학술논문
Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from EPICOVIDEHA survey
Document Type
article
Author
Pagano, Livio; Salmanton-García, Jon; Marchesi, Francesco; Blennow, Ola; da Silva, Maria Gomes; Glenthøj, Andreas; van Doesum, Jaap; Bilgin, Yavuz M; López-García, Alberto; Itri, Federico; Rodrigues, Raquel Nunes; Weinbergerová, Barbora; Farina, Francesca; Dragonetti, Giulia; Venemyr, Caroline Berg; van Praet, Jens; Jaksic, Ozren; Valković, Toni; Falces-Romero, Iker; Martín-Pérez, Sonia; Jiménez, Moraima; Dávila-Valls, Julio; Schönlein, Martin; Ammatuna, Emanuele; Meers, Stef; Delia, Mario; Stojanoski, Zlate; Nordlander, Anna; Lahmer, Tobias; Pinczés, László Imre; Buquicchio, Caterina; Piukovics, Klára; Ormazabal-Vélez, Irati; Fracchiolla, Nicola; Samarkos, Michail; Méndez, Gustavo-Adolfo; Hernández-Rivas, José-Ángel; Espigado, Ildefonso; Cernan, Martin; Petzer, Verena; Lamure, Sylvain; di Blasi, Roberta; de Almedia, Joyce Marques; Dargenio, Michelina; Biernat, Monika M; Sciumè, Mariarita; de Ramón, Cristina; de Jonge, Nick; Batinić, Josip; Aujayeb, Avinash; Marchetti, Monia; Fouquet, Guillemette; Fernández, Noemí; Zambrotta, Giovanni; Sacchi, Maria Vittoria; Guidetti, Anna; Demirkan, Fatih; Prezioso, Lucia; Ráčil, Zdeněk; Nucci, Marcio; Mladenović, Miloš; Liévin, Raphaël; Hanáková, Michaela; Gräfe, Stefanie; Sili, Uluhan; Machado, Marina; Cattaneo, Chiara; Adžić-Vukičević, Tatjana; Verga, Luisa; Labrador, Jorge; Rahimli, Laman; Bonanni, Matteo; Passamonti, Francesco; Pagliuca, Antonio; Corradini, Paolo; Hoenigl, Martin; Koehler, Philipp; Busca, Alessandro; Cornely, Oliver A; Serrano, Laura; Susana, José-María Ribera-Santa; Meletiadis, Joseph; Tsirigotis, Panagiotis; Coppola, Nicola; Mikulska, Malgorzata; Erben, Nurettin; Besson, Caroline; Merelli, Maria; González-López, Tomás-José; Loureiro-Amigo, Jorge; García-Vidal, Carolina; de Kort, Elizabeth; Cuccaro, Annarosa; Zompi, Sofia; Reizine, Florian; Finizio, Olimpia; Duléry, Rémy; Calbacho, Maria; Abu-Zeinah, Ghaith; Malak, Sandra
Source
Blood. 140(26)
Subject
Language
Abstract
Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P < .001), active HM (P < .001), and severe and critical COVID-19 (P = .007 and P < .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P < .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P < .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals.