COVID-19 Vaccination Reduces Serious Disease, But Lymphoma Patients Continue to Be Vulnerable

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Patients with lymphoma can be immunocompromised due to their disease, anti-cancer therapy, and concomitant immunosuppressive treatments, which make them more vulnerable to developing a COVID-19 infection.

COVID-19 vaccination has been found to reduce the incidence of severe disease in the overall general population; however, vaccinated individuals with lymphoma may not achieve the same level of protection due to a failed antiviral immune response, according to the results of a review published in Hematological Oncology.1

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The study authors found that individuals with hematologic malignancies may be immunocompromised due to the cancer, anti-cancer therapy, and concomitant immunosuppressive treatments, which make them more vulnerable to developing a COVID-19 infection.1

In a study independent of the review, patients with lymphoma were found to present COVID-19 symptoms within a median of 5 to 6 days before hospitalization, with fever, cough, and dyspnea. Additionally, investigators found that the hospitalization rate for lymphoma subtypes were high.2

The goal of the review was to provide better guidance on helping manage patients with lymphoma for the diagnosis, treatment, and follow-up of the disease. The authors provided an overview of prognostic factors and the fatality rate for those with lymphoma who develop COVID-19, and then followed by reviewing prophylaxis options. Additionally, investigators added how to manage patients with lymphoma when they are exposed to COVID-19, the level of disease severity, and history of infection.1

According to the study authors, the reported overall mortality rate of those with lymphoma who got COVID-19 was more than 30% greater than those in the general population with COVID-19 and those with lymphoma without COVID-19. However, the study also found that there were no major consequences of disease course or mortality due to antineoplastic treatment at the time of COVID-19 diagnosis or in the few months prior to diagnosis.1

For vaccination, there were a lack of documented data of patients with lymphoma who were vaccinated against COVID-19; however, data in the review showed that individuals with cancer who developed COVID-19 still had a substantial risk of comorbidity and death, even after full vaccination.1

The study authors found that the risk factors included older age, a single vaccine dose without previous COVID-19, and anti-CD20 therapy in the previous 3 months. After the review, investigators determined that vaccination does reduce mortality rate when compared to pre-vaccination, but these individuals continue to be vulnerable.1

In one study used in the review, investigators determined that there was a large proportion of individuals with lymphoma who failed to respond to the mRNA vaccines, but all individuals without lymphoma had a response to the vaccine.1

Investigators also found that those who were treatment naïve or who discontinued treatment for more than 2 years responsed to vaccination similarly to the control group. Another study had similar results, according to the review authors.1

Furthermore, investigators added that the efficacy of COVID-19 booster vaccinations for patients with lymphoma was beneficial for those who did not achieve seroconversion after completing the vaccination series. Another study analyzed for the review showed that more than half of the individuals who completed the vaccination series and did not achieve seroconversion did so after administration of a booster dose.1

Investigators suggested antiviral agents and monoclonal antibodies should be used to prevent the progression of severe-critical COVID-19 in this patient population. They added that the combination of tixagevimab-cilgavimab can be used for pre-exposure prophylaxis of COVID-19.1

Finally, investigators call for more research on the use of monoclonal antibodies and antiviral agents for this patient population.1

References

  1. Passamonti F, Nicastri E, Di Rocco A, Guarini A, et al. Management of patients with lymphoma and COVID-19: Narrative review and evidence-based practical recommendations. Hematol Oncol. 2023;41(1):3-15. doi:10.1002/hon.3086
  2. Bonuomo V, Ferrarini I, Dell'Eva M, Sbisà E, Krampera M, Visco C. COVID-19 (SARS-CoV-2 infection) in lymphoma patients: a review. World J Virol. 2021;10(6):312-325. doi:10.5501/wjv.v10.i6.312
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