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Journal of the American Society of Nephrology ; 32:40-41, 2021.
Article in English | EMBASE | ID: covidwho-1489299


Background: There is limited data on the safety and efficacy of SARS-CoV-2 mRNA vaccines in kidney transplant recipients (KTRs). Methods: We conducted a prospective, multi-center study of 58 adult KTRs receiving mRNA-BNT162b2 or mRNA-1273 vaccines to assess vaccine safety and efficacy. Primary outcome was biopsy-proven rejection within 3 months of vaccination. Secondary outcomes included adverse events, serum creatinine, proteinuria, donor-derived cell-free DNA (ddcfDNA) levels, and antibody and cellular immunity generation against SARSCoV-2. Results: Median age was 62 with 41% females. Median time post-transplantation was 48 months. Only one patient (2%) developed acute cellular rejection though patient had been recently converted to belatacept. There were no severe adverse events or deaths during follow-up. Two patients (3%) developed SARS-CoV-2 infection, one of whom required hospitalization. There was no significant change in serum creatinine, proteinuria or ddcfDNA during the study. Following vaccination, 36%, 25% and 20% of KTRs developed anti-spike, anti-S1 and anti-RBD antibodies. KTRs on mycophenolate-based and steroid-maintenance regimens were less likely to develop an anti-spike antibody response. 100% of KTRs with anti-spike and anti-RBD antibodies had a neutralizing response, compared to 44% in KTRs with anti-spike but without anti-RBD antibodies (RR 2.25, 95% CI 1.08-4.67). There was a significant increase in IFN-gamma spots per 106 PBMCs incubated with S1 peptides following vaccination (p=0.0143). Conclusions: SARS-CoV-2 vaccination in KTRs was safe and associated with the generation of cellular immune response and in a third of patients with anti-spike antibody response. The degree of protection gained by these responses needs to be evaluated in future studies.

Clinical Cancer Research ; 26(18 SUPPL), 2020.
Article in English | EMBASE | ID: covidwho-992048


Background: Early reports suggest a possible increased risk of serious complications and death in COVID-19patients with cancer. However, rigorous comparisons with non-cancer control patients with COVID-19 are lacking. Methods: We systematically identified all patients with a history of cancer admitted to two major academic medicalcenters in Boston with symptomatic COVID-19 infections between 03/13/2020 and 05/10/2020. 162 cases wereidentified, and matched 1:2 by age, gender, race, and admission date with systematically identified controls withouta cancer history. Sociodemographics, comorbidities, presenting symptoms, hospital course, and COVID-19outcomes were extracted from medical records for all patients. Cancer history and treatments were documented forcases. Clinical characteristics and outcomes were compared between cases and controls using conditional logisticregression. Among cancer patients, logistic regression models were fit to identify predictors of death/discharge tohospice. Results: As of 06/05/2020, among 162 cancer patients (median time since diagnosis, 35.6 [range 0.39-435]months;80% with solid tumor, 20%, hematologic diagnosis), 27.8% died or were discharged to hospice and 4.3%were still hospitalized. Among the 324 controls, 25.6% died or were discharged to hospice, and 3.1% were stillhospitalized. Median duration of hospitalization was 9 days for both cases and controls. The proportion of controlswho were intubated (36.1%) was higher than cases (27.2%). The odds of mortality/discharge to hospice (vs.discharge to home/facility) were similar between cancer cases and matched controls (univariable OR: 1.15, 95% CI:0.73-1.82;multivariable OR: 1.54, 95% CI: 0.90-2.65). In multivariable analyses, cancer patients were more likely tobe immunosuppressed (OR: 4.21, 95% CI: 2.42-7.34), to have presented at hospital admission with fatigue (OR:1.71, 95% CI: 1.05-2.78), and were less likely to have a premorbid neurologic condition (OR: 0.37, 95% CI: 0.16-0.82). Among cancer cases, patients with metastatic disease or who had received cancer-directed therapy in thelast 6 months (n=74, 46%) did not have higher odds of death/discharge to hospice following their hospital course(univariable OR: 1.37, 95% CI: 0.68-2.75;multivariable OR: 1.77, 95% CI: 0.80-3.93) compared to patients with noevidence of disease and no treatment within 6 months. Conclusions: Patients with a history of cancer hospitalized for COVID-19 had similar hospital course and mortalityto matched hospitalized COVID-19+ controls without cancer. Additionally, we did not find an association betweenhaving metastatic disease or recent cancer treatment and experiencing an adverse outcome. During the onset andsurge peak of the COVID-19 crisis in Boston, people with a history of cancer admitted to two large teachinghospitals for COVID-19 infection fared no worse than those without a history of cancer.