Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Center for Science, Health, and Society, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
The Center for Clinical Informatics Research and Education, The MetroHealth System, the Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Science, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Blood Rev. 2022 Jul;54:100931. doi: 10.1016/j.blre.2022.100931. Epub 2022 Jan 31.
There has been limited data presented to characterize and quantify breakthrough SARS-CoV-2 infections, hospitalizations, and mortality in vaccinated patients with hematologic malignancies (HM). We performed a retrospective cohort study of patient electronic health records of 514,413 fully vaccinated patients from 63 healthcare organizations in the US, including 5956 with HM and 508,457 without malignancies during the period from December 2020 to October 2021. The breakthrough SARS-CoV-2 infections in patients with HM steadily increased and reached 67.7 cases per 1000 persons in October 2021. The cumulative risk of breakthrough infections during the period in patients with HM was 13.4%, ranging from 11.0% for acute lymphocytic leukemia to 17.2% and 17.4% for multiple myeloma and chronic myeloid leukemia respectively, all higher than the risk of 4.5% in patients without malignancies (p < 0.001). No significant racial disparities in breakthrough infections were observed. The overall hospitalization risk was 37.8% for patients with HM who had breakthrough infections, significantly higher than 2.2% for those who had no breakthrough infections (hazard ratio or HR: 34.49, 95% CI: 25.93-45.87). The overall mortality risk was 5.7% for patients with HM who had breakthrough infections, significantly higher than the 0.8% for those who had no breakthrough infections (HR: 10.25, 95% CI: 5.94-17.69). In summary, this study shows that among the fully vaccinated population, patients with HM had significantly higher risk for breakthrough infections compared to patients without cancer and that breakthrough infections in patients with HM were associated with significant clinical outcomes including hospitalizations and mortality.
在接种疫苗的血液恶性肿瘤 (HM) 患者中，目前关于突破性 SARS-CoV-2 感染、住院和死亡的特征和量化数据有限。我们对来自美国 63 家医疗机构的 514413 名完全接种疫苗患者的电子健康记录进行了回顾性队列研究，其中包括 5956 名 HM 患者和 508457 名无恶性肿瘤患者。HM 患者的突破性 SARS-CoV-2 感染持续增加，2021 年 10 月达到每 1000 人 67.7 例。HM 患者在此期间突破性感染的累积风险为 13.4%，从急性淋巴细胞白血病的 11.0%到多发性骨髓瘤和慢性髓性白血病的 17.2%和 17.4%，均高于无恶性肿瘤患者的 4.5%（p<0.001）。未观察到突破性感染的明显种族差异。HM 患者中有突破性感染的患者的总体住院风险为 37.8%，显著高于无突破性感染的患者的 2.2%（风险比或 HR：34.49，95%CI：25.93-45.87）。HM 患者中有突破性感染的患者的总体死亡率风险为 5.7%，显著高于无突破性感染的患者的 0.8%（HR：10.25，95%CI：5.94-17.69）。总之，这项研究表明，在完全接种疫苗的人群中，HM 患者突破性感染的风险明显高于无癌症患者，并且 HM 患者的突破性感染与包括住院和死亡在内的显著临床结局相关。
