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SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry

2023; Elsevier BV; Volume: 24; Issue: 4 Linguagem: Inglês

10.1016/s1470-2045(23)00056-6

1474-5488

Alessio Cortellini, Josep Tabernero, Uma Mukherjee, Ramón Salazar, Anna Sureda, Clara Maluquer, Daniela Ferrante, Mark Bower, Rachel Sharkey, Oriol Mirallas, Andrea Plaja, Marc Cucurull, Ricard Mesı́a, Alessia Dalla Pria, Thomas Newsom-Davis, Mieke Van Hemelrijck, Ailsa Sita-Lumsden, Eleanor Apthorp, Bruno Vincenzi, Giuseppina Rita Di Fazio, Giuseppe Tonini, Francesco Pantano, Alexia Bertuzzi, Sabrina Rossi, Joan Brunet, Matteo Lambertini, Paolo Pedrazzoli, Federica Biello, Francesca D’Avanzo, Alvin Lee, Marianne Shawe‐Taylor, Lucy Rogers, Cian Murphy, Lauren Cooper, Ramis Andaleeb, Saira Khalique, Samira Bawany, Sarah Ahmed, M Carmen Carmona-García, Roser Fort‐Culillas, Raquel Liñan, Federica Zoratto, Gianpiero Rizzo, Marta Perachino, Kris Doonga, Gianluca Gaïdano, Riccardo Bruna, Andrea Patriarca, Clara Martínez-Vila, Ignacio Pérez Criado, Raffaele Giusti, Francesca Mazzoni, Lorenzo Antonuzzo, Armando Santoro, Alessandro Parisi, Paola Queirolo, Avinash Aujayeb, Lorenza Rimassa, Nikolaos Diamantis, Rossella Bertulli, Claudia Angela Maria Fulgenzi, Antonio D’Alessio, Isabel Ruiz‐Camps, Nadia Saoudi, David Garcia Illescas, Irene García Medina, María Laura Fox, Alessandra Gennari, Juan Aguilar‐Company, David J. Pinato, Joanne S Evans, Judith Swallow, Georgina Hanbury, Chris Chung, Meera Patel, Gino Dettorre, Katherine Belessiotis, Dolly Saorise, Eleanor Jones, Eleanor Apthorp, Charlotte Moss, Beth Russell, Sarah Townsend, Amanda Jackson, Angela Loizidou, Martine Piccart, Fanny Pommeret, E. Colomba-Blameble, Aleix Prat, Claudia Andrea Cruz, Roxana Reyes, Elia Seguí, Javier Marco‐Hernández, Margarita Viladot, Nadia Harbeck, Rachel Wuerstlein, Franziska Henze, Sven Mahner, Eudald Felip, Lorenza Scotti, Andrea Marrari, Federica Grosso, Vittorio Fusco, Sara Delfanti, Maura Rossi, Alberto Zambelli, Carlo Tondini, Lorenzo Chiudinelli, Michela Franchi, Michela Libertini, Salvatore Provenzano, Daniele Generali, Salvatore Grisanti, Alice Baggi, Valeria Tovazzi, Corrado Ficorella, Giampiero Porzio, Maristella Saponara, Marco Filetti, Marco Tucci, Rossana Berardi, Luca Cantini, Francesco Paoloni, Annalisa Guida, Sergio Bracarda, María Iglesias, Ana Sánchez, Marco Tagliamento,

COVID-19 Clinical Research Studies

BackgroundCOVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2.MethodsOnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)–delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974.FindingsAt the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24–68) from COVID-19 diagnosis, were included (964 [50·7%] of 1902 patients with sex data were female and 938 [49·3%] were male). Overall, 317 (16·6%; 95% CI 14·8–18·5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the pre-vaccination phase (191 [19·1%; 95% CI 16·4–22·0] of 1000 patients). The prevalence was similar in the alpha–delta phase (110 [16·8%; 13·8–20·3] of 653 patients, p=0·24), but significantly lower in the omicron phase (16 [6·2%; 3·5–10·2] of 256 patients, p<0·0001). In the alpha–delta phase, 84 (18·3%; 95% CI 14·6–22·7) of 458 unvaccinated patients and three (9·4%; 1·9–27·3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7·4%; 95% CI 3·5–13·5] of 136 boosted patients, 18 [9·8%; 5·8–15·5] of 183 patients who had two vaccine doses vs 277 [18·5%; 16·5–20·9] of 1489 unvaccinated patients, p=0·0001), respiratory sequelae (six [4·4%; 1·6–9·6], 11 [6·0%; 3·0–10·7] vs 148 [9·9%; 8·4–11·6], p=0·030), and prolonged fatigue (three [2·2%; 0·1–6·4], ten [5·4%; 2·6–10·0] vs 115 [7·7%; 6·3–9·3], p=0·037).InterpretationUnvaccinated patients with cancer remain highly vulnerable to COVID-19 sequelae irrespective of viral strain. This study confirms the role of previous SARS-CoV-2 immunisation as an effective measure to protect patients from COVID-19 sequelae, disruption of therapy, and ensuing mortality.FundingUK National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.