Risk and outcomes of breakthrough COVID‐19 infections in vaccinated immunocompromised patients: A meta‐analysis

Deng, Guangtong; Zhou, Qian; Meng, Yu; Sun, Huiyan; Du, Songtao; Liu, Yihuang; Zeng, Furong

doi:10.1002/mco2.307

Cited by 3 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with previous literature, which has uniformly shown increased incidence of poor SARS-CoV-2 outcomes in patients with cancer, and specifically hematologic cancer . We focused on severe vs nonsevere COVID-19 among vaccinated patients with hematologic malignant neoplasms and SARS-CoV-2 infection because comparisons with unvaccinated patients or patients without cancer have been sufficiently investigated and comparison with patients without evidence of infection would have high risk of bias due to differential surveillance and missing data.…”

Section: Discussionsupporting

confidence: 88%

“…Cytotoxic chemotherapy and different classes of immune-suppressive drugs, including 2 that are often used in treatment of hematologic malignant neoplasms (glucocorticoids and lymphocyte-depleting drugs), also were associated with increased frequency of severe disease. A meta-analysis of studies focused on hematologic malignant neoplasms reported larger effect sizes (relative risk for hospitalization, 2.54; relative risk for death, 2.88), but the comparison was vs controls without malignant neoplasms …”

Section: Introductionmentioning

confidence: 99%

“…Patients with hematologic cancers are at higher risk for severe COVID-19 and death than the general population, even when following standard mRNA vaccination regimens, including booster or additional vaccine doses . Studies have demonstrated ongoing elevated risk of severe COVID-19 among patients coded as having hematologic malignant neoplasms, despite vaccination and boosting . In our previous study of more than 110 000 US veterans with SARS-CoV-2 infection after vaccination, the broad set of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes for leukemias or lymphomas was associated with increased frequency of severe COVID-19 (adjusted odds ratio [aOR], 1.58; 95% CI, 1.33-1.88).…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Studies have demonstrated ongoing elevated risk of severe COVID-19 among patients coded as having hematologic malignant neoplasms, despite vaccination and boosting. 2,[4][5][6][7][8][9][10][11][12][13] In our previous study of more than 110 000 US veterans with SARS-CoV-2 infection after vaccination, the broad set of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for leukemias or lymphomas was associated with increased frequency of severe COVID-19 (adjusted odds ratio [aOR], 1.58; 95% CI, 1.33-1.88).…”

Section: Introductionmentioning

confidence: 99%

“…A meta-analysis of studies focused on hematologic malignant neoplasms reported larger effect sizes (relative risk for hospitalization, 2.54; relative risk for death, 2.88), but the comparison was vs controls without malignant neoplasms. 6 Our previous study and most others have lumped different hematologic malignant neoplasms together 5,7 or have focused on 1 disease. The aim of this study is to quantify risk of severe COVID-19 among US veterans with SARS-CoV-2 infection following vaccination and with 1 of 8 different classes of hematologic malignant and premalignant conditions and to analyze clinical and demographic variables associated with severe disease.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration

Anand,

Vo,

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceWith SARS-CoV-2 transforming into an endemic disease and with antiviral treatments available, it is important to establish which patients remain at risk of severe COVID-19 despite vaccination.ObjectiveTo quantify the associations of clinical and demographic variables with odds of severe COVID-19 among patients with hematologic cancers.Design, Setting, and ParticipantsThis case-control study included all patients with hematologic malignant neoplasms in the national Veterans Health Administration (VHA) who had documented SARS-CoV-2 infection after vaccination. Groups of patients with severe (cases) vs nonsevere (controls) COVID-19 were compared. Data were collected between January 1, 2020, and April 5, 2023, with data on infection collected between January 1, 2021, and September 30, 2022. All patients with diagnostic codes for hematologic malignant neoplasms who had documented vaccination followed by documented SARS-CoV-2 infection and for whom disease severity could be assessed were included. Data were analyzed from July 28 to December 30, 2023.ExposuresClinical (comorbidities, predominant viral variant, treatment for malignant neoplasm, booster vaccination, and antiviral treatment) and demographic (age and sex) variables shown in prior studies to be associated with higher or lower rates of severe COVID-19. Comorbidities included Alzheimer disease or dementia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart failure, and peripheral vascular disease.Main Outcome and MeasuresThe main outcome was severe COVID-19 compared with nonsevere SARS-CoV-2 infection. Severe COVID-19 was defined as death within 28 days, mechanical ventilation, or hospitalization with use of dexamethasone or evidence of hypoxemia or use of supplemental oxygen. Multivariable logistic regression was used to estimate the associations of demographic and clinical variables with the odds of severe COVID-19, expressed as adjusted odds ratios (aORs) with 95% CIs.ResultsAmong 6122 patients (5844 [95.5%] male, mean [SD] age, 70.89 [11.57] years), 1301 (21.3%) had severe COVID-19. Age (aOR per 1-year increase, 1.05; 95% CI, 1.04-1.06), treatment with antineoplastic or immune-suppressive drugs (eg, in combination with glucocorticoids: aOR, 2.32; 95% CI, 1.93-2.80), and comorbidities (aOR per comorbidity, 1.35; 95% CI, 1.29-1.43) were associated with higher odds of severe disease, whereas booster vaccination was associated with lower odds (aOR, 0.73; 95% CI, 0.62-0.86). After oral antiviral drugs became widely used in March 2022, 20 of 538 patients (3.7%) with SARS-CoV-2 infection during this period had progression to severe COVID-19.Conclusions and RelevanceIn this case-control study of patients with hematologic cancers, odds of severe COVID-19 remained high through mid-2022 despite vaccination, especially in patients requiring treatment.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration

Anand,

Vo,

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

SARS-CoV-2 Mpro inhibitor identification using a cellular gain-of-signal assay for high-throughput screening

Delgado,

Vishwakarma,

Moghadasi

et al. 2024

SLAS Discovery

View full text Add to dashboard Cite

Predictors of Breakthrough SARS-CoV-2 Infection after Vaccination

Walmsley,

Nabipoor,

Lovblom

et al. 2023

Vaccines

View full text Add to dashboard Cite

The initial two-dose vaccine series and subsequent booster vaccine doses have been effective in modulating SARS-CoV-2 disease severity and death but do not completely prevent infection. The correlates of infection despite vaccination continue to be under investigation. In this prospective decentralized study (n = 1286) comparing antibody responses in an older- (≥70 years) to a younger-aged cohort (aged 30–50 years), we explored the correlates of breakthrough infection in 983 eligible subjects. Participants self-reported data on initial vaccine series, subsequent booster doses and COVID-19 infections in an online portal and provided self-collected dried blood spots for antibody testing by ELISA. Multivariable survival analysis explored the correlates of breakthrough infection. An association between higher antibody levels and protection from breakthrough infection observed during the Delta and Omicron BA.1/2 waves of infection no longer existed during the Omicron BA.4/5 wave. The older-aged cohort was less likely to have a breakthrough infection at all time-points. Receipt of an original/Omicron vaccine and the presence of hybrid immunity were associated with protection of infection during the later Omicron BA.4/5 and XBB waves. We were unable to determine a threshold antibody to define protection from infection or to guide vaccine booster schedules.

show abstract

Risk and outcomes of breakthrough COVID‐19 infections in vaccinated immunocompromised patients: A meta‐analysis

Cited by 3 publications

References 5 publications

Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration

Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration

SARS-CoV-2 Mpro inhibitor identification using a cellular gain-of-signal assay for high-throughput screening

Predictors of Breakthrough SARS-CoV-2 Infection after Vaccination

Contact Info

Product

Resources

About