COVID-19 severity by vaccination status in the NCI COVID-19 and Cancer Patients Study (NCCAPS)

Abstract

We investigated the association of SARS CoV-2 vaccination with COVID-19 severity in a longitudinal study of adult cancer patients with COVID-19. A total of 1610 patients who were within 14 days of an initial positive SARS CoV-2 test and had received recent anticancer treatment or had a history of stem cell transplant or CAR-T cell therapy were enrolled between May 21, 2020, and February 1, 2022. Patients were considered fully vaccinated if they were 2 weeks past their second dose of mRNA vaccine (BNT162b2 or mRNA-1273) or a single dose of adenovirus vector vaccine (Ad26.COV2.S) at the time of positive SARS CoV-2 test. We defined severe COVID-19 disease as hospitalization for COVID-19 or death within 30 days. Vaccinated patients were significantly less likely to develop severe disease compared with those who were unvaccinated (odds ratio = 0.44, 95% confidence interval = 0.28 to 0.72, P < .001). These results support COVID-19 vaccination among cancer patients receiving active immunosuppressive treatment.

Figure 1.

National Cancer Institute COVID-19 and Cancer Patients Study monthly accrual by vaccination status and malignancy type (solid tumor vs hematologic malignancy). May 2020 to January or February 2022. January and February 2022 are combined as the last day of patient enrollment before closure of the study to new enrollments was February 1, 2022.

Figure 2.

Forest plot of odds ratios and corresponding 95% confidence intervals for severe disease by vaccination status in subgroups by time period, malignancy type, and cancer treatment type. Point estimate indicator size is proportional to the size of the subgroup, and confidence intervals that extend past the axis are truncated and denoted with an arrow at the axis limit. ^aIncludes chronic leukemias, multiple myeloma, myelodysplastic syndromes. ^bFor all therapy types except transplant, patients were included in the treatment group if they had received this type of treatment within 6 weeks before COVID-19 diagnosis. Patients may be in more than 1 treatment group if they were on multiple treatment types at the time of COVID diagnosis. ^cPatients were included in this category if they had received autologous or allogenic stem cell transplant or bone marrow transplant or CAR-T cell therapy any time before diagnosis of COVID-19. ^dIncludes endocrine therapy, local therapies (ie, intrathecal, intrahepatic, intralesional), hydroxyurea, octreotide, BCG, and radionuclide therapies.