Improved Survival of Lymphoma Patients with COVID-19 in the Modern Treatment and Vaccination Era

Abstract

Lymphoma patients are at greater risk of severe consequences from COVID-19 infection, yet most reports of COVID-19-associated outcomes were published before the advent of COVID-19 vaccinations and monoclonal antibodies (mAbs). In this retrospective study, we report the real-world outcomes of 68 lymphoma or CLL patients who developed COVID-19 infection during the omicron surge in the US. We found that 34% of patients were hospitalized as a result of COVID-19 infection. The death rate due to COVID-19 was 9% (6/68) in the overall population and 26% (6/23) in hospitalized patients. During the preintervention COVID-19 era, the mortality rate reported in cancer patients was 34%, which increased to 60.2% in hospitalized patients. Thus, the death rates in our study were much lower when compared to those in cancer patients earlier in the pandemic, and may be attributed to modern interventions. In our study, 60% (18/30) of patients with serology data available did not develop anti-COVID-19 spike protein antibodies following vaccination. Most patients (74%, 17/23) who were hospitalized due to COVID-19 infection did not receive COVID-19 mAb treatment. Our results pointed to the importance of humoral immunity and the protective effect of COVID-19 mAbs in improving outcomes in lymphoma patients.

Clinical efficacy of anti‐SARS‐CoV‐2 monoclonal antibodies in preventing hospitalisation and mortality among patients infected with Omicron variants: A systematic review and meta‐analysis

“…Eight studies with available data about hospitalisation and mortality rate 29,31,33–38 were included in the meta‐analysis of the difference in the frequency of those outcomes in SARS‐CoV‐2 Omicron‐positive patients treated with anti‐SARS‐CoV‐2 mAbs and SARS‐CoV‐2 Omicron‐positive patients treated with other therapy. The prevalence of hospitalisation among Omicron‐positive patients treated with anti‐SARS‐CoV‐2 mAbs was 2.8% (89/3169), while it was much lower when compared with controls (Omicron‐positive patients treated with other therapies) 11% (154/1371).…”

“…Eight studies with available data about hospitalisation and mortality rate 29,31,[33][34][35][36][37][38] were included in the meta-analysis of the difference in mAbs (OR = 0.38, 95% CI OR = 0.17-0.85, p = 0.020) (Figure 3). immunocompromised patients (SOTR + malignancies, inborn errors of immunity, and immunosuppressant conditions) (Supplement material: S6-S7); (3) Including studies that evaluated mAbs applied as therapy (excluding those applied as prophylaxis) (Supplement material: S8-S11).…”

“…First, the number of SARS‐CoV‐2 Omicron‐positive patients was small, especially concerning each anti‐SARS‐CoV‐2 mAbs within the same study. Second, in several studies, therapy in the control group was not reported; in two studies, the specific mAb was not even stated 33,38 . Third, we could not compare the efficacy of different anti‐SARS‐CoV‐2 mAbs nor combination therapy regarding clinical outcomes.…”

“…There was no untreated control group, so it is difficult to determine the relative efficacy. Della Pia et al., 33 in a retrospective cohort study done on lymphoma patients from the USA, did not show a statistically significant impact on the rate of hospitalisation or mortality between patients who received COVID‐19 monoclonal antibody treatment and those who did not receive COVID‐19 mAbs treatment ( p = 0.070; UVA OR 0.338 [95% CI = 0.112–1.013] p = 0.053; MVA OR 0.324 [95% CI = 0.096–1.098]). The reason for no significance probably lies in the small sample size in a study by Della Pia et al 33 .…”

“…Second, in several studies, therapy in the control group was not reported; in two studies, the specific mAb was not even stated. 33,38 Third, we could not compare the efficacy of different anti-SARS-CoV-2 mAbs nor combination therapy regarding clinical outcomes. We could not perform subgroup analyses to stratify patients according to used mAbs and rate the hospitalisation and mortality.…”