Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration.

Autor:	Anand ST; VA Boston Cooperative Studies Program, Boston, Massachusetts., Vo AD; VA Boston Cooperative Studies Program, Boston, Massachusetts., La J; VA Boston Cooperative Studies Program, Boston, Massachusetts., Do NV; VA Boston Cooperative Studies Program, Boston, Massachusetts.; Boston University School of Medicine, Boston, Massachusetts.; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts., Fillmore NR; VA Boston Cooperative Studies Program, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Dana-Farber Cancer Institute, Boston, Massachusetts., Brophy M; VA Boston Cooperative Studies Program, Boston, Massachusetts.; Boston University School of Medicine, Boston, Massachusetts.; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts., Branch-Elliman W; VA Boston Cooperative Studies Program, Boston, Massachusetts.; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; VA Boston Center for Healthcare Organization and Implementation Research, Boston, Massachusetts., Monach PA; VA Boston Cooperative Studies Program, Boston, Massachusetts.; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Feb 05; Vol. 7 (2), pp. e240288. Date of Electronic Publication: 2024 Feb 05.
DOI:	10.1001/jamanetworkopen.2024.0288
Abstrakt:	Importance: With SARS-CoV-2 transforming into an endemic disease and with antiviral treatments available, it is important to establish which patients remain at risk of severe COVID-19 despite vaccination. Objective: To quantify the associations of clinical and demographic variables with odds of severe COVID-19 among patients with hematologic cancers. Design, Setting, and Participants: This case-control study included all patients with hematologic malignant neoplasms in the national Veterans Health Administration (VHA) who had documented SARS-CoV-2 infection after vaccination. Groups of patients with severe (cases) vs nonsevere (controls) COVID-19 were compared. Data were collected between January 1, 2020, and April 5, 2023, with data on infection collected between January 1, 2021, and September 30, 2022. All patients with diagnostic codes for hematologic malignant neoplasms who had documented vaccination followed by documented SARS-CoV-2 infection and for whom disease severity could be assessed were included. Data were analyzed from July 28 to December 30, 2023. Exposures: Clinical (comorbidities, predominant viral variant, treatment for malignant neoplasm, booster vaccination, and antiviral treatment) and demographic (age and sex) variables shown in prior studies to be associated with higher or lower rates of severe COVID-19. Comorbidities included Alzheimer disease or dementia, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart failure, and peripheral vascular disease. Main Outcome and Measures: The main outcome was severe COVID-19 compared with nonsevere SARS-CoV-2 infection. Severe COVID-19 was defined as death within 28 days, mechanical ventilation, or hospitalization with use of dexamethasone or evidence of hypoxemia or use of supplemental oxygen. Multivariable logistic regression was used to estimate the associations of demographic and clinical variables with the odds of severe COVID-19, expressed as adjusted odds ratios (aORs) with 95% CIs. Results: Among 6122 patients (5844 [95.5%] male, mean [SD] age, 70.89 [11.57] years), 1301 (21.3%) had severe COVID-19. Age (aOR per 1-year increase, 1.05; 95% CI, 1.04-1.06), treatment with antineoplastic or immune-suppressive drugs (eg, in combination with glucocorticoids: aOR, 2.32; 95% CI, 1.93-2.80), and comorbidities (aOR per comorbidity, 1.35; 95% CI, 1.29-1.43) were associated with higher odds of severe disease, whereas booster vaccination was associated with lower odds (aOR, 0.73; 95% CI, 0.62-0.86). After oral antiviral drugs became widely used in March 2022, 20 of 538 patients (3.7%) with SARS-CoV-2 infection during this period had progression to severe COVID-19. Conclusions and Relevance: In this case-control study of patients with hematologic cancers, odds of severe COVID-19 remained high through mid-2022 despite vaccination, especially in patients requiring treatment.
Databáze:	MEDLINE
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