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Clinical Trial
. 2022 Nov;127(10):1787-1792.
doi: 10.1038/s41416-022-01952-x. Epub 2022 Aug 22.

Natural immunity to SARS-CoV-2 and breakthrough infections in vaccinated and unvaccinated patients with cancer

Alessio Cortellini  1   2 , Juan Aguilar-Company  3   4 , Ramon Salazar  5 , Mark Bower  6 , Ailsa Sita-Lumsden  7 , Andrea Plaja  8 , Alvin J X Lee  9 , Alexia Bertuzzi  10 , Carlo Tondini  11 , Nikolaos Diamantis  12 , Clara Martinez-Vila  13 , Aleix Prat  14 , Eleanor Apthorp  15 , Alessandra Gennari  16 , David J Pinato  17   16
Affiliations
Clinical Trial

Natural immunity to SARS-CoV-2 and breakthrough infections in vaccinated and unvaccinated patients with cancer

Alessio Cortellini et al. Br J Cancer. 2022 Nov.

Abstract

Background: Consolidated evidence suggests spontaneous immunity from SARS-CoV-2 is not durable, leading to the risk of reinfection, especially in the context of newly emerging viral strains. In patients with cancer who survive COVID-19 prevalence and severity of SARS-CoV-2 reinfections are unknown.

Methods: We aimed to document natural history and outcome from SARS-CoV-2 reinfection in patients recruited to OnCovid (NCT04393974), an active European registry enrolling consecutive patients with a history of solid or haematologic malignancy diagnosed with COVID-19.

Results: As of December 2021, out of 3108 eligible participants, 1806 COVID-19 survivors were subsequently followed at participating institutions. Among them, 34 reinfections (1.9%) were reported after a median time of 152 days (range: 40-620) from the first COVID-19 diagnosis, and with a median observation period from the second infection of 115 days (95% CI: 27-196). Most of the first infections were diagnosed in 2020 (27, 79.4%), while most of reinfections in 2021 (25, 73.5%). Haematological malignancies were the most frequent primary tumour (12, 35%). Compared to first infections, second infections had lower prevalence of COVID-19 symptoms (52.9% vs 91.2%, P = 0.0008) and required less COVID-19-specific therapy (11.8% vs 50%, P = 0.0013). Overall, 11 patients (32.4%) and 3 (8.8%) were fully and partially vaccinated against SARS-CoV-2 before the second infection, respectively. The 14-day case fatality rate was 11.8%, with four death events, none of which among fully vaccinated patients.

Conclusion: This study shows that reinfections in COVID-19 survivors with cancer are possible and more common in patients with haematological malignancies. Reinfections carry a 11% risk of mortality, which rises to 15% among unvaccinated patients, highlighting the importance of universal vaccination of patients with cancer.

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Conflict of interest statement

AC received consulting fees from MSD, BMS, AstraZeneca, Roche; speakers’ fee from AstraZeneca, MSD, Novartis and Eisai. AG has declared consulting/advisory role for Roche, MSD, Eli Lilly, Pierre Fabre, EISAI and Daichii Sankyo; speakers bureau for Eisai, Novartis, Eli Lilly, Roche, Teva, Gentili, Pfizer, AstraZeneca, Celgene and Daichii Sankyo; research funds: EISAI, Eli Lilly, and Roche. DJP received lecture fees from ViiV Healthcare, Bayer Healthcare, BMS, Roche, EISAI, Falk Foundation, travel expenses from BMS and Bayer Healthcare; consulting fees for Mina Therapeutics, EISAI, Roche, DaVolterra and AstraZeneca; research funding (to institution) from MSD and BMS. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study flowchart.
IQR interquartile range.
Fig. 2
Fig. 2. Histogram plot reporting COVID-19 symptoms and surrogates of COVID-19 severity for first and second infections.
Visual summary of COVID-19 symptoms (a) and proxies of COVID-19 severity (b) prevalence across infections. The prevalence of each specific symptom is computed using the number of symptomatic patients as the denominator.
Fig. 3
Fig. 3. COVID-19 mortality according to vaccination status.
Visual summary of the 14-day case fatality rates among patients experiencing SARS-CoV-2 reinfection.
See this image and copyright information in PMC

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