Survival and risk of COVID-19 after SARS-COV-2 vaccination in a series of 2391 cancer patients

Abstract

Background: Patients with cancer are at high risk of severe or lethal COVID-19. The impact of SARS-COV-2 vaccination on the risk of developing COVID-19 was investigated in an exhaustive series of patients from a comprehensive cancer center.

Methods: This is a study of the exhaustive population of 2391 cancer patients who were prescribed SARS-COV-2 vaccination until 09/21. Patient characteristics, documented SARS-COV-2 infection with RT-PCR, and survival were collected. The primary endpoint was the rate of COVID-19 after vaccination. Secondary endpoints included risk factors to develop COVID-19 after vaccination, with a comparison with the cohort of vaccinated health care workers (HCW), and risk factors for death.

Results: From January to September 2021, among 2391 patients with cancer under active treatment in whom a SARS-COV-2 vaccine was prescribed, 659 (28%), 1498 (63%) and 139 (6%) received 1, 2, and 3 doses, respectively. Ninety five patients received a single dose of vaccine after a previous COVID-19. Two thousand two hundred eighty five health care workers (HCW) received one (N = 17, 0.7%), 2-3 (N = 2026, 88.7%) vaccine doses and one dose after COVID-19 (N = 242, 10.6%). With a median follow-up of 142 and 199 days for patients and HCW, respectively. Thirty nine (1.6%) patients and 35 (1.5%) HCW developed COVID-19 after vaccination. Six of 39 cancer patients and no HCW died because ofCOVID-19 within 50 days after diagnosis. Independent risk factors for COVID-19 in vaccinated patients were age, single dose of vaccine without previous COVID-19 and anti-CD20 treatment in the last three months. Independent risk factors for death included metastatic disease, gender, cancer type, but also documented COVID-19 before vaccination.

Conclusions: Patients receiving two or more doses of COVID-19 vaccine have reduced risk of COVID-19. The risk of death of vaccinated cancer patients presenting COVID-19 remains high. COVID-19 before vaccination is associated with an increased overall risk of death.

Keywords: COVID-19; Cancer patients; Health care workers; Survival; Vaccination.

Fig. 1

Cumulative incidence of RT-PCR + documented COVID-19 after SARS-COV-2 vaccine. A: Incidence of documented COVID-19 from the first vaccination dose in health care workers (green) vs cancer patients (blue) (logrank = 3.11, p = 0.07). B: Since the first dose of SARS-COV-2 vaccine according to the number of vaccine doses. In blue: patients having received one dose of SARS-COV-2 vaccine (28 events/659); in green patients having received 2 doses of SARS-COV-2 vaccine (11 events/1498); in brown patients having received 3 doses of SARS-COV-2 vaccine (0 events/139); in purple: patients having received 1 dose of SARS-COV-2 vaccine after a previously documented COVID-19 (0 events/95) (Logrank = 53.9, p < 0.0001); C: Since the last dose of dose of SARS-COV-2 vaccine (blue: 1 dose; green: 2 doses; brown: 3 doses; purple 1 dose after a documented COVID-19; logrank = 34.7, p < 0.0001). D: COVID-19 in cancer patients after the first dose of SARS-COV-2 vaccine per number of vaccine doses (landmark analysis at 21 days) (blue: 1 dose; green: 2 doses; brown: 3 doses; purple 1 dose after a documented COVID-19; logrank = 16.7, p = 0.001); E: Since the first dose of the different vaccine types: Chadox1 (blue), BNT162b2 (green) mRNA-1273 (brown); Ad26.cov2.S (green); logrank = 2.5, p = 0.47). F: Incidence of documented COVID-19 from the first vaccination dose patients receiving homologous or heterologous vaccines (31/2391 (1.6%) patients) (logrank = 0.16, p = 0.68). Curves are plotted from the date of the first SARS-COV-2 vaccination dose (A,B,D,E,F) or from the date of the last SARS-COV-2 vaccination dose (C). Median follow-up 142 days for patients, 199 days for HCW.

Fig. 2

Mortality of COVID-19 diagnosed after vaccination. A: Time (days) from the positive SARS-COV-2 RT-PCR + post vaccine to the date of death or the date of last news. B: Cumulative risk of death from the first day of vaccination in patients who developed COVID-19 (green) or did not develop (blue) a documented COVID-19 after first vaccination dose.