Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February–June 2020; n = 769 (66%)) and later (July 2020–February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11–0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01–3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22–0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81–1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.

Background: Patients with B-lymphocyte malignancies (BCMs) receiving B-lymphocyte-targeted therapies have increased risk of severe COVID-19 outcomes and impaired antibody response to SARS-CoV-2 mRNA vaccination in comparison to non-hematologic oncologic patients or general population. Consequently, it is vital to explore vaccine-induced T-lymphocyte responses in patients referred for the understanding of immune protection against SARS-CoV2 infections. The objective of the present study was to analyze the recall immune responses carried out by T lymphocytes after two COVID-19 mRNA vaccine doses. Methods: We enrolled 40 patients with BCMs and 10 healthy controls (HCs) after 4 weeks from the second mRNA vaccine dose. Spike (S)-specific T-lymphocyte responses were assessed in peripheral blood mononuclear lymphocytes (PBMCs) by intracellular IFN-γ staining combined with flow cytometry. Furthermore, the humoral response was assessed with the measurement of anti-spike antibodies. Results: From March to July 2021, 40 patients (median age 68) received mRNA vaccines. The overall antibody response for BCMs was 52.5% versus 100% for the healthy controls (p = 0.008). The antibody response was different across BCMs: 18.75% for non-Hodgkin lymphoma, 54.5% for chronic lymphocytic leukemia, and 92.3% for multiple myeloma. Responses varied by malignancy type and treatment, with anti-CD20 therapies showing the lowest response (6.7%). T-lymphocyte analysis revealed reduced numbers and altered differentiation stages in patients compared to the controls. However, the vaccine-induced T response was generally robust, with variations in specific T subpopulations. Conclusions: mRNA vaccines induced significant humoral and cellular immune responses in B-cell lymphoid malignancy patients, although responses varied by treatment type and malignancy. Further research is needed to optimize vaccination strategies in this population.

Background: Preliminary studies on patients with COVID-19 and haematological malignancies (HM) show a high mortality in this population. The AMHH aimed to collect data from adult patients with HM. Objective: The primary outcome was mortality and evaluation of potential predictive parameters of mortality. Methods: This was a multicentre registry-based study with prospective data collection admitted to 27 Italian hospitals within the Madrid region between Feb 28 and May 25, 2020, with laboratory-confirmed and symptomatic COVID-19. This case series included consecutive patients with HM aged ≥18 years. Multivariable Cox proportional hazards model was used to identify factors associated with mortality. Results: Of 833 patients reported, 697 were enrolled with a median follow-up of 43 days (IQR 32-53). Median age was 72 years (IQR 60–79), 413 (60%) patients were male, and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Most (87%) patients were managed as inpatients. Overall, 230 (33%) of 697 patients died. When compared with the general population with COVID-19, the HM patients have 3-fold higher rates of mortality (33% vs 10%). In multivariable analyses, older age (hazard ratio 5.20, 95% CI 2.12–12.8); diagnosis of acute myeloid leukaemia (2.22, 1.31–3.74), recent use of cytotoxic chemotherapy (1.50, 0.99–2.29) or MoAb (2.02, 1.14–3.60), and severe or critical COVID-19 who did not receive antiviral therapy (HR 2.20, 95% CI 1.44-3.35) were associated with worse overall survival. Conclusion: This study adds to the evidence that patients with HM have worse outcomes than the general population with COVID-19. The high mortality among HM patients with these risk factors highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available.