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.
【초록키워드】 Tumor, Vaccine, BNT162b2 vaccine, vaccination, mRNA-1273, SARS-COV-2 infection, Cancer, Sex, risk, outcome, medications, smoking, variants, Bone marrow, COVID, vaccine dose, BNT162b2, Pfizer, outcomes, Cohort, Myeloma, Multiple myeloma, COVID-19 infection, SARS-CoV-2 variants, cancers, lymphoma, Patient, Logistic regression, breakthrough infections, age, Breakthrough infection, smoking status, patients, leukemia, booster, Moderna, Evidence, Bone marrow transplantation, Hematologic malignancy, COVID-19 cases, solid tumors, tumors, Patients with cancer, mRNA COVID-19 vaccine, higher risk, 95% CI, increased risk, COVID-19 case, COVID-19 infections, Odds ratios, malignancies, mRNA COVID-19 vaccines, National, hematologic, lymphoid, controls, new SARS-CoV-2, analyzed, identify, adjusted, significantly higher, was reduced, ranged, immunosuppressive effect, Solid, 【제목키워드】 COVID-19, COVID,