Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

• Authors: PAGANO Livio; SALMANTON-GARCIA Jon; MARCHESI Francesco; BLENNOW Ola; GOMES da Silva Maria; GLENTHOJ Andreas; JAAP van Doesum; BILGIN Yavuz M; LOPEZ-GARCIA Alberto; ITRI Federico; RODRIGUES Raquel Nunes; WEINBERGEROVA Barbora; FARINA Francesca; DRAGONETTI Giulia; VENEMYR Caroline Berg; JENS van Praet; JAKSIC Ozren; VALKOVIC Toni; FALCES-ROMERO Iker; MARTIN-PEREZ Sonia; JIMENEZ Moraima; DAVILA-VALLS Julio; SCHONLEIN Martin; AMMATUNA Emanuele; MEERS Stef; DELIA Mario; STOJANOSKI Zlate; NORDLANDER Anna; LAHMER Tobias; PINCZES Laszlo Imre; BUQUICCHIO Caterina; PIUKOVICS Klara; ORMAZABAL-VELEZ Irati; FRACCHIOLLA Nicola; SAMARKOS Michail; MENDEZ Gustavo-Adolfo; HERNANDEZ-RIVAS Jose-Angel; ESPIGADO Ildefonso; CERNAN Martin; PETZER Verena; LAMURE Sylvain; ROBERTA di Blasi; MARQUES de Almedia Joyce; DARGENIO Michelina; BIERNAT Monika M; SCIUME Mariarita; CRISTINA de Ramon; NICK de Jonge; BATINIC Josip; AUJAYEB Avinash; MARCHETTI Monia; FOUQUET Guillemette; FERNANDEZ Noemi; ZAMBROTTA Giovanni; SACCHI Maria Vittoria; GUIDETTI Anna; DEMIRKAN Fatih; PREZIOSO Lucia; RÁČIL Zdeněk; NUCCI Marcio; MLADENOVIC Milos; LIEVIN Raphael; HANAKOVA Michaela; GRAFE Stefanie; SILI Uluhan; MACHADO Marina; CATTANEO Chiara; ADZIC-VUKICEVIC Tatjana; VERGA Luisa; LABRADOR Jorge; RAHIMLI Laman; BONANNI Matteo; PASSAMONTI Francesco; PAGLIUCA Antonio; CORRADINI Paolo; HOENIGL Martin; KOEHLER Philipp; BUSCA Alessandro; CORNELY Oliver A
• Year of publication: 2022
• Type: Article in Periodical
• Magazine / Source: Blood
• MU Faculty or unit: Faculty of Medicine
• Web: https://ashpublications.org/blood/article/140/26/2773/486672/Breakthrough-COVID-19-in-vaccinated-patients-with
• Doi: http://dx.doi.org/10.1182/blood.2022017257
• Keywords: COVID-19; patients with hematologic malignancies
• Description: Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) 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 mRNAbased (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.