Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 40, Issue 13, Pages 1414-+Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1200/JCO.21.02419
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Funding
- NCATS [U24 TR002306]
- National Institute of General Medical Sciences [5U54GM104942-04]
- Indiana University Precision Health Initiative
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center Support Grant from the National Cancer Institute [P30 CA 082709]
- Cancer Center Support Grant from the National Cancer Institute [P30 CA012197]
- Bioinformatics Shared Resources under the NCI Cancer Center Support Grant [P30 CA012197]
- National Foundation for Cancer Research
- Leukemia and Lymphoma Society Career Development Award [LLS 3386-19]
- National Marrow Donor Program Be The Match Foundation
- Bill and Melinda Gates Foundation [INV-018455]
- Bill and Melinda Gates Foundation [INV-018455] Funding Source: Bill and Melinda Gates Foundation
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This study provides real-world evidence on the risks and outcomes of breakthrough COVID-19 infections in vaccinated patients with cancer. The study found that patients with cancer, especially those with hematologic malignancies, are at higher risk for developing breakthrough infections and severe outcomes. Vaccination significantly reduces the risk of breakthrough infections in all cancer patients, and Moderna's mRNA-1273 vaccine shows a greater reduction in breakthrough infection risk for patients with multiple myeloma compared to Pfizer's BNT162b2 vaccine.
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 m R NA-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. (C) 2022 by American Society of Clinical Oncology
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