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. 2022 Dec 29;140(26):2773-2787.
doi: 10.1182/blood.2022017257.

Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

Livio Pagano  1   2 , Jon Salmanton-García  3   4 , Francesco Marchesi  5 , Ola Blennow  6 , Maria Gomes da Silva  7 , Andreas Glenthøj  8 , Jaap van Doesum  9 , Yavuz M Bilgin  10 , Alberto López-García  11 , Federico Itri  12 , Raquel Nunes Rodrigues  7 , Barbora Weinbergerová  13 , Francesca Farina  14 , Giulia Dragonetti  1 , Caroline Berg Venemyr  8 , Jens van Praet  15 , Ozren Jaksic  16 , Toni Valković  17 , Iker Falces-Romero  18 , Sonia Martín-Pérez  19 , Moraima Jiménez  20   21 , Julio Dávila-Valls  19 , Martin Schönlein  22 , Emanuele Ammatuna  21 , Stef Meers  23 , Mario Delia  24 , Zlate Stojanoski  25 , Anna Nordlander  6 , Tobias Lahmer  26 , László Imre Pinczés  27 , Caterina Buquicchio  28 , Klára Piukovics  29 , Irati Ormazabal-Vélez  30 , Nicola Fracchiolla  31 , Michail Samarkos  32 , Gustavo-Adolfo Méndez  33 , José-Ángel Hernández-Rivas  34 , Ildefonso Espigado  35 , Martin Cernan  36 , Verena Petzer  37 , Sylvain Lamure  38 , Roberta di Blasi  39 , Joyce Marques de Almedia  40 , Michelina Dargenio  41 , Monika M Biernat  42 , Mariarita Sciumè  31 , Cristina de Ramón  43   44 , Nick de Jonge  45 , Josip Batinić  46   47   48 , Avinash Aujayeb  49 , Monia Marchetti  50 , Guillemette Fouquet  51 , Noemí Fernández  52 , Giovanni Zambrotta  53   54 , Maria Vittoria Sacchi  50 , Anna Guidetti  55 , Fatih Demirkan  56 , Lucia Prezioso  57 , Zdeněk Ráčil  58   59 , Marcio Nucci  60 , Miloš Mladenović  61 , Raphaël Liévin  39 , Michaela Hanáková  58   59 , Stefanie Gräfe  3   4   62 , Uluhan Sili  63 , Marina Machado  64 , Chiara Cattaneo  65 , Tatjana Adžić-Vukičević  61 , Luisa Verga  53   54 , Jorge Labrador  66 , Laman Rahimli  3   4 , Matteo Bonanni  1   2 , Francesco Passamonti  67 , Antonio Pagliuca  68 , Paolo Corradini  69 , Martin Hoenigl  70   71   72 , Philipp Koehler  3   4   73 , Alessandro Busca  74 , Oliver A Cornely  3   73   75   76   77
Affiliations

Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

Livio Pagano et al. Blood. .

Erratum in

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.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

A complete list of the EPICOVIDEHA Survey collaborators appears in “Appendix.”

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Patient distribution by serological response after last COVID-19 vaccination before COVID-19 diagnosis. (A) By baseline malignancy; (B) by last treatment for HM immediately before COVID-19 diagnosis.
Figure 2.
Figure 2.
Survival probability by most prevalent underlying condition.
Figure 3.
Figure 3.
Survival probability of patients by COVID-19 treatment.
Figure 4.
Figure 4.
Survival probability by COVID-19 treatment and COVID-19 severity. (A) Patients who were asymptomatic; (B) patients with mild disease; (C) patients with severe disease; and (D) patients who were critically ill.
Figure 5.
Figure 5.
Survival probability by SARS-CoV-2 variant.
Figure 6.
Figure 6.
Patient distribution by number of SARS-CoV-2 vaccination doses administered before COVID-19 diagnosis, and COVID-19 severity.
See this image and copyright information in PMC

Comment in

References

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Supplementary concepts