Those with blood cancers ‘can’t rely on vaccination’ for protection from severe COVID-19
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Key takeaways:
- Age, treatment with antineoplastic or immune-suppressive drugs, and comorbidities conferred higher odds of severe COVID-19.
- Booster vaccination linked to lower odds of severe disease.
Regardless of vaccination status, individuals with hematologic malignancies had increased odds of developing severe COVID-19 until oral antivirals became widely available in mid-2022, according to data published in JAMA Network Open.
Researchers reported that increasing age, disease requiring treatment, and comorbidities all conferred higher odds of for developing severe disease, while booster vaccination status appeared associated with lower odds.
“Patients with hematologic cancers are at high enough risk for severe COVD-19 that they can’t rely on vaccination to protect them completely,” Paul A. Monach, MD, PhD, chief of the rheumatology section at Veterans Affairs Boston Healthcare System and an associate professor at Harvard Medical School, told Healio. “These patients should plan ahead to get antiviral treatment, which means knowing that they should test soon after symptom onset, call their doctor or provider promptly if the test is positive and, ideally, plan with the provider in advance for what adjustments they would need to make with other medications if the antiviral drug they will get is Paxlovid [nirmatrelvir/ritonavir; Pfizer].”
Researchers conducted a case-control study to quantify potential associations of clinical and demographic variables with odds of severe COVID-19 among vaccinated patients with hematologic cancers.
The study cohort (n = 6,122; 95.5% men) included those with hematologic malignant neoplasms in the national Veterans Health Administration who had documented SARS-CoV-2 infection following vaccination. Researchers compared groups with severe and nonsevere infection among cases collected between Jan. 1, 2021, and Sept. 30, 2022.
Severe COVID-19 compared with nonsevere SARS-CoV-2 infection served as the study’s main outcome measurement; researchers defined severe COVID-19 as death within 28 days, mechanical ventilation or hospitalization with use of dexamethasone or evidence of hypoxemia or use of supplemental oxygen.
Among the patients included in the study, 1,301 (21.3%) had severe COVID-19.
Results showed higher odds of severe disease associated with increasing age (adjusted OR per 1-year increase = 1.05; 95% CI, 1.04-1.06), treatment with antineoplastic or immune-suppressive drugs (adjusted OR = 2.32; 95% CI, 1.93-2.8) and comorbidities (adjusted OR per comorbidity = 1.35; 95% CI, 1.29-1.43), whereas researchers reported lower odds among those who received booster vaccination (adjusted OR = 0.73; 95% CI, 0.62-0.86).
Once oral antiviral drugs became more widely used starting in March 2022, 20 of 538 patients (3.7%) with SARS-CoV-2 progressed to severe COVID-19.
The results, Monach said, highlight that patients receiving antineoplastic or immune-suppressive treatment for hematologic malignant neoplasms are at high risk for severe COVID-19 if they are infected with SARS-CoV-2 after being vaccinated.
“Knowing the true magnitude of benefit of the different antiviral drugs, repeated booster shots and previous infection with SARS-CoV-2 would be helpful and would require a different study design, [called] ‘target trial emulation’ since doing a clinical trial at this point would be unethical,” Monach told Healio. “We were hoping to discover which hematologic cancers and which drugs used to treat them brought the greatest risk, but the diversity was so high that even studying over 6,000 patients didn’t allow us to figure that out.”
For more information:
Paul A. Monach, MD, PhD, can be reached at paul.monarch@va.gov.
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