Unboosted cancer patients have higher COVID-19 death risk

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In a new study from Brown University, researchers found vaccinated (but not boosted) people with cancer who have breakthrough COVID-19 infections remain at high risk for hospitalization and death.

They found that vaccinated patients who experienced breakthrough COVID-19 infections had a hospitalization rate of 65%, an ICU or mechanical ventilation rate of 19%, and a 13% death rate.

In the study, the team collected data for the study before booster vaccines were recommendation for patients with cancer by the US Centers for Disease Control and Prevention.

Similar high COVID-19 mortality rates among fully vaccinated individuals have been reported in other immunocompromised patient populations, such as organ transplant recipients, prior to the utilization of additional vaccine doses.

At the time the study was conducted, patients were considered fully vaccinated after having received two doses of either the Pfizer-BioNTech vaccine or the Moderna vaccine, or one dose of the Johnson & Johnson vaccine, with the last dose long enough before breakthrough COVID-19 to consider them fully vaccinated.

Researchers collected the data from November 2020 through May 2021, before booster vaccines were recommended by the CDC.

The team identified 1,787 patients with cancer and COVID-19 for the study, the vast majority of which were unvaccinated.

The number of fully vaccinated was 54, and 46% of those fully vaccinated had reduced levels of lymphocytes—the T cells and B cells responsible for immunological responses to viruses.

Lymphopenia commonly occurs in patients with cancer receiving anti-CD20 monoclonal antibodies or CAR-T-cell treatments for hematologic malignancies, including lymphoma and leukemia.

The study appears to support previous observations that patients with hematologic malignancies are at greater risk for severe outcomes from COVID-19.

Patients on a treatment regimen of corticosteroids also appeared to be more susceptible to hospitalization.

The team says it’s important to note that many of the same factors that prior to the availability of vaccination—age, comorbidities, performance status, and progressing cancer—still seem to drive many of the bad outcomes.

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The study is published in Annals of Oncology. One author of the study is Dimitrios Farmakiotis.

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