Hackensack Meridian John Theurer Cancer Center investigators have published one of the first reports regarding real-world outcomes of people with lymphoma who contracted COVID-19 during the era of modern treatments and vaccination. They found that the rate of death due to COVID-19 during the omicron surge among people with lymphoma dropped compared to the mortality rate observed prior to the use of monoclonal antibody therapies and vaccines (referred to as the “pre-intervention era”). However, they also found that nearly three-fourths of patients with lymphoma who were hospitalized due to COVID-19 did not receive monoclonal antibody treatment. The findings, which were published in the August 31, 2022 issue of the journal Cancers, highlight the need for a new approach to treating people with cancer who become infected with COVID-19.
“Our data show that the mortality rate due to COVID-19 during the omicron surge in lymphoma patients is comparably lower than the rate reported during the pre-intervention era. This improvement may be attributed to modern therapeutic interventions, such as COVID-19 vaccinations and monoclonal antibody treatments,” said lead author Alexandra Della Pia, PharmD, clinical pharmacy specialist in the Lymphoma Division at Hackensack Meridian John Theurer Cancer Center.
“Given the known differences in cancer patients, particularly lymphoma patients, in their ability to fight infection, it is important to optimize our COVID-19 approach in this immunocompromised population considering available vaccinations as well as both antiviral and monoclonal antibody therapies including preemptive tixagevimab combination cilgavimab that can protect for up to six months.
People receiving treatments for cancer that lower immunity are at increased risk of more severe COVID-19 and have a higher risk of death should they become infected. Patients with lymphoma already have a reduced immune response even before cancer treatment because the disease causes dysfunction in the immune system, which translates to impaired production of antibodies during COVID-19 infection. Although vaccines and monoclonal antibody treatments have been shown in studies to be highly effective for reducing the severity of COVID-19 infection and lowering the risk of hospitalization and death, these clinical trials excluded people with cancer and did not consider differences in the disease course of COVID-19 in immunocompromised patients.
This retrospective study looked back at the outcomes of 68 people with lymphoma or chronic lymphocytic leukemia (CLL, which is similar to a subtype of lymphoma called SLL) at Hackensack University Medical Center who developed COVID-19 during the omicron surge in the United States. The mortality rate from COVID-19 was 9% for all patients (a decline from 34% reported in the pre-intervention era) and 26% for hospitalized patients (versus 60.2% pre-intervention).
For 30 patients in whom serological data were available, 60% did not develop antibodies after COVID-19 vaccination. Although no difference in mortality or hospitalization between vaccinated and unvaccinated people with lymphoma was found, all patients with serologic data available who were hospitalized or died from COVID-19 were negative for antibodies following vaccination. However, among the patients who did develop antibodies, none of them required hospitalization, indicating that it still remains vitally important to vaccinate patients with lymphoma and CLL against COVID-19.
Among the 34% of patients who were hospitalized, 74% did not receive monoclonal antibody treatment for COVID-19. The researchers emphasized that monoclonal antibody treatment for COVID-19 is critically important to compensate for the suboptimal immune response in people with lymphoma or CLL, since their disease and its treatment suppress immunity.
“As the COVID-19 pandemic continues to evolve with new variants, so does the complexity of managing patients with blood cancers such as lymphoma and CLL, who are particularly susceptible to severe disease,” concluded senior author Tatyana Feldman, M.D., a lymphoma expert at Hackensack Meridian John Theurer Cancer Center. “Additional studies are needed to better understand the scheduling and benefit of repeat COVID-19 vaccinations in people with cancer so we can optimize the prevention and treatment of the infection in these patients.”