Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration.

Publication date: Feb 05, 2024

With SARS-CoV-2 transforming into an endemic disease and with antiviral treatments available, it is important to establish which patients remain at risk of severe COVID-19 despite vaccination. To quantify the associations of clinical and demographic variables with odds of severe COVID-19 among patients with hematologic cancers. This case-control study included all patients with hematologic malignant neoplasms in the national Veterans Health Administration (VHA) who had documented SARS-CoV-2 infection after vaccination. Groups of patients with severe (cases) vs nonsevere (controls) COVID-19 were compared. Data were collected between January 1, 2020, and April 5, 2023, with data on infection collected between January 1, 2021, and September 30, 2022. All patients with diagnostic codes for hematologic malignant neoplasms who had documented vaccination followed by documented SARS-CoV-2 infection and for whom disease severity could be assessed were included. Data were analyzed from July 28 to December 30, 2023. Clinical (comorbidities, predominant viral variant, treatment for malignant neoplasm, booster vaccination, and antiviral treatment) and demographic (age and sex) variables shown in prior studies to be associated with higher or lower rates of severe COVID-19. Comorbidities included Alzheimer disease or dementia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart failure, and peripheral vascular disease. The main outcome was severe COVID-19 compared with nonsevere SARS-CoV-2 infection. Severe COVID-19 was defined as death within 28 days, mechanical ventilation, or hospitalization with use of dexamethasone or evidence of hypoxemia or use of supplemental oxygen. Multivariable logistic regression was used to estimate the associations of demographic and clinical variables with the odds of severe COVID-19, expressed as adjusted odds ratios (aORs) with 95% CIs. Among 6122 patients (5844 [95. 5%] male, mean [SD] age, 70. 89 [11. 57] years), 1301 (21. 3%) had severe COVID-19. Age (aOR per 1-year increase, 1. 05; 95% CI, 1. 04-1. 06), treatment with antineoplastic or immune-suppressive drugs (eg, in combination with glucocorticoids: aOR, 2. 32; 95% CI, 1. 93-2. 80), and comorbidities (aOR per comorbidity, 1. 35; 95% CI, 1. 29-1. 43) were associated with higher odds of severe disease, whereas booster vaccination was associated with lower odds (aOR, 0. 73; 95% CI, 0. 62-0. 86). After oral antiviral drugs became widely used in March 2022, 20 of 538 patients (3. 7%) with SARS-CoV-2 infection during this period had progression to severe COVID-19. In this case-control study of patients with hematologic cancers, odds of severe COVID-19 remained high through mid-2022 despite vaccination, especially in patients requiring treatment.

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Concepts Keywords
Cancers Antiviral
Diabetes Aor
Sex Cancers
Veterans Ci


Type Source Name
disease MESH COVID-19
disease VO vaccinated
disease MESH Cancers
disease MESH endemic disease
disease VO vaccination
pathway REACTOME SARS-CoV-2 Infection
disease MESH infection
disease MESH Alzheimer disease
pathway KEGG Alzheimer disease
disease MESH dementia
disease MESH chronic obstructive pulmonary disease
disease MESH heart failure
disease MESH peripheral vascular disease
disease MESH death
drug DRUGBANK Dexamethasone
drug DRUGBANK Oxygen
disease VO age
disease MESH comorbidity
disease MESH Infectious Diseases
drug DRUGBANK Methylphenidate
disease MESH chronic kidney disease
disease VO frequency
disease VO vaccine
disease VO vaccine dose
disease VO adenovirus vaccine
disease MESH Hodgkin lymphoma
disease MESH non Hodgkin lymphoma
disease MESH chronic lymphocytic leukemia
disease MESH acute lymphocytic leukemia
disease MESH myeloproliferative disorders
disease MESH myelodysplastic syndromes
disease MESH chronic myelogenous leukemia
disease MESH acute myeloblastic leukemia
disease IDO blood
drug DRUGBANK Methionine
disease IDO symptom
disease IDO facility
drug DRUGBANK Prednisone
drug DRUGBANK Methylprednisolone
disease VO population
disease MESH Chronic Conditions
disease VO primary vaccination
disease VO dose
drug DRUGBANK Ritonavir
drug DRUGBANK Sodium lauryl sulfate
disease MESH refractory anemia
disease MESH monoclonal gammopathy
disease MESH leukemias
disease MESH histiocytoses
disease MESH myeloid sarcoma
drug DRUGBANK Baricitinib
drug DRUGBANK Tocilizumab
drug DRUGBANK Lauric Acid

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