Patients with blood cancer at greater risk for severe breakthrough COVID-19 infection
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Patients with blood cancer appeared at greater risk for severe and life-threatening COVID-19 illness than healthy individuals and did not always achieve optimal protection from vaccination, according to a registry-based study in Blood.
However, researchers observed a substantial reduction in mortality among these patients after COVID-19 vaccines became widely available.
“Vaccination in [patients with hematologic malignancies] is not an option but must be a moral obligation,” Livio Pagano, MD, associate professor of hematology at Catholic University of Sacred Heart in Rome and attending physician in the division of hematology at Fondazione Policlinico Universitario Agostino Gemelli, told Healio. “We compared the results of this study with a survey we carried out in the pre-vaccination period, and it shows us a clear reduction in the mortality rate.”
Pagano cited widespread vaccination of all his patients — along with better knowledge of the infection and more effective drugs available for treatment, such as monoclonal antibodies — as reasons for the reduction.
“Before vaccines, I observed a large number of patients with acute myeloid leukemia who incurred infection, and the mortality rate among these patients was over 40%. In this survey, the preliminary data tell us that the infection in these patients after vaccination is very rare and the mortality rate has decreased,” Pagano said.
Pagano and colleagues set out to describe the epidemiology, risk factors and mortality rates of patients with hematologic malignances using EPICOVIDEHA, European Hematology Association-Infectious Diseases Working Party’s (EHA-IDWP) open web-based registry of all cases of COVID-19 among adults with hematologic malignancies.
The analysis included data on 113 patients (61.1% men, 85.8% aged older than 50 years) who developed COVID-19 after complete or partial vaccination from Jan. 1 through Aug. 31. About 80% of the patients had lymphoproliferative malignancies, 77.8% had received two doses of the COVID-19 vaccination and 77% had received vaccination at least 14 days before COVID-19 infection.
Results showed 79 patients experienced severe or critical disease, including 75 (66.4%) who required hospitalization. Among the hospitalized patients, 16 (21.3%) underwent ICU admission, including 10 who required mechanical ventilation.
Researchers reported an overall mortality rate of 12.4% (n = 14) after follow-up of 30 days after COVID-19 diagnosis, and all but one of those patients died of COVID-19 as the main or secondary cause.
Multivariable analysis showed only one factor independently associated with risk for death among the vaccinated patients: age (HR = 1.05, 95% CI. 1-1.1).
Pagano said COVID-19 is no different than other infections in its increased likelihood to infect people with lymphomas, who are more likely to have suppressed immune systems. He told Healio it was notable to see a clear reduction of patients with myeloproliferative diseases who developed COVID-19 after vaccination, which could support that vaccination is especially effective among these patients.
“It will be interesting to see what will happen in our patients after the vaccination campaign has affected a large part of the general population and a third, and very likely a fourth, dose of vaccine is administered,” Pagano said. “I hope I can say that this type of survey will no longer be needed.”
For more information:
Livio Pagano, MD, can be reached at livio.pagano@unicatt.it.
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