New Study: COVID-19 Breakthrough Cases Can Be A Serious Threat to Blood Cancer Patients, Including Me

As a journalist and three-time survivor of stage IV non-Hodgkin's lymphoma who is "immunocompromised," according to my oncologist, I've been reporting on the heightened threat that Covid-19 poses for lymphoma patients with great interest, and admittedly some anxiety.

As they say, denial ain't just a river in Egypt. I can neither run nor hide from the fact that there are now multiple studies worldwide showing that people with lymphoma and other blood cancers are at a substantially higher risk than healthy individuals for severe and life-threatening COVID-19 illness, and research suggests that lymphoma patients don't always achieve optimal protection from vaccination. 

A new American Society of Hematology Blood study, the first to report on post-vaccination COVID-19 cases in patients with blood cancer, offers preliminary findings about the incidence of so-called "breakthrough infection" among my fellow blood cancer patients. 

Breakthrough infection refers to people who are fully vaccinated but still get Covid-19.

The study drew data from an open online registry, EPICOVIDEHA, which collects reports of patients with blood cancers who developed COVID-19 infection. 

As of August 31, out of the 4,000 total cases in the registry, there were 113 reported cases of COVID-19 occurring after vaccination. 

More than three out of four of these breakthrough cases occurred in patients who were fully vaccinated with either the AstraZeneca vaccine or the mRNA vaccines such as Moderna or Pfizer. 

Approximately 23% had been partially vaccinated, receiving just one dose of an mRNA vaccine, when they became infected with COVID-19. 

Within the group of breakthrough cases, 79 patients experienced severe or critical COVID-19 infection, with 75 needing to be hospitalized. 

After a follow-up of 30 days post-COVID-19 diagnosis, 14 (12.4%) patients died, and COVID-19 was deemed the cause of death for all but one of those individuals. 

The study researchers emphasize that although the mortality rate in patients with breakthrough COVID-19 cases was high, it was still much lower than before vaccines were available. 

In an interview with The Reno Dispatch, study author Livio Pagano (right), MD, of the Università Cattolica del Sacro Cuore in Italy, told me, “Vaccines have significantly lowered the overall mortality rate in our patients with hematologic malignancies. Still, some patients are not showing a full protective response from vaccination, so it is important that we understand which patients are more susceptible to breakthrough infection so we can investigate how to protect them.”

This gives me some comfort, if not a lot. 

As for why lymphomas are harder hit by COVID-19 breakthrough cases, Pagano explained, “The majority of patients who do not respond to vaccination are those with lympho-proliferative disease such as lymphomas and multiple myeloma."

Pagano said these patients are often immunocompromised due to altered functionality of lymphocytes -- both from the underlying malignancy and the chemo-immune treatments -- so they do not always receive optimal protection from the vaccines.

"These patients appear to be more vulnerable to breakthrough COVID-19 infection," he said. "Patients with lymphomas are advised, even after getting the vaccine, to continue supportive measures such as wearing masks, washing hands, and reducing physical contact with other people.”

Previous studies using the registry’s data reported that during the pre-vaccination period of the pandemic, people with blood cancers and COVID-19 had mortality rates ranging from 30% to 50% (depending on type of underlying blood cancer).

“Before vaccination, if our patients with hematologic malignancies [blood cancers] developed COVID-19, they died in a lot of cases,” Pagano said in a press statement. 

“With these preliminary data, we showed that vaccination is not able to completely protect, but surely it has a strong role in reducing the mortality for COVID-19 for people with blood cancers.”

The study also found that the level of COVID-19 vaccine response was associated with the type of underlying blood cancer. 

People with myeloproliferative disorders (disorders of red blood cells and platelets) were the least likely to develop COVID-19 after vaccination, and people with lymphoproliferative disorders (disorders of lymphocytes, the white blood cells of the immune system) were the most likely. 

Of the 113 breakthrough COVID-19 cases, 80% occurred in people with lymphoproliferative conditions such as chronic lymphocytic leukemia, non-Hodgkin's lymphoma, Hodgkin's lymphoma, and multiple myeloma.

“Unfortunately, people with lymphomas are more likely to have suppressed immune systems and to develop infections, and it is no different for COVID-19,” said Dr. Pagano. 

“In future studies we will look at the efficacy of additional vaccine doses to understand if they can reduce infection in our patients, especially those with lymphoproliferative disorders.”

The type of COVID-19 vaccine did not affect the risk of breakthrough cases. 

Approximately 70% of the patients in this study received an mRNA vaccine such as the Moderna or Pfizer vaccine, and the remaining patients received the AstraZeneca vector-based vaccine or the Sinovac inactivated vaccine. 

There was no significant difference in the prevention of COVID-19 between these two groups.

“The key message is that we must make a great effort to vaccinate as many people as we can,” said Pagano. 

“We can’t only vaccinate our patients with hematologic malignancies; it is also important to vaccinate their caregivers so we can form a barrier of protection around them, because their own immunity from the vaccine is not enough.”

These are important facts that we all deserve and need to know. But they are sometimes hard for me to read and even harder to acknowledge.