Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P < .001), active HM (P < .001), and severe and critical COVID-19 (P = .007 and P < .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P < .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P < .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals.

Admiraal de Ruyter Hospital Goes the Netherlands

Algemeen Ziekenhuis Klina VZW Brasschaat Belgium

Amsterdam UMC location VUmc Amsterdam the Netherlands

Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Azienda Ospedaliera San Gerardo Monza Monza Italy

Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari Bari Italy

CHU Montpellier Montpellier France

Clinical and Translational Fungal Working Group University of California San Diego La Jolla CA

Clinical Hospital Center Rijeka Rijeka Croatia

Clinical Microbiology and Infectious Diseases Department Hospital General Universitario Gregorio Marañón Madrid Spain

Cochin Hospital Assistance Publique Hôpitaux de Paris Paris France

Complejo Hospitalario de Navarra Iruña Pamplona Spain

COVID hospital Batajnica Belgrade Serbia

Croatian Cooperative Group for Hematological Diseases Croatia

Departament de Medicina Universitat Autònoma de Barcelona Bellaterra Spain

Department 1 of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology University of Cologne Cologne Germany

Department of Haematology Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University Wroclaw Poland

Department of Hematological Medicine King's College Hospital NHS Foundation Trust Kings College London and Anthony Nolan London United Kingdom

Department of Hematology and Oncology Medical University of Innsbruck Innsbruck Austria

Department of Hematology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Hematology Hospital Universitario de Burgos Burgos Spain

Department of Hematology University Hospital Virgen Macarena University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla Seville Spain

Department of Hematology Vall d'Hebron Hospital Universitari Experimental Hematology Vall d'Hebron Institute of Oncology Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Federal University of Rio de Janeiro Rio de Janeiro Brazil

Department of Internal Medicine Hematology and Oncology University Hospital Brno Brno Czech Republic

Department of Internal Medicine South Division Faculty of Medicine University of Szeged Szeged Hungary

Department of Medicine and Surgery University of Insubria and ASST Sette Laghi Ospedale di Circolo of Varese Varese Italy

Department of Nephrology and Infectious diseases AZ Sint Jan Brugge Oostende AV Brugge Belgium

Department of Oncology Hematology and Bone Marrow Transplantation with Section of Pneumology University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Physiology Faculty of Medicine Masaryk University Brno Czech Republic

Division of Hematology Department of Internal Medicine University of Debrecen Debrecen Hungary

Division of Infectious Diseases and Global Public Health Department of Medicine University of California San Diego San Diego CA

Division of Infectious Diseases Department of Internal Medicine Medical University of Graz Graz Austria

Dokuz Eylul University Division of Hematology Izmir Turkey

Ematologia con Trapianto Ospedale Dimiccoli Barletta Barletta Italy

Faculty of Medicine and University Hospital Cologne Center for Molecular Medicine Cologne University of Cologne Cologne Germany

Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany

Faculty of Medicine and University Hospital Cologne Clinical Trials Centre Cologne University of Cologne Cologne Germany

Faculty of Medicine and University Hospital Cologne Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany

Faculty of Medicine University of Zagreb Zagreb Croatia

Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy

Fundación Jimenez Diaz University Hospital Health Research Institute IIS FJD Madrid Spain

German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Rome Italy

Hematology Department Hospital Universitario de Salamanca Salamanca Spain

Hematology Unit ASST Spedali Civili Brescia Italy

Hematology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Hematology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

Hematology Unit Università Cattolica del Sacro Cuore Rome Italy

Hopital Saint Louis Paris France

Hospital Escuela de Agudos Dr Ramón Madariaga Posadas Argentina

Hospital Nuestra Señora de Sonsoles Ávila Spain

Hospital Universitario Infanta Leonor Madrid Spain

Hospital Universitario Marqués de Valdecilla Santander Spain

Hospital University of Parma Hematology and Bone Marrow Unit Parma Italy

Institute of Hematology and Blood Transfusion Prague Czech Republic

Instituto de Investigación Biomédica de Salamanca Centro de Investigación del Cáncer IBMCC Salamanca Spain

IRCCS Ospedale San Raffaele Milan Italy

Istituto Oncologico della Svizzera Italiana Bellinzona Switzerland

La Paz University Hospital Madrid Spain

Laikon Hospital Athens Greece

Marmara University Istanbul Turkey

Medizinische Klinik 2 Klinikum rechts der Isar TU München Munich Germany

Northumbria Healthcare Newcastle United Kingdom

Ospedale Vito Fazzi Lecce Italy

Portuguese Institute of Oncology Lisbon Portugal

San Luigi Gonzaga Hospital Orbassano Orbassano Italy

Stem Cell Transplant Center AOU Citta' della Salute e della Scienza Turin Italy

Università Milano Bicocca Milan Italy

Universitätsklinikum Hamburg Eppendorf Hamburg Germany

University Clinic of Hematology Skopje North Macedonia

University Hospital Centre Zagreb Zagreb Croatia

University Hospital Dubrava Zagreb Croatia

University Hospital Olomouc Olomouc Czech Republic

University Medical Center Groningen Groningen the Netherlands

University of Milan and Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy

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Blood. 2022 Dec 29;140(26):2763-2765. doi: 10.1182/blood.2022018396. PubMed

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