Limited data have been published on the epidemiology and outcomes of breakthrough COVID-19 in patients with hematological malignancy (HM) after anti-SARS-CoV-2 vaccination. Adult HM who received at least one dose of anti-SARS-CoV-2 vaccine and diagnosed with breakthrough COVID-19 between January 2021 and March 2022 and registered in EPICOVIDEHA were included in this analysis. A total of 1548 cases were included, mainly with lymphoid malignancies (1181 cases, 76%). After viral genome sequencing in 753 cases (49%), Omicron variant was prevalent (517, 68.7%). Most of the patients received at least two vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received specific treatment for COVID-19. After 30-days follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with Omicron variant was of 7.9%, comparable to that reported for the other variants. The 30-day mortality rate was significantly lower than in the pre-vaccine era (31%). In the univariable analysis, older age (p<0.001), active HM (p<0.001), severe and critical COVID-19 (p=0.007 and p<0.001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (p<0.001). In the multivariable model, older age, active disease, critical COVID-19 and at least 2-3 comorbidities were correlated with a higher mortality, whereas the administration of monoclonal antibodies, alone (p<0.001) or combined with antivirals (p=0.009), was observed protective. While mortality is significantly lower than in the pre-vaccination 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. EPICOVIDEHA (www.clinicaltrials.gov; National Clinical Trials identifier NCT04733729) is an international open web-based registry for patients with HMs infected with SARS-CoV-2.
Breakthrough COVID-19 in vaccinated patients with hematologic malignancies : results from EPICOVIDEHA survey / L. Pagano, J. Salmanton-García, F. Marchesi, O. Blennow, M. Gomes da Silva, A. Glenthøj, J.A. van Doesum, Y.M. Bilgin, A. Lopez-Garcia, F. Itri, R. Nunes Rodrigues, B. Weinbergerová, F. Farina, G. Dragonetti, C. Berg Venemyr, J. Van Praet, O. Jaksic, T. Valkovic, I. Falces-Romero, S. Martin-Perez, M. Jiménez, J. Davila-Valls, M. Schonlein, E. Ammatuna, S. Meers, M. Delia, Z. Stojanoski, A. Nordlander, T. Lahmer, L.I. Pinczés, C. Buquicchio, K. Piukovics, I. Ormazabal-Velez, N.S. Fracchiolla, M. Samarkos, G. Mendez, J. Hernández-Rivas, I. Espigado, M. Cernan, V. Petzer, S. Lamure, R. Di Blasi, J. Marques de Almeida, M. Dargenio, M.M. Biernat, M. Sciumè, C. de Ramón, N.A. De Jonge, J. Batinic, A. Aujayeb, M. Marchetti, G. Fouquet, N. Fernández Escalada, G.P.M. Zambrotta, M.V. Sacchi, A. Guidetti, F. Demirken, L. Prezioso, Z. Racil, M. Nucci, M. Mladenovic, R. Lievin, M. Hanakova, S.K. Grafe, U. Sili, M. Machado, C. Cattaneo, T. Adzic-Vukicevic, L. Verga, J. Labrador, L. Rahimli, M. Bonanni, F. Passamonti, A. Pagliuca, P. Corradini, M. Hoenigl, P. Koehler, A. Busca, O.A. Cornely. - In: BLOOD. - ISSN 0006-4971. - (2022 Sep 20). [Epub ahead of print] [10.1182/blood.2022017257]
Breakthrough COVID-19 in vaccinated patients with hematologic malignancies : results from EPICOVIDEHA survey
A. Guidetti;F. Passamonti;P. Corradini;
2022
Abstract
Limited data have been published on the epidemiology and outcomes of breakthrough COVID-19 in patients with hematological malignancy (HM) after anti-SARS-CoV-2 vaccination. Adult HM who received at least one dose of anti-SARS-CoV-2 vaccine and diagnosed with breakthrough COVID-19 between January 2021 and March 2022 and registered in EPICOVIDEHA were included in this analysis. A total of 1548 cases were included, mainly with lymphoid malignancies (1181 cases, 76%). After viral genome sequencing in 753 cases (49%), Omicron variant was prevalent (517, 68.7%). Most of the patients received at least two vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received specific treatment for COVID-19. After 30-days follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with Omicron variant was of 7.9%, comparable to that reported for the other variants. The 30-day mortality rate was significantly lower than in the pre-vaccine era (31%). In the univariable analysis, older age (p<0.001), active HM (p<0.001), severe and critical COVID-19 (p=0.007 and p<0.001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (p<0.001). In the multivariable model, older age, active disease, critical COVID-19 and at least 2-3 comorbidities were correlated with a higher mortality, whereas the administration of monoclonal antibodies, alone (p<0.001) or combined with antivirals (p=0.009), was observed protective. While mortality is significantly lower than in the pre-vaccination 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. EPICOVIDEHA (www.clinicaltrials.gov; National Clinical Trials identifier NCT04733729) is an international open web-based registry for patients with HMs infected with SARS-CoV-2.
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