COVID-19 Infection, Vaccination Outcomes in Explored at ASH Annual Meeting

The COVID-19 pandemic has taken a toll on patients living with hematologic cancers and other blood disorders, according to a press release from the 63rd American Society of Hematology (ASH) Annual Meeting and Exposition, held December 11 through 14, 2021.

“Hematologists have continued to play a unique role in contributing to the emerging science of COVID-19, especially given our expertise in clotting, and ASH has continued to provide leadership in an uncertain time with vetted resources and timely guidance for how best to manage our patients amid the pandemic,” said Laura Micahelis, MD, of the Medical College of Wisconsin in a press release.¹ 

Multiple studies presented at the meeting shared data on the persistent burden of COVID-19 on people living with blood disorders. Some studies utilized data from the ASH Research Collaborative COVID-19 Registry for Hematology.

Results of 1 study ² found that patients with blood cancers—especially patients with more advanced disease—are “especially vulnerable to serious COVID-19 outcomes,” including severe illness and death. Research results showed that 17% of patients with blood cancers who were infected with COVID-19 died from COVID-19 related illnesses, a mortality rate described as “strikingly higher” than what was seen in the general population. 

“Having a poor prognosis for underlying disease prior to COVID-19 and deciding to forgo ICU-level care for that disease were the most powerful predictors of mortality among patients with blood cancer and COVID-19—and the 2 may very well be related,” said Lisa K. Hicks, MD, MSc, of St. Michael’s Hospital in Toronto, Canada.

The data also showed that patients whose physician estimated that they had less than 6 months to live due to their cancer prior to getting COVID-19 had a 6-fold higher odds of dying; these odds “nearly doubled” in people who chose to forgo more intensive care due to the pandemic. However, these patients “represented only a small proportion of the overall sample.”

Investigators also evaluated whether treatment for blood cancer would affect COVID-19 mortality, finding that receive cancer treatment in the year prior to COVID-19 infection did not significantly increase the risk of death; however, this was linked to an increased risk of hospitalization if COVID-19 was contracted.

In another study,³ an analysis of 257 patients with acute leukemia or myelodysplastic syndromes (MDS) who developed COVID-19 found that neutropenia and active MDS or leukemia “strongly and independently” predicted severe COVID-19 illness. However, once these patients were hospitalized, neither active disease alone nor receipt of ongoing cancer treatment was associated with greater odds of dying from COVID-19. 

Results of a different study⁴ showed that roughly 15% of people with blood cancers and other blood disorders had no vaccination-related antibodies after being vaccinated against COVID-19. Although findings of this study were encouraging—with 85% of participants showing antibody response—investigators cautioned that additional precautions may be necessary to prevent COVID-19 in this patient population. 

In particular, patients with lymphoma and patients currently receiving treatment are the least likely to generate antibodies after COVID-19 vaccination. 

“Some patients with hematologic diseases do not have an adequate antibody response and might, therefore, not have sufficient protection from vaccination,” said Susanne Saussele, MD, of Universität Heidelberg in Germany. “This study can help guide vaccination strategies for these patients.”

Finally, results of one of the largest studies to-date of antibody response in patients with acute myeloid leukemia (AML) and MDS5 found that patients responded well to 2 doses of the Moderna mRNA vaccine, seeing a “particularly dramatic increase in levels of antibodies against the virus” after receiving their second vaccine dose. 

“The fact that antibody levels increased so dramatically after the second vaccine dose suggests potential utility in additional dosing, even for patients who initially respond poorly to the vaccine,” said Jeffrey Lancet, MD, of the H. Lee Moffitt Cancer Center and Research Institute in Florida. “The study should be confirmed in a larger group of patients. However, based on these data, we feel comfortable advising patients with AML or MDS that they should get vaccinated against COVID-19.”

References

1. COVID-19 takes a toll on people with blood cancers and disorders. News release. American Society of Hematology. December 11, 2021. Accessed December 13, 2021. https://www.hematology.org/newsroom/press-releases/2021/covid-19-takes-a-toll-on-people-with-blood-cancers-and-disorders 
2. Hicks LK, Redd RA, Anderson JC, et al. Risks for hospitalization and death among patients with blood disorders from the ASH RC COVID-19 Registry for Hematology. Presented at: 63rd ASH Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA. Abstract 3040. 
3. Desai P, Goldberg AD, Anderson KC, et al. Clinical predictors of outcome in adult patients with acute leukemias and myelodysplastic syndrome and COVID-19 infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub. 63rd ASH Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA. Abstract 280.
4. Rotterdam J, Thiaucourt M, Schwaab J, et al. Antibody response to vaccination with BNT162b2, mRNA-1273, and ChADOx1 in patients with myeloid and lymphoid neoplasms. 63rd ASH Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA. Abstract 218. 
5. Jain AG, Dong NC, Ball S, et al. Responses to SARS-CoV-2 vaccines in patients with myelodysplastic syndrome and acute myeloid leukemia. Presented at: 63rd ASH Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA. Abstract 217.