COVID‐19 in vaccinated versus unvaccinated hematologic malignancy patients

Abstract

The effect of vaccination on severity of subsequent COVID‐19 in patients with hematologic malignancies (HM) is unknown. In this single‐center retrospective cohort study, we found no difference in severity of COVID‐19 disease in vaccinated (n = 16) versus unvaccinated (n = 54) HM patients using an adjusted multiple logistic regression model. Recent anti‐B‐cell therapy was associated with more severe illness. This article is protected by copyright. All rights reserved

COVID‐19 vaccine effectiveness in patients with hematologic malignancy

“…Although clearly important in determining outcomes, antiviral therapies have neither been mentioned nor accounted for in majority of studies examining outcomes following breakthrough infections, which further makes inference difficult from these reports. [5][6][7] In conclusion, patients with HM have a lower response to COVID-19 vaccine, higher rates of breakthrough infections, and subsequently worse outcomes than patients with solid malignancy. Compared to noncancer patients, the vaccine effectiveness against symptomatic infections seems lower in patients with HM visiting academic centers (cumulative infection risk: 4.9% vs. 14.9%) 7 ; however, epidemiological studies are still needed to understand the effectiveness of mRNA vaccination, especially boosters, against COVID-19 severity in this group.…”

“…DeVoe et al should be commended for including whole-genome sequencing information, albeit for only 16% of the cohort. 5 Also, hospital-or registry-based reports have generally not been able to account for other environmental factors or social determinants of health between vaccinated and unvaccinated groups, all of which could have a direct impact on their COVID-19 exposure, immune response, access to healthcare, clinical trials, and latest anti-COVID therapies, and thus subsequent outcomes. Finally, a persistent theme across studies has been the impact of immunosuppressive agents, that is, anti-B cell therapies, such as anti-CD20 mAb rituximab, on decreasing the vaccine response and increasing COVID-19 severity in HM.…”

“…In a small, single-center retrospective cohort study of 70 HM patients with COVID-19, DeVoe et al report no statistical difference in outcomes (hospitalization or COVID-19 severity based on the world health organization (WHO) scale) between vaccinated (15 fully vaccinated, one partially vaccinated) and unvaccinated groups (n = 54). 5 Similar findings of comparable outcomes were reported by another registry-based study comparing breakthrough infections in 131 patients with any cancer (specifically, 19 fully vaccinated and 18 partially vaccinated HM patients) with infections in unvaccinated controls. 6 Both studies primarily included data before or during the Delta variant dominance and had considered receipt of two doses as "full" vaccination.…”

“…reported 14.5% of patients had received convalescent plasma, 5 however, did not provide distribution between the vaccinated and unvaccinated groups. Although clearly important in determining outcomes, antiviral therapies have neither been mentioned nor accounted for in majority of studies examining outcomes following breakthrough infections, which further makes inference difficult from these reports 5–7 …”

Prevention and treatment of COVID-19 in patients with benign and malignant blood disorders

“…As a group, those patients are consistently shown to have a high risk of a severe and complicated COVID-19 course with high rates of hospitalization, respiratory failure and death; the risk is particularly elevated in those with B-cell lymphoid malignancies who received lymphocytotoxic therapies. In addition, the humoral vaccine response in this high risk group is blunted and they are less likely to seroconvert after vaccination, although a relatively robust cellular immunity response to vaccine appears to be preserved; however, the data on cellular immunity is still too scarce to allow generalization [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. A systematic review that identified 57 studies reporting on 7393 patients reported heterogenous vaccine-induced seroconversion rates and cellular immunity in HM patients, but the response was in general lower than reported in healthy participants in the same studies, with the lowest immunity rates reported in CLL, and the highest in myeloproliferative disorders [ 6 ].…”