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. 2023 Oct 10;7(19):5691-5697.
doi: 10.1182/bloodadvances.2022008827.

Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies

Kelly S Chien  1 , Christine B Peterson  2 , Elliana Young  3 , Dai Chihara  4 , Elizabet E Manasanch  4 , Jeremy L Ramdial  5 , Philip A Thompson  1
Affiliations

Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies

Kelly S Chien et al. Blood Adv. .

Abstract

Patients with hematologic malignancies have both an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and higher morbidity/mortality. They have lower seroconversion rates after vaccination, potentially leading to inferior coronavirus disease 2019 (COVID-19) outcomes, despite vaccination. We consequently evaluated the clinical outcomes of COVID-19 infections in 243 vaccinated and 175 unvaccinated patients with hematologic malignancies. Hospitalization rates were lower in the vaccinated group when compared with the unvaccinated group (31.3% vs 52.6%). However, the rates of COVID-19-associated death were similar at 7.0% and 8.6% in vaccinated and unvaccinated patients, respectively. By univariate logistic regression, females, older patients, and individuals with higher modified Charlson Comorbidity Index scores were at a higher risk of death from COVID-19 infections. To account for the nonrandomized nature of COVID-19 vaccination status, a propensity score weighting approach was used. In the final propensity-weighted model, vaccination status was not significantly associated with the risk of death from COVID-19 infections but was associated with the risk of hospitalization. The predicted benefit of vaccination was an absolute decrease in the probability of death and hospitalization from COVID-19 infections by 2.3% and 22.9%, respectively. In conclusion, COVID-19 vaccination status in patients with hematologic malignancies was associated with a decreased risk of hospitalization but not associated with a decreased risk of death from COVID-19 infections in the pre-Omicron era. Protective strategies, in addition to immunization, are warranted in this vulnerable patient population.

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Conflict of interest statement

Conflict-of-interest disclosure: P.A.T. has received research funding from and consulted for AstraZeneca, outside the submitted work. The remaining authors declare no competing financial interests.

Figures

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Graphical abstract
Figure 1.
Figure 1.
Stacked cumulative incidence plot of COVID-19–associated deaths vs all deaths.
Figure 2.
Figure 2.
Survival from COVID-19 infections by vaccination status.
Figure 3.
Figure 3.
Standardized mean differences by IPW vs unweighted covariates. Hisp, Hispanic; IPW, inverse probability of treatment weighting; PCD, plasma cell dyscrasias; Unk, unknown.
See this image and copyright information in PMC

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