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5149 Incidence and Management of COVID-19 Infections in Vaccinated Patients with CLL

Program: Oral and Poster Abstracts
Session: 905. Outcomes Research—Lymphoid Malignancies: Poster III
Hematology Disease Topics & Pathways:
Research, Clinical Research, health outcomes research
Monday, December 11, 2023, 6:00 PM-8:00 PM

Chaitra S Ujjani, MD1, Ted Gooley, PhD2*, Tanya Siddiqi, MD3, Deborah M. Stephens, DO4, Catherine Broome, MD5, Stephen E Spurgeon, MD6, Catherine Lai, MD7,8, Allison Winter, MD9, Georgios Pongas, MD10, Alex Greninger11*, Joshua A. Hill, MD1*, Susan M. O'Brien12, Matthew S. Davids, MD, MMSc13, Kerry A Rogers, MD14, Alexey Danilov, MD15, Genesis Quezada1*, Haiying Zhu11*, Amy Sperling1*, Tyler Sorensen1*, Kelsey Launchbury1*, William G. Wierda, MD, PhD16, Mazyar Shadman, MD, MPH17* and Philip A. Thompson, MBBS18*

1Fred Hutchinson Cancer Center, Seattle, WA
2Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA
3City of Hope, Irvine, CA
4Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
5Georgetown University, Washington, DC
6Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
7Abramson Cancer Center, Georgetown University Hospital, Washington, DC
8Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
9Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
10University of Miami, Miami, FL
11University of Washington, Seattle, WA
12UCI Cancer Center, Laguna Hills, CA
13Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
14Division of Hematology, The Ohio State University, Columbus, OH
15Department of Hematology and HCT, City of Hope National Medical Center, La Canada Flintridge, CA
16Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
17Fred Hutchinson Cancer Research Center, Seattle, WA
18University of Melbourne, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Australia


Due to impaired immune function and medical comorbidities, CLL patients (pts) are at risk for significant mortality with COVID-19. Given our concern for this vulnerable population, we formed a national collaboration to evaluate the efficacy of SARS-CoV-2 vaccines (NCT04852822). We previously reported decreased seroconversion rates amongst pts receiving B-cell directed therapy and characterized the T-cell responses (Ujjani et al, Blood Advances, 2022). Here we present data regarding the incidence and management of COVID-19 in this vaccinated population.


In this prospective observational study, adults with CLL/SLL were eligible if no known prior history of SARS-CoV-2 infection. Pts enrolled into 2 cohorts: 1) at time of initial 2-dose mRNA vaccine or 1-dose adenoviral vector vaccine, 2) at the time of the subsequently authorized booster vaccine. Pts in the initial vaccination cohort were permitted to enroll in the booster cohort. Patient reported infections, subsequent boosters, and therapeutic interventions were collected at 6, 12, 18, 24 months.


There were 243 pts enrolled in the initial vaccine cohort from 03/21-09/21 and 129 in the booster cohort from 08/21-02/22; 73 pts from initial cohort enrolled into the booster cohort. Patient characteristics are in Table 1. Eight pts (3.3%) reported COVID-19 in the initial cohort within 1 year of receiving the initial vaccine or prior to receipt of a booster (06/21-12/21). In the booster cohort, 32 pts (25%) reported at least 1 COVID-19 infection; first infections reported 10/21-12/22. Infections occurred a median of 135 days (93-247) after the initial vaccine and 132 days (range 19-312) after the booster. Second infections were noted in 1 patient (0.4%) in the initial cohort and 6 in the booster cohort (5%).

The incidence of COVID-19 was comparable amongst men and women in the initial cohort (4%, 2%) and booster cohort (25%, 24%) as well as those who received mRNA-1273 and BNT162b2 vaccines (2%, 4%) and (24%, 26%). There were no infections in the 6 pts who received Ad26.COV2.S in the initial cohort nor 4 in booster cohort. Infections by treatment in initial cohort: 1% of treatment-native, 4% BTKi, 7% CD20 mAb + venetoclax, 9% BTKi + venetoclax. Infections in booster cohort: 24% of treatment-native, 28% BTKi, 33% CD20 mAb + venetoclax, 20% CD20 mAb + BTKi, 25% BTKi + venetoclax, 67% BTKi + venetoclax + CD20 mAb.

Treatment for COVID-19 was administered to 75% of infected pts in initial cohort; 63% in booster cohort. Therapies are listed in Table 2. Hospitalization rates amongst infected pts in the initial and booster cohorts were 38% (3/8) and 13% (4/32). Two pts required ICU stay in the initial cohort; 1 was intubated; whereas only 1 patient in the booster cohort required ICU but was not intubated. The median length of hospital stay was 8 days (range 5-30) for the initial cohort; 3 days (range 1-9) for the booster cohort. Three pts died of COVID-19 in the initial cohort; there were no deaths in the booster cohort.

Twenty percent of pts received tixagevimab/cilgavimab for COVID-19 prophylaxis in the initial cohort; 37% in booster cohort. All infections (8/8) occurred in the initial cohort prior to the receipt of tixagevimab/cilgavimab or in those who did not receive prophylaxis; 84% (27/32) in the booster cohort. Most pts developed COVID-19 after first booster (75%); 19% after second booster, 6% after third booster.

Several clinical features were evaluated as potential risk factors for infection: age, anti-S level, treatment, gender, vaccine brand. By univariate logistic regression models, none were found to be statistically predictive of infection. However, increasing values of anti-S levels were associated with a numerically decreased probability of infection in both cohorts: initial cohort OR 0.71 (95% CI 0.49-1.03), booster cohort OR 0.91 (95% CI 0.83-1.00).


In one of the largest and longest prospective evaluations of vaccinated pts with CLL, we noted the incidence of COVID-19 to rise from 3.3% in the initial cohort to 25% in the booster cohort, likely due to the emergence of new variants and reduction in social distancing practices. Shorter hospital stays and improved mortality reflect dominance of variants that cause less severe illness, use of anti-viral therapy, and improved measures in supporting critically ill pts, despite suboptimal utilization of prophylaxis. Higher levels of anti-S trended with lower rates of infection.

Disclosures: Ujjani: Lilly: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria; Pharmacyclics: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria; PCYC: Research Funding; Beigene: Consultancy, Honoraria; Kite, a Gilead Company: Consultancy, Other: Travel expenses , Research Funding; Astrazeneca: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy; Abbvie: Consultancy, Honoraria, Research Funding; Atara: Consultancy. Siddiqi: AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Beigene: 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; Gilead: Membership on an entity's Board of Directors or advisory committees. Stephens: AbbVie: Consultancy; AstraZeneca: Consultancy, Research Funding; BeiGene: Consultancy; Bristol-Myers Squibb: Consultancy; Celgene: Consultancy; Genentech: Consultancy; Janssen: Consultancy; Lilly: Consultancy; Novartis: Research Funding. Broome: Argenx; Incyte; Rigel; Sanofi; Star Therapeutics: Research Funding; Alexion; Dianthus: Consultancy. Lai: Daiichi: Consultancy; Pfizer: Consultancy; Novartis: Consultancy; Taiho: Consultancy; Astellas: Consultancy; Rigel: Consultancy; BMS: Consultancy; Genentech: Consultancy; Jazz: Consultancy, Research Funding; AbbVie: Consultancy. Winter: AstraZeneca: Consultancy; ADC Therapeutics: Consultancy; BeiGene: Consultancy; Seattle Genetics: Consultancy; Janssen: Consultancy. Greninger: Abbott: Other: contract testing; Cepheid: Other: contract testing; novavax: Other: contract testing; Pfizer: Other: contract testing; Janssen: Other: contract testing; Hologic: Other: contract testing; Gilead: Research Funding. Hill: moderna: Consultancy; allovir: Consultancy, Research Funding; deverra: Research Funding. O'Brien: Pharmacyclics: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Regeneron: Research Funding; Lilly: Consultancy, Research Funding; Johnson & Johnson: Consultancy; Janssen: Consultancy; Beigene: Consultancy, Research Funding; Astrazeneca: Consultancy; Abbvie: Consultancy. Davids: Merck: Consultancy; MEI Pharma: Research Funding; Janssen: Consultancy; Research to Practice: Consultancy; Mingsight Pharmaceuticals: Consultancy; Ascentage Pharma: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Eli Lilly: Consultancy; Secura Bio: Consultancy; AstraZeneca: Consultancy, Research Funding; Curio Science: Consultancy; Takeda: Consultancy; Surface Oncology: Research Funding; TG Therapeutics: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Novartis: Research Funding; ONO Pharmaceuticals: Consultancy; Adaptive Biosciences: Consultancy; Aptitude Health: Consultancy; BeiGene: Consultancy; BMS: Consultancy. Rogers: Beigene: Consultancy; Genentech: Consultancy, Research Funding; AstraZeneca: Consultancy; Janssen: Consultancy; Loxo@Lilly: Consultancy; Novartis: Research Funding; Pharmacyclics: Consultancy; AbbVie: Consultancy, Research Funding. Danilov: Abbvie: Consultancy, Research Funding; Bayer: Research Funding; Nurix: Consultancy, Research Funding; MEI: Consultancy, Research Funding; Lilly Oncology: Consultancy, Research Funding; Beigene: Consultancy, Research Funding; Cyclacel: Research Funding; Janssen: Consultancy; Astra Zeneca: Consultancy, Research Funding; Bristol Meyers Squibb: Consultancy, Research Funding; Genentech: Consultancy; GenMab: Consultancy, Research Funding; Merck: Consultancy. Wierda: National Comprehensive Cancer Network: Other: Nonrelevant Financial Relationship/Chair, CLL). Supported by the NIH/NCI under award number P30 CA016672 and used MDACC Cancer Center Support Grant (CCSG) shared resources; Janssens Biotech: Research Funding; GlaxoSmithKline: Research Funding; Juno Therapeutics: Research Funding; Nurix THerapeutics: Research Funding; Bristol Myers Squibb (Juno & Celgene): Consultancy, Research Funding; Gilead Sciences: Research Funding; Cyclacel: Consultancy, Research Funding; Loxo Oncology, Inc./Lilly: Research Funding; Janssens Biotech Inc: Research Funding; NIH P30 CA016672/MDACC Cancer Center Support Grant: Research Funding; Pharmacyclics LLC: Research Funding; Accutar Biotechnology: Research Funding; AbbVie: Consultancy, Research Funding; Genentech: Research Funding; AstraZeneca/Acerta Pharma: Consultancy, Research Funding; KITE Pharma: Research Funding; Sunesis: Research Funding; Miragen: Research Funding; Oncternal Therapeutics, Inc.: Research Funding; Numab THerapeutics: Research Funding; GSK/Novartis: Research Funding. Shadman: abbvie: Consultancy; genentech: Consultancy, Research Funding; pharmacyclics: Consultancy, Research Funding; beigene: Consultancy, Research Funding; Lilly: Consultancy; regeneron: Consultancy, Research Funding; AbbVie, Genentech, Inc., AstraZeneca, Pharmacyclics, BeiGene, BMS, MorphoSys/Incyte, Kite, Eli Lilly, Genmab, Mustang Bio, Regeneron, ADC therapeutics, Fate Therapeutics, Janssen, MEI Pharma: Consultancy; Mustang Bio, BMS, Pharmacyclics, Genentech, Inc., AbbVie,TG Therapeutics, BeiGene, AstraZeneca, Genmab, MorphoSys/Incyte, Vincerx: Research Funding. Thompson: genentech: Consultancy; janssen: Consultancy, Speakers Bureau; Lilly: Consultancy; merck: Consultancy, Speakers Bureau; pharmacyclics: Consultancy; beigene: Consultancy; astrazeneca: Consultancy, Speakers Bureau; adaptive biotechnologies: Consultancy, Research Funding, Speakers Bureau; abbvie: Consultancy.

*signifies non-member of ASH