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3536 COVID-19 Severity and Survival over Time in Vaccinated Patients with Hematologic Malignancies

Program: Oral and Poster Abstracts
Session: 902. Health Services and Quality—Lymphoid Malignancies: Poster II
Hematology Disease Topics & Pathways:
adult, Research, epidemiology, Clinical Research, Human, Study Population
Sunday, December 11, 2022, 6:00 PM-8:00 PM

Joaquin Martinez Lopez1*, Javier De La Cruz2*, Rodrigo Gil-Manso3*, Celina Benavente Cuesta4*, Lauren Benito, MD5*, jose Angel Hernandez, MD6*, Maria Regina Herraez7*, Pilar Herrera Puente8*, Mi Kwon, MD, PhD9*, Keina Quiroz, MD10*, Andres Arroyo, Ph11*, Adrian Alegre, MD, PhD12, María Pilar Llamas Sillero, MD, PhD13*, Javier López Jiménez, MD, PhD14*, Pedro Sanchez-Godoy, MD15*, Rafael F. Duarte, MD, PhD, FRCP16, Jose L. Diez Martin, MD PhD17*, Víctor Jiménez-Yuste, MD, PhD18* and Julio Garcia-Suarez19*

1Hospital 12 De Octubre, Complutense University, CNIO, Madrid, Spain
2Hospital Universitario 12 De Octubre, Instituto De Investigación Sanitaria, Madrid, Spain
3Hematology Department, Hospital 12 de Octubre, Madrid, Spain
4Department of Haematology, Hospital Clínico San Carlos. Madrid, Spain, Madrid, ESP
5Hematology Department, Hospital Universitario de Getafe, Madrid, Spain
6Hospital Universitario Infanta Leonor, Madrid, Spain
7SERMAS, MAdrid, Spain
8Hematology and Hemotherapy, Hospital Universitario Ramón y Cajal, Madrid, Spain
9Department of Hematology, Hospital General Universitario Gregorio Marañón, Gregorio Marañon Health Research Institute, Madrid, Spain
10Hospital de Mostoles, Mostoles, Spain
11Department of Biochemestry, Complutense University, i+12, Madrid, Spain
12Department of Hematology, Univeritary Hospital La Princesa, Madrid, Madrid, Spain
13Hospital Universitario Fundacion Jimenez Diaz - IISFJD-UAM, Madrid, Spain
14Hematology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
15Hematology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
16Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
17Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
18Hospital Universitario La Paz, Madrid, Spain
19Hospital Universitario Principe de Asturias, Alcala De Henares, ESP

Introduction. The incidence, severity and mortality of coronavirus disease-2019 (COVID-19) has changed over time. The complex relations between new coronavirus variants and advances in detection, prevention and treatment impacted on patient characteristics and outcomes is unknown in hematological patients. Nonetheless, in unvaccinated patients with hematologic malignancies (HM), these rates were much higher than in the general population. We documented the COVID-19 pandemic dynamics in a previous population-based study performed in the Madrid region, Spain, in 1166 consecutive patients, and reported 30 and 60-day survival rates of 68% and 56% in unvaccinated patients with HM. In the present study we aimed to describe patient characteristics, severity and mortality in patients with HM and COVID-19 infection following vaccination roll-out.
Methods. Data from adult patients with HM and COVID-19 infection in the 16 months period from 2021, March 1st to 2022, July 15th were included in this observational study. Confirmed infection cases were reported by the Departments of Hematology of 10 Hospitals, members of the Madrid Regional Health Service (SERMAS) and affiliated with the Madrid Society of Hematology. The key data extracted for the purposes of this analysis were pre-infection patient characteristics, cancer type and treatment, and information on COVID-19 management. The key end points of the study were hospital admission, clinical severity of COVID-19, mortality (30-day mortality and 30- and 60-day survival probability estimates). Patients were analyzed according to time of COVID-19 diagnosis in three periods; those diagnosed from 1st March 2021 through 30th November 201, were defined as the delta cohort; patients diagnosed from December 1, 2021, to February 28, 2022, were defined as the early omicron cohort, and patients diagnosed from 1 March 2022 and 15 July 2022 were defined as the late omicron cohort.
Results. 346 out of 436 cases reported were included in this analysis. Median age was 66 years (IQR, 55 to 77), 47% were women and 17% had 2 or more comorbidities. The two most frequent HM were Non-Hodgkin Lymphoma (37%) and Multiple Myeloma (25%), and 18% myeloid neoplasms; 18% of patients received autologous or allogenic stem cell transplantation and 92% were on active cancer therapy in the 30-days prior to COVID-19 infection. None of the above patient characteristics showed significant (P <0.05) differences between periods [first period, n=42 (12%); second, n=123 (36%); and third, n=181 (52%)].
Overall, 94% of patients received at least one dose of COVID-19 vaccine. In the third period, 31% of patients were treated with Paxlovid.
Hospital admissions decreased in the second and third periods (34%) compared to the first period (57%), odds ratio 0.37 (0.19 to 0.72); clinical severity also decreased over time, severe and critical cases were respectively 4% and 21%, odds ratio 0.28 (0.14 to 0.56). 30, 60 and 90-day survival estimates were respectively 85%, 80% and 80% in the first period and 93%, 90% and 87% in the second and third period, hazard ratio 0.64 (0.30 to 1.33). None of the above comparisons between the second and third periods showed significant (P <0.05) differences. These estimated survivals were considerable higher regarding pre-vaccination periods 66% and 58% survival at 30 and 60 days. Increasing age over 60 years and having three or more comorbidities were the two patient characteristics we identified associated with higher clinical severity and lower survival. In the 70-79 age group, 30/60/90-day survival was 91% / 87% and 84%, hazard ratio 4.9 (1.1 to 22) compared to under 60 years old age group; > 80 years old survival was reduced to 80% (69 to 93), hazard ratio 7.2 (1.6 to 32).

Conclusions: Almost all patients with HM and COVID-19 have started a COVID-19 vaccination scheme. Since the vaccination roll-out was launched for patients with HM 15 months ago, more than half of the COVID-19 infection cases in patients with HM occurred in the last four months. We identified no cancer therapies feature associated with clinical outcomes. Clinical severity decreased over time; 30 and 60-day survival estimates were higher than in previously reported unvaccinated patients with HM. An ongoing overall analysis over time, since the start of the pandemic, is needed to fully assess the impact up to now of the COVID-19 pandemic in the highly vulnerable patients with HM.

Disclosures: Hernandez: Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Beigene: Membership on an entity's Board of Directors or advisory committees; Lilly: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS/Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz: Membership on an entity's Board of Directors or advisory committees; Rovi: Membership on an entity's Board of Directors or advisory committees; Incyte: Membership on an entity's Board of Directors or advisory committees. Alegre: Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding; GSK: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Sanofi: Research Funding. Jiménez-Yuste: Roche, NovoNordisk, Sanofi, Sobi, Takeda, Grifols, Bayer, Pfizer, Octapharma, CSL Behring: Research Funding; Roche, Novo Nordisk, Sanofi, Sobi, Takeda, Grifols, Bayer, Pfizer, Spark, BioMarin, Octapharma, CSL Behring: Consultancy; Roche, NovoNordisk, Sanofi, Sobi, Takeda, Grifols, Bayer, Pfizer, Spark, Octapharma, CSL Behring: Honoraria.

*signifies non-member of ASH