Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria. Electronic address: https://twitter.com/MedUni_Wien.
Hemato-Oncological Day Hospital Unit, Franz Tappeiner Hospital, Meran/Merano, Italy.
ESMO Open. 2023 Jun;8(3):101559. doi: 10.1016/j.esmoop.2023.101559. Epub 2023 Apr 25.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has particularly impacted patients with hemato-oncological malignancies, as they showed not only a higher propensity for severe courses but also weaker immune responses after vaccination. Still, data on the influence of pandemic waves and vaccinations on outcomes are rare. This study aimed to analyze the timely course of infections and vaccinations in a real-life cohort of patients with hemato-oncological diseases.
In this cohort study, 1817 patients with hemato-oncological diseases from 1 February 2020 to 15 December 2022 at the 'Franz Tappeiner' Hospital in Merano/Meran, Italy, were followed for SARS-CoV-2 infections and vaccinations.
Of 1817 patients with hemato-oncological malignancies, 735 (40.5%) were infected at least once with SARS-CoV-2, and 1614 (88.8%) received one or more doses of the approved vaccinations. Patients receiving antineoplastic treatment had a lower SARS-CoV-2 infection rate [35.1% versus 41.0%; odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.95], but higher risk of hospitalization (13.4% versus 6.9%; OR 2.11, 95% CI 1.25-3.69) compared with untreated patients. Overall, the case fatality rate (CFR) was 3.4%. Unvaccinated patients were more prone to severe coronavirus disease 2019 (COVID-19) courses requiring hospitalization (OR 2.34, 95% CI 1.25-4.36) and had a higher CFR (7.3% versus 1.6%; OR 4.98, 95% CI 2.16-12.98) than their vaccinated counterparts. In the Delta wave, patients with two vaccinations had a lower infection risk (OR 0.18, 95% CI 0.10-0.35) and tendentially lower hospitalization rates (OR 0.25, 95% CI 0.05-1.29) than unvaccinated patients. In the Omicron wave, 345/1198 (28.8%) patients with three or more vaccinations had breakthrough infections, resulting in a similar risk for infection (OR 0.88, 95% CI 0.60-1.30) but numerically lower risk for hospitalization (24/345, 7.0%) than unvaccinated individuals (4/40, 10.0%). Scheduled visits were postponed in 128/335 (38.2%) patients due to COVID-19, and deferrals correlated with pandemic wave (P = 0.002) and vaccination status (P < 0.001).
SARS-CoV-2 infections and outcomes differ between distinct phases of the pandemic. Vaccination with variant-specific vaccines should be prioritized as general protective measures are increasingly lifted.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 大流行对血液肿瘤患者的影响尤为严重，因为他们不仅更容易出现严重的病程，而且在接种疫苗后免疫反应也较弱。然而，关于大流行浪潮和疫苗接种对结果的影响的数据仍然很少。本研究旨在分析现实生活中血液肿瘤患者队列中感染和疫苗接种的及时情况。
在这项队列研究中，意大利 Merano/Meran 的 Franz Tappeiner 医院于 2020 年 2 月 1 日至 2022 年 12 月 15 日期间对 1817 名血液肿瘤患者进行了 SARS-CoV-2 感染和疫苗接种情况的随访。
1817 名血液恶性肿瘤患者中，735 名（40.5%）至少感染过一次 SARS-CoV-2，1614 名（88.8%）接受过一种或多种批准疫苗的接种。接受抗肿瘤治疗的患者 SARS-CoV-2 感染率较低[35.1%比 41.0%；比值比（OR）0.78，95%置信区间（CI）0.64-0.95]，但住院风险较高[13.4%比 6.9%；OR 2.11，95% CI 1.25-3.69]与未接受治疗的患者相比。总体而言，病死率（CFR）为 3.4%。未接种疫苗的患者更易发生需要住院治疗的严重 2019 年冠状病毒病（COVID-19）病程（OR 2.34，95% CI 1.25-4.36），且 CFR 较高（7.3%比 1.6%；OR 4.98，95% CI 2.16-12.98）比接种疫苗的患者。在 Delta 波中，接受两剂疫苗的患者感染风险较低（OR 0.18，95% CI 0.10-0.35），住院率也呈下降趋势（OR 0.25，95% CI 0.05-1.29）与未接种疫苗的患者相比。在 Omicron 波中，345/1198（28.8%）名接种三剂或更多疫苗的患者出现突破性感染，导致感染风险相似（OR 0.88，95% CI 0.60-1.30），但住院风险（24/345，7.0%）较未接种疫苗的个体（4/40，10.0%）低。由于 COVID-19，128/335（38.2%）名患者推迟了预约就诊，而推迟就诊与大流行浪潮（P=0.002）和疫苗接种状况（P<0.001）有关。
SARS-CoV-2 感染和结果在大流行的不同阶段有所不同。应优先接种针对变异的疫苗作为一般保护措施，因为这些措施正在逐渐取消。
