Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Blood Adv. 2023 Oct 10;7(19):5691-5697. doi: 10.1182/bloodadvances.2022008827.
Patients with hematologic malignancies have both an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and higher morbidity/mortality. They have lower seroconversion rates after vaccination, potentially leading to inferior coronavirus disease 2019 (COVID-19) outcomes, despite vaccination. We consequently evaluated the clinical outcomes of COVID-19 infections in 243 vaccinated and 175 unvaccinated patients with hematologic malignancies. Hospitalization rates were lower in the vaccinated group when compared with the unvaccinated group (31.3% vs 52.6%). However, the rates of COVID-19-associated death were similar at 7.0% and 8.6% in vaccinated and unvaccinated patients, respectively. By univariate logistic regression, females, older patients, and individuals with higher modified Charlson Comorbidity Index scores were at a higher risk of death from COVID-19 infections. To account for the nonrandomized nature of COVID-19 vaccination status, a propensity score weighting approach was used. In the final propensity-weighted model, vaccination status was not significantly associated with the risk of death from COVID-19 infections but was associated with the risk of hospitalization. The predicted benefit of vaccination was an absolute decrease in the probability of death and hospitalization from COVID-19 infections by 2.3% and 22.9%, respectively. In conclusion, COVID-19 vaccination status in patients with hematologic malignancies was associated with a decreased risk of hospitalization but not associated with a decreased risk of death from COVID-19 infections in the pre-Omicron era. Protective strategies, in addition to immunization, are warranted in this vulnerable patient population.
患有血液恶性肿瘤的患者感染严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的风险增加，发病率和死亡率更高。尽管接种了疫苗，但他们的血清转化率较低，这可能导致新冠肺炎 2019 疾病（COVID-19）的结果较差。因此，我们评估了 243 名接种疫苗和 175 名未接种疫苗的血液恶性肿瘤患者的 COVID-19 感染的临床结果。与未接种疫苗的患者相比，接种疫苗的患者住院率较低（31.3%对 52.6%）。然而，接种疫苗和未接种疫苗的患者 COVID-19 相关死亡的发生率分别为 7.0%和 8.6%，相似。通过单变量逻辑回归，女性、年龄较大的患者和 Charlson 合并症指数评分较高的个体患 COVID-19 感染死亡的风险更高。为了考虑 COVID-19 疫苗接种状态的非随机性，使用倾向评分加权方法。在最终的倾向评分加权模型中，疫苗接种状态与 COVID-19 感染死亡风险无显著相关性，但与住院风险相关。接种疫苗的预测获益是 COVID-19 感染死亡和住院的绝对概率分别降低 2.3%和 22.9%。总之，在奥密克戎时代之前，血液恶性肿瘤患者的 COVID-19 疫苗接种状态与住院风险降低相关，但与 COVID-19 感染死亡风险降低无关。除免疫接种外，还需要针对这一脆弱患者群体采取保护策略。
