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Risk and Outcome of Breakthrough COVID-19 Infections in Vaccinated Patients With Cancer: Real-World Evidence From the National COVID Cohort Collaborative.
Song, Qianqian; Bates, Benjamin; Shao, Yu Raymond; Hsu, Fang-Chi; Liu, Feifan; Madhira, Vithal; Mitra, Amit Kumar; Bergquist, Timothy; Kavuluru, Ramakanth; Li, Xiaochun; Sharafeldin, Noha; Su, Jing; Topaloglu, Umit.
  • Song Q; Wake Forest School of Medicine, Winston-Salem, NC.
  • Bates B; Rutgers University, New Brunswick, NJ.
  • Shao YR; Duke University Medical Center, Durham, NC.
  • Hsu FC; Wake Forest School of Medicine, Winston-Salem, NC.
  • Liu F; University of Massachusetts Chan Medical School, Boston, MA.
  • Madhira V; Palila Software LLC, Reno, NV.
  • Mitra AK; Harrison School of Pharmacy, Auburn University, Auburn, AL.
  • Bergquist T; Sage Bionetworks, Seattle, WA.
  • Kavuluru R; University of Kentucky, Lexington, KT.
  • Li X; Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN.
  • Sharafeldin N; School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
  • Su J; Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN.
  • Topaloglu U; Wake Forest School of Medicine, Winston-Salem, NC.
J Clin Oncol ; 40(13): 1414-1427, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1883563
ABSTRACT

PURPOSE:

To provide real-world evidence on risks and outcomes of breakthrough COVID-19 infections in vaccinated patients with cancer using the largest national cohort of COVID-19 cases and controls.

METHODS:

We used the National COVID Cohort Collaborative (N3C) to identify breakthrough infections between December 1, 2020, and May 31, 2021. We included patients partially or fully vaccinated with mRNA COVID-19 vaccines with no prior SARS-CoV-2 infection record. Risks for breakthrough infection and severe outcomes were analyzed using logistic regression.

RESULTS:

A total of 6,860 breakthrough cases were identified within the N3C-vaccinated population, among whom 1,460 (21.3%) were patients with cancer. Solid tumors and hematologic malignancies had significantly higher risks for breakthrough infection (odds ratios [ORs] = 1.12, 95% CI, 1.01 to 1.23 and 4.64, 95% CI, 3.98 to 5.38) and severe outcomes (ORs = 1.33, 95% CI, 1.09 to 1.62 and 1.45, 95% CI, 1.08 to 1.95) compared with noncancer patients, adjusting for age, sex, race/ethnicity, smoking status, vaccine type, and vaccination date. Compared with solid tumors, hematologic malignancies were at increased risk for breakthrough infections (adjusted OR ranged from 2.07 for lymphoma to 7.25 for lymphoid leukemia). Breakthrough risk was reduced after the second vaccine dose for all cancers (OR = 0.04; 95% CI, 0.04 to 0.05), and for Moderna's mRNA-1273 compared with Pfizer's BNT162b2 vaccine (OR = 0.66; 95% CI, 0.62 to 0.70), particularly in patients with multiple myeloma (OR = 0.35; 95% CI, 0.15 to 0.72). Medications with major immunosuppressive effects and bone marrow transplantation were strongly associated with breakthrough risk among the vaccinated population.

CONCLUSION:

Real-world evidence shows that patients with cancer, especially hematologic malignancies, are at higher risk for developing breakthrough infections and severe outcomes. Patients with vaccination were at markedly decreased risk for breakthrough infections. Further work is needed to assess boosters and new SARS-CoV-2 variants.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hematologic Neoplasms / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid / Vaccines / Variants Limits: Humans Language: English Journal: J Clin Oncol Year: 2022 Document Type: Article Affiliation country: Jco.21.02419

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hematologic Neoplasms / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid / Vaccines / Variants Limits: Humans Language: English Journal: J Clin Oncol Year: 2022 Document Type: Article Affiliation country: Jco.21.02419