker
AU - Martin-Perez, Sonia
AU - Jiménez, Moraima
AU - Davila-Valls, Julio
AU - Schonlein, Martin
AU - Ammatuna, Emanuele
AU - Meers, Stef
AU - Delia, Mario
AU - Stojanoski, Zlate
AU - Nordlander, Anna
AU - Lahmer, Tobias
AU - Pinczés, László Imre
AU - Buquicchio, Caterina
AU - Piukovics, Klára
AU - Ormazabal-Velez, Irati
AU - Fracchiolla, Nicola Stefano
AU - Samarkos, Michail
AU - Mendez, Gustavo-Adolfo
AU - Hernández-Rivas, José-Ángel
AU - Espigado, Ildefonso
AU - Cernan, Martin
AU - Petzer, Verena
AU - Lamure, Sylvain
AU - Di Blasi, Roberta
AU - Marques de Almeida, Joyce
AU - Dargenio, Michelina
AU - Biernat, Monika Maria
AU - Sciumè, Mariarita
AU - de Ramón, Cristina
AU - De Jonge, Nick Alexander
AU - Batinic, Josip
AU - Aujayeb, Avinash
AU - Marchetti, Monia
AU - Fouquet, Guillemette
AU - Fernández Escalada, Noemi
AU - Zambrotta, Giovanni Paolo Maria
AU - Sacchi, Maria Vittoria
AU - Guidetti, Anna
AU - Demirken, Fatih
AU - Prezioso, Lucia
AU - Racil, Zdenek
AU - Nucci, Marcio
AU - Mladenovic, Miloš
AU - Lievin, Raphaël
AU - Hanakova, Michaela
AU - Grafe, Stefanie K
AU - Sili, Uluhan
AU - Machado, Marina
AU - Cattaneo, Chiara
AU - Adzic-Vukicevic, Tatjana
AU - Verga, Luisa
AU - Labrador, Jorge
AU - Rahimli, Laman
AU - Bonanni, Matteo
AU - Passamonti, Francesco
AU - Pagliuca, Antonio
AU - Corradini, Paolo
AU - Hoenigl, Martin
AU - Koehler, Philipp
AU - Busca, Alessandro
AU - Cornely, Oliver A
N1 - Copyright © 2022 American Society of Hematology.
PY - 2022/12/29
Y1 - 2022/12/29
N2 - 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.
AB - 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.
KW - Adult
KW - Antibodies, Monoclonal
KW - Antibodies, Viral
KW - Antiviral Agents
KW - COVID-19 Testing
KW - COVID-19/epidemiology
KW - Hematologic Neoplasms/complications
KW - Humans
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85142183130&partnerID=8YFLogxK
U2 - 10.1182/blood.2022017257
DO - 10.1182/blood.2022017257
M3 - Journal article
C2 - 36126318
VL - 140
SP - 2773
EP - 2787
JO - Blood
JF - Blood
SN - 0006-4971
IS - 26
ER -