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COVID-19 Infection and Hematological Malignancies

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Infectious Agents and Cancer".

Deadline for manuscript submissions: closed (15 March 2023) | Viewed by 21600

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Special Issue Editor

Prof. Dr. Mingyi Chen

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Guest Editor

Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
Interests: molecular pathogenesis of lymphoma and leukemia; tumor immunology and GVHD; sickle cell disease; thrombosis; vascular biology; viral infections and cancerogenesis; cancer stem cells
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) in March 2020. In the past three years, COVID-19 has spread worldwide, causing several million deaths. Patients with hematological malignancies (HMs) are at high risk of developing severe and life-threatening infections, as they often have immune deficiency and are recipients of immunosuppressive treatments. Therefore, patients with hematological malignancies are at high risk of mortality due to COVID-19. A better understanding of the risk factors for adverse outcomes may facilitate improved clinical management of these patients.

In the past three years, many studies have focused on the baseline characteristics of patients with hematological malignancies who developed COVID-19 and analyzed the predictors of mortality. Leukemia, lymphoma, and myeloma represent heterogeneous hematological malignancies (HMs), which are characterized by severe immunosuppression. More recently, data regarding the incidence and clinical evolution of COVID-19 in patients with hematological malignancies such as leukemia, lymphomas, or myeloma have been reported, with the aim being to identify those patient populations that are more frequently associated with severe complications and death. The reason patients with HM are particularly vulnerable to SARS-CoV-2 infection may also be related to the detrimental effects of anti-neoplastic regimens (chemotherapy, BTK or PI3 kinase inhibitors, monoclonal antibodies for CD20 or CD30 and CD38 and CD19 CAR-T therapy, etc.) on the immune system.

We are interested in studies that shed light on the epidemiology, risk factors, pathophysiology, and outcomes of COVID-19 infection among patients with HMs. It is very encouraging to observe the benefit of COVID-19 vaccinations as a marked reduction in the risk of infections amongst HM patients. Future studies are needed to evaluate whether vaccinations will be able to prevent the development of COVID-19 and, above all, COVID-19-related mortality in the identified risk categories of HMs.

We are inviting papers on the topics listed below for submission to the Special Issue "COVID-19 Infection and Hematological Malignancies". This series of articles is presented by an international team of experts in the fields of hematology, virology, pathology, and infectious disease who enrich every aspect of this series on COVID-19 diagnosis, treatment, and mitigation strategies in patients with hematological cancers. Without their dedication, deep knowledge, and understanding of these tumors, participation in international studies and projects would not be possible. The high morbidity and mortality rates reported in patients with hematologic malignancies underscore the vulnerability of this patient population. Therefore, cautions for reducing the risk of contracting COVID-19 are of high interest. Patients with HMs and their families and caregivers should be fully vaccinated against influenza and SARS-CoV-2. In cases where clinical symptoms represent SAR-CoV-2 infection, rapid testing and treatment for COVID-19 with oral antiviral therapy or antibodies can be initiated promptly.

COVID-19-infection-induced changes in hematological malignancies and coagulation manifestations as prognostic markers in the prediction of disease severity. Performing early triage and the timely initiation of effective management may prevent disease progression and reduce the overall mortality rate.
Recognition of COVID-19-vaccine-induced lymphadenopathy as a diagnostic dilemma for radiologists and pathologists. The documentation of vaccination status is critical to decrease unnecessary biopsies and alleviate patient anxiety.
Discussion of the risk of COVID-19 infection in patients with underlying hematological malignancies. The significance of appropriate prevention and vaccination for those high-risk patients. The screening of antibody tests after COVID infection and/or vaccination in patients with lymphomas.
Improved understanding of COVID-19 epidemiology in patients with HMs (including hematopoietic stem cell transplant recipients). The results obtained will improve knowledge regarding the prevalence of this complication in the different categories of patients with HMs.
Outcomes of patients with hematologic malignancies and COVID-19, with special emphasis on systematic reviews and meta-analyses to estimate the risk of death and other important outcomes for these patients.
The treatment strategies for patients with highest-risk HMs with COVID-19 infection, and a summary of guidelines regarding clinical decisions for patients with hematological neoplasms in the COVID-19 pandemic.

In summary, this Special Issue is dedicated to the diagnosis and treatment of hematological malignancies during COVID-19 infection. We thank all the authors who will contribute articles regarding these interesting and timely topics. We hope this Special Issue is educational for caregivers in their daily practice toward enabling high-quality patient care.

Prof. Dr. Mingyi Chen
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

SARS-CoV-2/COVID-19 viral infection
hematological malignancies
immunology and vaccination
targeted therapy and risk stratification

Published Papers (11 papers)

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Editorial

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3 pages, 197 KiB

Open AccessEditorial

Preface of the Special Issue “COVID-19 Infection and Hematological Malignancies”

by Mingyi Chen and Larry D. Anderson, Jr.

Cancers 2022, 14(18), 4497; https://doi.org/10.3390/cancers14184497 - 16 Sep 2022

Cited by 1 | Viewed by 1108

Abstract

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

Research

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13 pages, 1303 KiB

Open AccessArticle

Antibody Response to the SARS-CoV-2 Vaccine and COVID-19 Vulnerability during the Omicron Pandemic in Patients with CLL: Two-Year Follow-Up of a Multicenter Study

by Francesca R. Mauro, Diana Giannarelli, Clementina M. Galluzzo, Andrea Visentin, Anna M. Frustaci, Paolo Sportoletti, Candida Vitale, Gianluigi Reda, Massimo Gentile, Luciano Levato, Roberta Murru, Daniele Armiento, Maria C. Molinari, Giulia Proietti, Sara Pepe, Filomena De Falco, Veronica Mattiello, Luca Barabino, Roberta Amici, Marta Coscia, Alessandra Tedeschi, Corrado Girmenia, Livio Trentin and Silvia Baroncelli Show full author list Hide full author list

Cancers 2023, 15(11), 2993; https://doi.org/10.3390/cancers15112993 - 30 May 2023

Cited by 3 | Viewed by 1481

Abstract

High morbidity and mortality due to COVID-19 were described in the pre-vaccination era in patients with chronic lymphocytic leukemia (CLL). To evaluate COVID-19 morbidity after the SARS-CoV-2 vaccine, we carried out a prospective study in 200 CLL patients. The median age of patients was 70 years; 35% showed IgG levels ≤ 550 mg/dL, 61% unmutated IGHV, and 34% showed TP53 disruption. Most patients, 83.5%, were previously treated, including 36% with ibrutinib and 37.5% with venetoclax. The serologic response rates to the second and third dose of the vaccine were 39% and 53%, respectively. With a median follow-up of 23.4 months, 41% of patients experienced COVID-19, 36.5% during the Omicron pandemic, and 10% had subsequent COVID-19 events. Severe COVID-19 requiring hospitalization was recorded in 26% of patients, and 4% died. Significant and independent factors associated with the response to the vaccine and vulnerability to COVID-19 were age (OR: 0.93; HR: 0.97) and less than 18 months between the start of targeted agents and vaccine (OR: 0.17; HR: 0.31). TP53 mutation and ≥two prior treatments also emerged as significant and independent factors associated with an increased risk of developing COVID-19 (HR: 1.85; HR: 2.08). No statistical difference in COVID-19 morbidity was found in patients with or without antibody response to the vaccine (47.5% vs. 52.5%; p = 0.21). Given the persistent risk of infection due to the continuous emergence of SARS-CoV-2 variants, our results support the importance of new vaccines and protective measures to prevent and mitigate COVID-19 in CLL patients. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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21 pages, 5178 KiB

Open AccessArticle

Comparison of Computed Tomography Scoring Systems in Patients with COVID-19 and Hematological Malignancies

by Marta Hałaburda-Rola, Joanna Drozd-Sokołowska, Magdalena Januszewicz and Laretta Grabowska-Derlatka

Cancers 2023, 15(9), 2417; https://doi.org/10.3390/cancers15092417 - 22 Apr 2023

Viewed by 1366

Abstract

Background: Numerous computed tomography (CT) scales have been proposed to assess lung involvement in COVID-19 pneumonia as well as correlate radiological findings with patient outcomes. Objective: Comparison of different CT scoring systems in terms of time consumption and diagnostic performance in patients with hematological malignancies and COVID-19 infection. Materials and methods: Retrospective analysis included hematological patients with COVID-19 and CT performed within 10 days of diagnosis of infection. CT scans were analyzed in three different semi-quantitative scoring systems, Chest CT Severity Score (CT-SS), Chest CT Score(CT-S), amd Total Severity Score (TSS), as well as qualitative modified Total Severity Score (m-TSS). Time consumption and diagnostic performance were analyzed. Results: Fifty hematological patients were included. Based on the ICC values, excellent inter-observer reliability was found among the three semi-quantitative methods with ICC > 0.9 (p < 0.001). The inter-observer concordance was at the level of perfect agreement (kappa value = 1) for the mTSS method (p < 0.001). The three-receiver operating characteristic (ROC) curves revealed excellent and very good diagnostic accuracy for the three quantitative scoring systems. The AUC values were excellent (0.902), very good (0.899), and very good (0.881) in the CT-SS, CT-S and TSS scoring systems, respectively. Sensitivity showed high levels at 72.7%, 75%, and 65.9%, respectively, and specificity was recorded at 98.2%, 100%, 94.6% for the CT-SS, CT-S, and TSS scoring systems, respectively. Time consumption was the same for Chest CT Severity Score and TSS and was longer for Chest CT Score (p < 0.001). Conclusions: Chest CT score and chest CT severity score have very high sensitivity and specificity in terms of diagnostic accuracy. The highest AUC values and the shortest median time of analysis in chest CT severity score indicate this method as preferred for semi-quantitative assessment of chest CT in hematological patients with COVID-19. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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17 pages, 1940 KiB

Open AccessArticle

Low Spike Antibody Levels and Impaired BA.4/5 Neutralization in Patients with Multiple Myeloma or Waldenstrom’s Macroglobulinemia after BNT162b2 Booster Vaccination

by Margherita Rosati, Evangelos Terpos, Jenifer Bear, Robert Burns, Santhi Devasundaram, Ioannis Ntanasis-Stathopoulos, Maria Gavriatopoulou, Efstathios Kastritis, Meletios-Athanasios Dimopoulos, George N. Pavlakis and Barbara K. Felber

Cancers 2022, 14(23), 5816; https://doi.org/10.3390/cancers14235816 - 25 Nov 2022

Cited by 13 | Viewed by 1613

Abstract

Patients with symptomatic monoclonal gammopathies have impaired humoral responses to COVID-19 vaccination. Their ability to recognize SARS-CoV-2 Omicron variants is of concern. We compared the response to BNT162b2 mRNA vaccinations of patients with multiple myeloma (MM, n = 60) or Waldenstrom’s macroglobulinemia (WM, n = 20) with healthy vaccine recipients (n = 37). Patient cohorts on active therapy affecting B cell development had impaired binding and neutralizing antibody (NAb) response rate and magnitude, including several patients lacking responses, even after a 3rd vaccine dose, whereas non-B cell depleting therapies had a lesser effect. In contrast, MM and WM cohorts off-therapy showed increased NAb with a broad response range. ELISA Spike-Receptor Binding Domain (RBD) Ab titers in healthy vaccine recipients and patient cohorts were good predictors of the ability to neutralize not only the original WA1 but also the most divergent Omicron variants BA.4/5. Compared to WA1, significantly lower NAb responses to BA.4/5 were found in all patient cohorts on-therapy. In contrast, the MM and WM cohorts off-therapy showed a higher probability to neutralize BA.4/5 after the 3rd vaccination. Overall, the boost in NAb after the 3rd dose suggests that repeat vaccination of MM and WM patients is beneficial even under active therapy. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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19 pages, 2037 KiB

Open AccessArticle

Strong Humoral but Not Cellular Immune Responses against SARS-CoV-2 in Individuals with Oncohematological Disease Who Were Treated with Rituximab before Receiving a Vaccine Booster

by Montserrat Torres, Magdalena Corona, Sara Rodríguez-Mora, Guiomar Casado-Fernández, Alejandro Zurdo-Castronuño, Elena Mateos, Fernando Ramos-Martín, Clara Sánchez-Menéndez, María Aranzazú Murciano-Antón, Javier García-Pérez, José Alcamí, Mayte Pérez-Olmeda, Mayte Coiras, Javier López-Jiménez, Valentín García-Gutiérrez and on behalf of the Multidisciplinary Group of Study of COVID-19 (MGS-COVID)

Cancers 2022, 14(22), 5537; https://doi.org/10.3390/cancers14225537 - 10 Nov 2022

Cited by 2 | Viewed by 1931

Abstract

The humoral immune response developed after receiving the full vaccination schedule against COVID-19 is impaired in individuals who received anti-CD20 therapy 6–9 months before vaccination. However, there is little information about the cellular immune responses elicited in these individuals. In this study, we analyzed the humoral and cellular immune responses in 18 individuals with hematological disease who received the last dose of rituximab 13.8 months (IQR 9.4–19) before the booster dose. One month after receiving the booster dose, the seroconversion rate in the rituximab-treated cohort increased from 83.3% to 88.9% and titers of specific IgGs against SARS-CoV-2 increased 1.53-fold (p = 0.0098), while the levels of neutralizing antibodies increased 3.03-fold (p = 0.0381). However, the cytotoxic activity of peripheral blood mononuclear cells (PBMCs) from rituximab-treated individuals remained unchanged, and both antibody-dependent cellular cytotoxicity (ADCC) and direct cellular cytotoxicity (CDD) were reduced 1.7-fold (p = 0.0047) and 2.0-fold (p = 0.0086), respectively, in comparison with healthy donors. Breakthrough infections rate was higher in our cohort of rituximab-treated individuals (33.33%), although most of the infected patients (83.4%) developed a mild form of COVID-19. In conclusion, our findings confirm a benefit in the humoral, but not in the cellular, immune response in rituximab-treated individuals after receiving a booster dose of an mRNA-based vaccine against COVID-19. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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16 pages, 809 KiB

Open AccessArticle

Simultaneous Onset of Haematological Malignancy and COVID: An Epicovideha Survey

by Chiara Cattaneo, Jon Salmanton-García, Francesco Marchesi, Shaimaa El-Ashwah, Federico Itri, Barbora Weinbergerová, Maria Gomes Da Silva, Michelina Dargenio, Julio Dávila-Valls, Sonia Martín-Pérez, Francesca Farina, Jaap Van Doesum, Toni Valković, Caroline Besson, Christian Bjørn Poulsen, Alberto López-García, Pavel Žák, Martin Schönlein, Klára Piukovics, Ozren Jaksic, Alba Cabirta, Natasha Ali, Uluhan Sili, Nicola Fracchiolla, Giulia Dragonetti, Tatjana Adžić-Vukičević, Monia Marchetti, Marina Machado, Andreas Glenthøj, Olimpia Finizio, Fatih Demirkan, Ola Blennow, Maria Chiara Tisi, Ali S. Omrani, Milan Navrátil, Zdeněk Ráčil, Jan Novák, Gabriele Magliano, Moraima Jiménez, Carolina Garcia-Vidal, Nurettin Erben, Maria Ilaria Del Principe, Caterina Buquicchio, Rui Bergantim, Josip Batinić, Murtadha Al-Khabori, Luisa Verga, Tomáš Szotkowski, Michail Samarkos, Irati Ormazabal-Vélez, Stef Meers, Johan Maertens, László Imre Pinczés, Martin Hoenigl, Ľuboš Drgoňa, Annarosa Cuccaro, Yavuz M. Bilgin, Avinash Aujayeb, Laman Rahimli, Stefanie Gräfe, Mariarita Sciumè, Miloš Mladenović, Gökçe Melis Çolak, Maria Vittoria Sacchi, Anna Nordlander, Caroline Berg Venemyr, Michaela Hanáková, Nicole García-Poutón, Ziad Emarah, Giovanni Paolo Maria Zambrotta, Raquel Nunes Rodrigues, Raul Cordoba, Gustavo-Adolfo Méndez, Monika M. Biernat, Oliver A. Cornely and Livio Pagano Show full author list Hide full author list

Cancers 2022, 14(22), 5530; https://doi.org/10.3390/cancers14225530 - 10 Nov 2022

Cited by 4 | Viewed by 2512

Abstract

Background: The outcome of patients with simultaneous diagnosis of haematological malignancies (HM) and COVID-19 is unknown and there are no specific treatment guidelines. Methods: We describe the clinical features and outcome of a cohort of 450 patients with simultaneous diagnosis of HM and COVID-19 registered in the EPICOVIDEHA registry between March 2020 to February 2022. Results: Acute leukaemia and lymphoma were the most frequent HM (35.8% and 35.1%, respectively). Overall, 343 (76.2%) patients received treatment for HM, which was delayed for longer than one month since diagnosis in 57 (16.6%). An overall response rate was observed in 140 (40.8%) patients after the first line of treatment. After a median follow-up of 35 days, overall mortality was 177/450 (39.3%); 30-day mortality was significantly higher in patients not receiving HM treatment (42.1%) than in those receiving treatment (27.4%, p = 0.004), either before and/or after COVID-19, or compared to patients receiving HM treatment at least after COVID-19 (15.2%, p < 0.001). Age, severe/critical COVID-19, ≥2 comorbidities, and lack of HM treatment were independent risk factors for mortality, whereas a lymphocyte count >500/mcl at COVID-19 onset was protective. Conclusions: HM treatment should be delivered as soon as possible for patients with simultaneous diagnosis of COVID-19 and HM requiring immediate therapy. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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22 pages, 1794 KiB

Open AccessArticle

Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario

by Carolin Krekeler, Lea Reitnauer, Ulrike Bacher, Cyrus Khandanpour, Leander Steger, Göran Ramin Boeckel, Justine Klosner, Phil-Robin Tepasse, Marcel Kemper, Marc Tim Hennies, Rolf Mesters, Matthias Stelljes, Norbert Schmitz, Andrea Kerkhoff, Christoph Schliemann, Jan-Henrik Mikesch, Nicole Schmidt, Georg Lenz, Annalen Bleckmann and Evgenii Shumilov

Cancers 2022, 14(22), 5512; https://doi.org/10.3390/cancers14225512 - 9 Nov 2022

Cited by 7 | Viewed by 2283

Abstract

Background: Two-dose COVID-19 vaccination often results in poor humoral response rates in patients with hematologic malignancies (HMs); yet responses to COVID-19 booster vaccines and the risk of COVID-19 infection post-booster are mostly uncertain. Methods: We included 200 outpatients with HMs and predominantly lymphoid neoplasms (96%, 191/200) in our academic center and reported on the humoral responses, which were assessed by measurement of anti-spike IgG antibodies in peripheral blood as early as 14 days after mRNA-based prime-boost vaccination, as well as factors hampering booster efficacy. Previous basic (double) immunization was applied according to the local recommendations with mRNA- and/or vector-based vaccines. We also report on post-booster COVID-19 breakthrough infections that emerged in the Omicron era and the prophylaxis strategies that were applied to poor and non-responders to booster vaccines. Results: A total of 55% (110/200) of the patients achieved seroconversion (i.e., anti-spike protein IgG antibody titer > 100 AU/mL assessed in median 48 days after prime-boost vaccination) after prime-boost vaccination. Multivariable analyses revealed age, lymphocytopenia, ongoing treatment and prior anti-CD20 B-cell depletion to be independent predictors for booster failure. With each month between anti-CD20-mediated B-cell depletion and booster vaccination, the probability of seroconversion increased by approximately 4% (p < 0.001) and serum–antibody titer (S-AbT) levels increased by 90 AU/mL (p = 0.011). Notably, obinutuzumab treatment was associated with an 85% lower probability for seroconversion after prime-boost vaccination compared to rituximab (p = 0.002). Of poor or non-responders to prime-boost vaccination, 41% (47/114) underwent a second booster and 73% (83/114) underwent passive immunization. COVID-19 breakthrough infections were observed in 15% (29/200) of patients after prime-boost vaccination with predominantly mild courses (93%). Next to seroconversion, passive immunization was associated with a significantly lower risk of COVID-19 breakthrough infections after booster, even in vaccine non-responders (all p < 0.05). In a small proportion of analyzed patients with myeloid neoplasms (9/200), the seroconversion rate was higher compared to those with lymphoid ones (78% vs. 54%, accordingly), while the incidence rate of COVID-19 breakthrough infections was similar (22% vs. 14%, respectively). Following the low frequency of myeloid neoplasms in this study, the results may not be automatically applied to a larger cohort. Conclusions: Patients with HMs are at a high risk of COVID-19 booster vaccine failure; yet COVID-19 breakthrough infections after prime-boost vaccination are predominantly mild. Booster failure can likely be overcome by passive immunization, thereby providing immune protection against COVID-19 and attenuating the severity of COVID-19 courses. Further sophistication of clinical algorithms for preventing post-vaccination COVID-19 breakthrough infections is urgently needed. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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11 pages, 505 KiB

Open AccessArticle

Remdesivir Decreases Mortality in COVID-19 Patients with Active Malignancy

by Jerzy Jaroszewicz, Justyna Kowalska, Małgorzata Pawłowska, Magdalena Rogalska, Dorota Zarębska-Michaluk, Marta Rorat, Beata Lorenc, Piotr Czupryna, Katarzyna Sikorska, Anna Piekarska, Anna Dworzańska, Izabela Zaleska, Włodzimierz Mazur, Dorota Kozielewicz, Krzysztof Kłos, Regina Podlasin, Grzegorz Angielski, Barbara Oczko-Grzesik, Magdalena Figlerowicz, Bartosz Szetela, Beata Bolewska, Paulina Frańczak-Chmura, Robert Flisiak and Krzysztof Tomasiewicz Show full author list Hide full author list

Cancers 2022, 14(19), 4720; https://doi.org/10.3390/cancers14194720 - 28 Sep 2022

Cited by 9 | Viewed by 2179

Abstract

Data on the use of remdesivir, the first antiviral agent against SARS-CoV-2, are limited in oncologic patients. We aimed to analyze contributing factors for mortality in patients with malignancies in the real-world CSOVID-19 study. In total, 222 patients with active oncological disorders were selected from a nationwide COVID-19 study of 4890 subjects. The main endpoint of the current study was the 28-day in-hospital mortality. Approximately half of the patients were male, and the majority had multimorbidity (69.8%), with a median age of 70 years. Baseline SpO₂ < 85% was observed in 25%. Overall, 59 (26.6%) patients died before day 28 of hospitalization: 29% due to hematological, and 20% due to other forms of cancers. The only factor increasing the odds of death in the multivariable model was eGFR < 60 mL/min/m² (4.621, p = 0.02), whereas SpO₂ decreased the odds of death at baseline (0.479 per 5%, p = 0.002) and the use of remdesivir (0.425, p = 0.03). This study shows that patients with COVID-19 and malignancy benefit from early remdesivir therapy, resulting in a decrease in early mortality by 80%. The prognosis was worsened by low glomerular filtration rate and low peripheral oxygen saturation at baseline underlying the role of kidney protection and early hospitalization. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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15 pages, 1788 KiB

Open AccessArticle

Clinical Post-SARS-CoV-2 Infection Scenarios in Vaccinated and Non-Vaccinated Cancer Patients in Three German Cancer Centers: A Retrospective Analysis

by Evgenii Shumilov, Lena Aperdannier, Nicole Schmidt, Christoph Szuszies, Albrecht Neesse, Petra Hoffknecht, Cyrus Khandanpour, Jan-Henrik Mikesch, Matthias Stelljes, Göran Ramin Boeckel, Phil-Robin Tepasse, Lea Reitnauer, Raphael Koch, Justin Hasenkamp, Ulrike Bacher, Simone Scheithauer, Lorenz Trümper, Norbert Schmitz, Gerald Wulf, Andrea Kerkhoff, Georg Lenz, Carolin Krekeler and Annalen Bleckmann Show full author list Hide full author list

Cancers 2022, 14(15), 3746; https://doi.org/10.3390/cancers14153746 - 31 Jul 2022

Cited by 3 | Viewed by 1963

Abstract

COVID-19 vaccines have become an integral element in the protection of cancer patients against SARS-CoV-2. To date, there are no direct comparisons of the course of COVID-19 infection in cancer patients between the pre- and post-vaccine era. We analyzed SARS-CoV-2 infections and their impact on cancer in COVID-19 vaccinated and non-vaccinated patients from three German cancer centers. Overall, 133 patients with SARS-CoV-2 were enrolled in pre- and post-vaccine eras: 84 non-vaccinated and 49 vaccinated, respectively. A mild course of COVID-19 was documented more frequently in vaccinated patients (49% vs. 29%), while the frequency of severe and critical courses occurred in approximately one-half of the non-vaccinated patients (22% vs. 42%, p = 0.023). Particularly, patients with hematologic neoplasms benefited from vaccination in this context (p = 0.031). Admissions to intermediate- and intensive-care units and the necessity of non-invasive and invasive respiratory support were reduced by 71% and 50% among vaccinated patients, respectively. The median length of admission was 11 days for non-vaccinated and 5 days for vaccinated patients (p = 0.002). COVID-19 mortality was reduced by 83% in vaccinated patients (p = 0.046). Finally, the median time from SARS-CoV-2 infection to restarting cancer therapy was 12 and 26 days among vaccinated and non-vaccinated groups, respectively (p = 0.002). Although this study does not have enough power to perform multivariate analyses to account for confounders, it provides data on COVID-19 in non-vaccinated and vaccinated cancer patients and illustrates the potential benefits of COVID-19 vaccines for these patients. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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Review

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14 pages, 333 KiB

Open AccessReview

COVID-19 and Adult Acute Leukemia: Our Knowledge in Progress

by Franziska Modemann, Susanne Ghandili, Stefan Schmiedel, Katja Weisel, Carsten Bokemeyer and Walter Fiedler

Cancers 2022, 14(15), 3711; https://doi.org/10.3390/cancers14153711 - 29 Jul 2022

Cited by 7 | Viewed by 2287

Abstract

The majority of publications regarding SARS-CoV-2 infections in adult patients with acute leukemia (AL) refer to hematological patients in general and are not focused on acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). We herein report a review of the current literature on adult AL patients infected with SARS-CoV-2. Overall, SARS-CoV-2-associated mortality ranges from 20–52% in patients with adult AL. AML patients have a particularly high COVID-19-related mortality. Of note, most of the available data relate to the pre-vaccination era and to variants before Omicron. The impact of COVID-19 infections on AL treatment is rarely reported. Based on the few studies available, treatment delay does not appear to be associated with an increased risk of relapse, whereas therapy discontinuation was associated with worse outcomes in AML patients. Therefore, the current recommendations suggest delaying systemic AL treatment in SARS-CoV-2-positive patients until SARS-CoV-2 negativity, if immediate AL treatment is not required. It is recommended to offer vaccination to all AL patients; the reported antibody responses are around 80–96%. Seronegative patients should additionally receive prophylactic administration of anti-SARS-CoV-2 monoclonal antibodies. Patients with AL infected with SARS-CoV-2 should be treated early with antiviral therapy to prevent disease progression and enable the rapid elimination of the virus. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

Other

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25 pages, 2033 KiB

Open AccessSystematic Review

Adult Patients with Cancer Have Impaired Humoral Responses to Complete and Booster COVID-19 Vaccination, Especially Those with Hematologic Cancer on Active Treatment: A Systematic Review and Meta-Analysis

by Efstathia Liatsou, Ioannis Ntanasis-Stathopoulos, Stavros Lykos, Anastasios Ntanasis-Stathopoulos, Maria Gavriatopoulou, Theodora Psaltopoulou, Theodoros N. Sergentanis and Evangelos Terpos

Cancers 2023, 15(8), 2266; https://doi.org/10.3390/cancers15082266 - 12 Apr 2023

Cited by 6 | Viewed by 1879

Abstract

The exclusion of patients with cancer in clinical trials evaluating COVID-19 vaccine efficacy and safety, in combination with the high rate of severe infections, highlights the need for optimizing vaccination strategies. The aim of this study was to perform a systematic review and meta-analysis of the published available data from prospective and retrospective cohort studies that included patients with either solid or hematological malignancies according to the PRISMA Guidelines. A literature search was performed in the following databases: Medline (Pubmed), Scopus, Clinicaltrials.gov, EMBASE, CENTRAL and Google Scholar. Overall, 70 studies were included for the first and second vaccine dose and 60 studies for the third dose. The Effect Size (ES) of the seroconversion rate after the first dose was 0.41 (95%CI: 0.33–0.50) for hematological malignancies and 0.56 (95%CI: 0.47–0.64) for solid tumors. The seroconversion rates after the second dose were 0.62 (95%CI: 0.57–0.67) for hematological malignancies and 0.88 (95%CI: 0.82–0.93) for solid tumors. After the third dose, the ES for seroconversion was estimated at 0.63 (95%CI: 0.54–0.72) for hematological cancer and 0.88 (95%CI: 0.75–0.97) for solid tumors. A subgroup analysis was performed to evaluate potential factors affecting immune response. Production of anti-SARS-CoV-2 antibodies was found to be more affected in patients with hematological malignancies, which was attributed to the type of malignancy and treatment with monoclonal antibodies according to the subgroup analyses. Overall, this study highlights that patients with cancer present suboptimal humoral responses after COVID-19 vaccination. Several factors including timing of vaccination in relevance with active therapy, type of therapy, and type of cancer should be considered throughout the immunization process. Full article

(This article belongs to the Special Issue COVID-19 Infection and Hematological Malignancies)

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