UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date

2022-03-14

Document Type

Article

Disciplines

Clinical Epidemiology | Immunology and Infectious Disease | Infectious Disease | Neoplasms | Oncology | Translational Medical Research | Virus Diseases

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.

Keywords

cancer, hematologic malignancies, COVID-19, breakthrough infections, UMCCTS funding

Rights and Permissions

Copyright © 2022 by American Society of Clinical Oncology. Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/

DOI of Published Version

10.1200/JCO.21.02419

Source

Song Q, Bates B, Shao YR, Hsu FC, Liu F, Madhira V, Mitra AK, Bergquist T, Kavuluru R, Li X, Sharafeldin N, Su J, Topaloglu U. Risk and Outcome of Breakthrough COVID-19 Infections in Vaccinated Patients With Cancer: Real-World Evidence From the National COVID Cohort Collaborative. J Clin Oncol. 2022 May 1;40(13):1414-1427. doi: 10.1200/JCO.21.02419. Epub 2022 Mar 14. PMID: 35286152; PMCID: PMC9061155. Link to article on publisher's site

Journal/Book/Conference Title

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Related Resources

Link to Article in PubMed

PubMed ID

35286152

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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