Most people with cancer who are infected with COVID-19 produce antibodies at a rate comparable to the rest of the population—but their ability to do so depends on the type of malignancy and the treatments they’ve received, according to a new study published by Thakkar et al in Nature Cancer. The findings may lead to better care for patients with cancer, who face a heightened risk of dying from COVID-19, and suggests that these patients should respond well to COVID-19 vaccines. 

“We conducted the study out of our concern that patients with cancer who develop COVID-19 may not benefit from the same degree of antibody protection as people without cancer, given that many are immuno-compromised,” said first study author Astha Thakkar, MBBS, a hematologic oncology fellow at Montefiore Medical Center/Albert Einstein College of Medicine. “Our findings provide assurance that most people with cancer are able to mount an antibody response to the coronavirus that is similar to the general population. People with a history of cancer are likely as protected from reinfection as those without a history of disease and are likely to respond well to vaccines, according to our study.” 

Seroconversion Rates

The retrospective study involved 261 patients with cancer, 77% of whom were diagnosed with solid tumors and 23% with hematologic malignancies. The study participants were cared for at Montefiore between March 1, 2020, and September 15, 2020, and tested positive for COVID-19 through polymerase chain reaction tests to detect coronavirus or prior COVID-19 exposure through antibody testing, or both.

The patients had an average age of 64 years and were almost evenly split between men and women. About 56% of patients (147 of 261) had symptomatic coronavirus infection, while 44% (114 of 261) had an asymptomatic infection. More than 40% of patients were Black, 30% were Hispanic, nearly 15% were White, 3% were Asian, and 6% belonged to other ethnic groups.

Their overall rate of seroconversion—production of antibodies in response to infection—was 92%. However, when patients with solid tumors and blood malignancies were compared, patients with blood cancers had a seroconversion rate of only 81.7%—significantly lower than the 94.5% seroconversion rate for patients with solid tumors. 

“The treatments commonly given to patients with blood cancers—anti-CD20 antibody therapy, stem cell transplants, and steroids—are known to suppress the immune system, which may explain the lower rate of antibodies developed in these patients and their increased risk for severe COVID-19 disease,” said senior author Balazs Halmos, MD, MS, Director of the Multidisciplinary Thoracic Oncology Program at Montefiore, Professor of Medicine at Einstein, and a member of the Albert Einstein Cancer Center (AECC). 

“We need to pay special attention to patients with blood cancers and think through proactive strategies to ensure this patient population is appropriately cared for,” said study coauthor Sanjay Goel, MBBS, a medical oncologist at Montefiore, Professor of Medicine at Einstein, and a member of AECC. “This study also raises the need for additional research on COVID-19 vaccines and current treatments for people with blood cancer.” 

Disclosure: This study was supported in part by the Albert Einstein Cancer Center, the Jane A. and Myles P. Dempsey fund, and the Pelka family fund. For full disclosures of the study authors, visit nature.com.