Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey
Authors: Pagano Livio , Salmanton-García Jon , Marchesi Francesco , Blennow Ola , Gomes da Silva Maria , Glenthøj Andreas , van Doesum Jaap , Bilgin Yavuz M. , López-García Alberto , Itri Federico , Nunes Rodrigues Raquel , Weinbergerová Barbora , Farina Francesca , Dragonetti Giulia , Berg Venemyr Caroline , van Praet Jens , Jaksic Ozren , Valković Toni , Falces-Romero Iker , Martín-Pérez Sonia , Jiménez Moraima , Dávila-Valls Julio , Schönlein Martin , Ammatuna Emanuele , Meers Stef , Delia Mario , Stojanoski Zlate , Nordlander Anna , Lahmer Tobias , Imre Pinczés László , Buquicchio Caterina , Piukovics Klára , Ormazabal-Vélez Irati , Fracchiolla Nicola , Samarkos Michail , Méndez Gustavo-Adolfo , Hernández-Rivas José-Ángel , Espigado Ildefonso , Cernan Martin , Petzer Verena , Lamure Sylvain , di Blasi Roberta , Marques de Almedia Joyce , Dargenio Michelina , Biernat Monika M. , Sciumè Mariarita , de Ramón Cristina , de Jonge Nick , Batinić Josip , Aujayeb Avinash , Marchetti Monia , Fouquet Guillemette , Fernández Noemí , Zambrotta Giovanni , Sacchi Maria Vittoria , Guidetti Anna , Demirkan Fatih , Prezioso Lucia , Ráčil Zdeněk , Nucci Marcio , Mladenović Miloš , Liévin Raphaël , Hanáková Michaela , Gräfe Stefanie , Sili Uluhan , Machado Marina , Cattaneo Chiara , Adžić-Vukičević Tatjana , Verga Luisa , Labrador Jorge , Rahimli Laman , Bonanni Matteo , Passamonti Francesco , Pagliuca Antonio , Corradini Paolo , Hoenigl Martin , Koehler Philipp , Busca Alessandro , Cornely Oliver A. 
Published: September 2022

Abstract
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 &lt; .001), active HM (P &lt; .001), and severe and critical COVID-19 (P = .007 and P &lt; .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P &lt; .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 &lt; .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.