1
|
Bytyci J, Ying Y, Lee LYW. Immunocompromised individuals are at increased risk of COVID-19 breakthrough infection, hospitalization, and death in the post-vaccination era: A systematic review. Immun Inflamm Dis 2024; 12:e1259. [PMID: 38661301 PMCID: PMC11044684 DOI: 10.1002/iid3.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Immunocompromised individuals have been shown to mount a reduced response to vaccination, resulting in reduced vaccine effectiveness in this cohort. Therefore, in the postvaccination era, immunocompromised individuals remain at high risk of breakthrough infection and COVID-19 related hospitalization and death, which persist despite vaccination efforts. There has been a marked paucity of systematic reviews evaluating existing data describing the clinical measures of efficacy of COVID-19 vaccination, specifically in immunocompromised populations. In particular, there is a scarcity of comprehensive evaluations exploring breakthrough infections and severe COVID-19 in this patient population. METHODS To address this gap, we conducted a systematic review which aimed to provide a summary of current clinical evidence of the effectiveness of COVID-19 vaccination in the immunocompromised population. Using PRISMA guidelines, we conducted a literature search on PubMed and the Cochrane database published between January 1, 2021 to September 1, 2022. RESULTS Our findings demonstrated that despite vaccination, immunocompromised patients remained at high risk of new breakthrough COVID-19 infection and severe COVID-19 outcomes compared to the general population. We found increased average relative risk (RR) of breakthrough infections in the immunocompromised population, including patients with cancer (RR = 1.4), HIV (RR = 1.92), chronic kidney disease (RR = 2.26), immunodeficiency (RR = 2.55), and organ transplant recipients (RR = 6.94). These patients are also at greater risk for hospitalizations and death following COVID-19 breakthrough infection. We found that the RR of hospitalization and death in Cancer patients was 1.08 and 2.82, respectively. CONCLUSION This demonstrated that vaccination does not offer an adequate level of protection in these groups, necessitating further measures such as Evusheld and further boosters.
Collapse
Affiliation(s)
- Jola Bytyci
- Oxford Medical SchoolUniversity of OxfordOxfordUK
| | - Yuxin Ying
- Oxford Medical SchoolUniversity of OxfordOxfordUK
| | - Lennard Y. W. Lee
- Institute of Cancer and Genomic 22 SciencesUniversity of BirminghamBirminghamUK
- Department of OncologyUniversity of OxfordOxfordUnited Kingdom
| |
Collapse
|
2
|
Jones RP, Lee LYW, Corrie PG, Danson S, Vimalachandran D. Individualized cancer vaccines versus surveillance after adjuvant chemotherapy for surgically resected high-risk stage 2 and stage 3 colorectal cancer: protocol for a randomized trial. Br J Surg 2023; 110:1883-1884. [PMID: 37856683 DOI: 10.1093/bjs/znad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Robert P Jones
- Department of Molecular & Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Pippa G Corrie
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah Danson
- Department of Oncology, University of Sheffield, Western Bank, Sheffield, UK
| | - Dale Vimalachandran
- Department of Molecular & Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, Chester, UK
| |
Collapse
|
3
|
Starkey T, Ionescu MC, Tilby M, Little M, Burke E, Fittall MW, Khan S, Liu JKH, Platt JR, Mew R, Tripathy AR, Watts I, Williams ST, Appanna N, Al-Hajji Y, Barnard M, Benny L, Burnett A, Bytyci J, Cattell EL, Cheng V, Clark JJ, Eastlake L, Gerrand K, Ghafoor Q, Grumett S, Harper-Wynne C, Kahn R, Lee AJX, Lomas O, Lydon A, Mckenzie H, Panneerselvam H, Pascoe JS, Patel G, Patel V, Potter VA, Randle A, Rigg AS, Robinson TM, Roylance R, Roques TW, Rozmanowski S, Roux RL, Shah K, Sheehan R, Sintler M, Swarup S, Taylor H, Tillett T, Tuthill M, Williams S, Ying Y, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fowler T, Johnson P, Lee LYW. A population-scale temporal case-control evaluation of COVID-19 disease phenotype and related outcome rates in patients with cancer in England (UKCCP). Sci Rep 2023; 13:11327. [PMID: 37491478 PMCID: PMC10368624 DOI: 10.1038/s41598-023-36990-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.
Collapse
Affiliation(s)
- Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Emma Burke
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sam Khan
- University of Leicester, Leicester, UK
| | | | - James R Platt
- Leeds Institute of Medical Research at St James's, Leeds, UK
| | - Rosie Mew
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | | | | | | | | | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | | | - Jola Bytyci
- Department of Oncology, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Grumett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Oliver Lomas
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna Lydon
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Hayley Mckenzie
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Jennifer S Pascoe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Vanessa A Potter
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Anne S Rigg
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tom W Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - René L Roux
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ketan Shah
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Remarez Sheehan
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Martin Sintler
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | - Mark Tuthill
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sarah Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Yuxin Ying
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Tim Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Siow Ming Lee
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Protheroe
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Fowler
- UK Health Security Agency, London, UK
- William Harvey Research Institute, London, UK
| | | | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
| |
Collapse
|
4
|
Starkey T, Tilby M, Lee LYW. Association of SARS-CoV-2 Antibody Level With Risk of Infection or Hospitalization-Reply. JAMA Oncol 2023; 9:871. [PMID: 37103944 DOI: 10.1001/jamaoncol.2023.0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Fittall M, Liu J, Platt J, Ionescu M, Sheehan R, Johal S, Mew R, Clark J, Watts I, Tripathy A, Little M, Patel G, Panneerselvam H, Appanna N, Burke E, McKenzie H, Tilby M, Khan S, Lee LYW. The National COVID Cancer Antibody Survey: a hyper-accelerated study proof of principle for cancer research. Br J Cancer 2023; 128:1977-1980. [PMID: 37081188 PMCID: PMC10118226 DOI: 10.1038/s41416-023-02251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
The COVID-19 pandemic has led to a range of novel and adaptive research designs. In this perspective, we use our experience coordinating the National COVID Cancer Antibody Survey to demonstrate how a balance between speed and integrity can be achieved within a hyper-accelerated study design. Using the COVID-19 pandemic as an example, we show this approach is necessary in the face of uncertain and evolving situations wherein reliable information is needed in a timely fashion to guide policy. We identify streamlined participant involvement, healthcare systems integration, data architecture and real-world real-time analytics as key areas that differentiate this design from traditional cancer trials, and enable rapid results. Caution needs to be taken to avoid the exclusion of patient subgroups without digital access or literacy. We summarise the merits and defining features of hyper-accelerated cancer studies.
Collapse
Affiliation(s)
- Matthew Fittall
- Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Justin Liu
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - James Platt
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS9 7TF, UK
| | - Maria Ionescu
- UK Health Security Agency, Fleetbank House, London, EC4Y 8AE, UK
| | | | | | - Rosie Mew
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - James Clark
- Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Izzy Watts
- University College Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Arvind Tripathy
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | | | - Grisma Patel
- Maidstone and Tunbridge Wells NHS Trust, Kent, TN2 4QJ, UK
| | | | | | - Emma Burke
- Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Hayley McKenzie
- University Hospital Southampton NHS Foundation Trust, Hampshire, SO16 6YD, UK
| | - Michael Tilby
- University Hospital Coventry, UHCW NHS Trust, Coventry, CV2 2DX, UK
| | - Sam Khan
- University of Leicester, Leicester, LE1 7RH, UK
| | - Lennard Y W Lee
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, EX2 5DW, UK.
| |
Collapse
|
6
|
Suribhatla R, Starkey T, Ionescu MC, Pagliuca A, Richter A, Lee LYW. Systematic review and meta-analysis of the clinical effectiveness of tixagevimab/cilgavimab for prophylaxis of COVID-19 in immunocompromised patients. Br J Haematol 2023; 201:813-823. [PMID: 37006158 DOI: 10.1111/bjh.18782] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
Immunocompromised patients, such as those with a haematological malignancy, are at higher risk of SARS-CoV-2 infection, severe outcomes and mortality. Tixagevimab/cilgavimab is a monoclonal antibody combination which binds to the SARS-CoV-2 spike protein. The PROVENT phase III clinical trial reported that tixagevimab/cilgavimab prophylaxis significantly reduced the risk of COVID-19 infection in immunocompromised participants. However, the trial was conducted before the Omicron variant became prevalent. This systematic review and meta-analysis provide an up-to-date summary of the real-world effectiveness of tixagevimab/cilgavimab in immunocompromised patients, including patients with haematological malignancies. Clinical studies from 1 January 2021 to 1 October 2022, which reported breakthrough COVID-19 infections after tixagevimab/cilgavimab, were included. COVID-19-related hospitalisations, intensive care admissions and mortality were also assessed. A meta-analysis was performed to ascertain overall clinical effectiveness. Eighteen studies, with 25 345 immunocompromised participants, including 5438 patients with haematological pathologies, were included in the review. The overall clinical effectiveness of tixagevimab/cilgavimab against COVID-19 breakthrough infection, hospitalisation, intensive care admission and COVID-19-specific mortality was 40.54%, 66.19%, 82.13% and 92.39%, respectively. This review highlights the clinical effectiveness of tixagevimab/cilgavimab at reducing COVID-19 infection and severe outcomes for immunosuppressed individuals, including patients with a haematological malignancy, during the Omicron-predominant era. Real-world studies are important to provide ongoing certainty of the clinical benefit for immunocompromised patients against new SARS-CoV-2 variants.
Collapse
Affiliation(s)
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University of Oxford, Oxford, UK
| |
Collapse
|
7
|
Appanna N, Patel G, Burke E, Burnett A, Clark J, Mew R, Khan S, Little M, Liu J, Panneerselvam H, Patel V, Platt J, Tilby M, Watts I, Harper‐Wynne C, Lee LYW. Safe prescribing in cancer patients during the COVID-19 pandemic: A new initiative from the UK Cancer Coronavirus Project (UKCCP) team. Int J Cancer 2023; 152:1275-1277. [PMID: 36454180 PMCID: PMC9877804 DOI: 10.1002/ijc.34387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022]
Affiliation(s)
| | - Grisma Patel
- Cancer Division, UCL Cancer Institute, University College LondonLondonUK
| | - Emma Burke
- Oxford University Hospitals NHS TrustLondonUK
| | | | - James Clark
- Department of Surgery and Cancer, Imperial College LondonLondonUK
| | - Rosie Mew
- Royal Devon and Exeter NHS Foundation TrustExeterUK
| | - Sam Khan
- Leicester Cancer Research Centre, University of LeicesterLeicesterUK
| | | | - Justin Liu
- Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | | | | | - James Platt
- Leeds Institute of Medical Research at St James's, University of LeedsLeedsUK
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Isabella Watts
- Department of Academic Oncology, Royal Free HospitalLondonUK
| | | | | |
Collapse
|
8
|
Lee LYW, Tilby M, Starkey T, Ionescu MC, Burnett A, Hattersley R, Khan S, Little M, Liu JKH, Platt JR, Tripathy A, Watts I, Williams ST, Appanna N, Al-Hajji Y, Barnard M, Benny L, Buckley A, Cattell E, Cheng V, Clark J, Eastlake L, Gerrand K, Ghafoor Q, Grumett S, Harper-Wynne C, Kahn R, Lee AJX, Lydon A, McKenzie H, Panneerselvam H, Pascoe J, Patel G, Patel V, Potter V, Randle A, Rigg AS, Robinson T, Roylance R, Roques T, Rozmanowski S, Roux RL, Shah K, Sintler M, Taylor H, Tillett T, Tuthill M, Williams S, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe AS, Fittall MW, Fowler T, Johnson P. Association of SARS-CoV-2 Spike Protein Antibody Vaccine Response With Infection Severity in Patients With Cancer: A National COVID Cancer Cross-sectional Evaluation. JAMA Oncol 2023; 9:188-196. [PMID: 36547970 PMCID: PMC9936347 DOI: 10.1001/jamaoncol.2022.5974] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/01/2022] [Indexed: 12/24/2022]
Abstract
Importance Accurate identification of patient groups with the lowest level of protection following COVID-19 vaccination is important to better target resources and interventions for the most vulnerable populations. It is not known whether SARS-CoV-2 antibody testing has clinical utility for high-risk groups, such as people with cancer. Objective To evaluate whether spike protein antibody vaccine response (COV-S) following COVID-19 vaccination is associated with the risk of SARS-CoV-2 breakthrough infection or hospitalization among patients with cancer. Design, Setting, and Participants This was a population-based cross-sectional study of patients with cancer from the UK as part of the National COVID Cancer Antibody Survey. Adults with a known or reported cancer diagnosis who had completed their primary SARS-CoV-2 vaccination schedule were included. This analysis ran from September 1, 2021, to March 4, 2022, a period covering the expansion of the UK's third-dose vaccination booster program. Interventions Anti-SARS-CoV-2 COV-S antibody test (Elecsys; Roche). Main Outcomes and Measures Odds of SARS-CoV-2 breakthrough infection and COVID-19 hospitalization. Results The evaluation comprised 4249 antibody test results from 3555 patients with cancer and 294 230 test results from 225 272 individuals in the noncancer population. The overall cohort of 228 827 individuals (patients with cancer and the noncancer population) comprised 298 479 antibody tests. The median age of the cohort was in the age band of 40 and 49 years and included 182 741 test results (61.22%) from women and 115 737 (38.78%) from men. There were 279 721 tests (93.72%) taken by individuals identifying as White or White British. Patients with cancer were more likely to have undetectable anti-S antibody responses than the general population (199 of 4249 test results [4.68%] vs 376 of 294 230 [0.13%]; P < .001). Patients with leukemia or lymphoma had the lowest antibody titers. In the cancer cohort, following multivariable correction, patients who had an undetectable antibody response were at much greater risk for SARS-CoV-2 breakthrough infection (odds ratio [OR], 3.05; 95% CI, 1.96-4.72; P < .001) and SARS-CoV-2-related hospitalization (OR, 6.48; 95% CI, 3.31-12.67; P < .001) than individuals who had a positive antibody response. Conclusions and Relevance The findings of this cross-sectional study suggest that COV-S antibody testing allows the identification of patients with cancer who have the lowest level of antibody-derived protection from COVID-19. This study supports larger evaluations of SARS-CoV-2 antibody testing. Prevention of SARS-CoV-2 transmission to patients with cancer should be prioritized to minimize impact on cancer treatments and maximize quality of life for individuals with cancer during the ongoing pandemic.
Collapse
Affiliation(s)
- Lennard Y. W. Lee
- Department of Oncology, University of Oxford, Oxford, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Michael Tilby
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Alex Burnett
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Rosie Hattersley
- Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom
| | - Sam Khan
- University of Leicester, Leicester, United Kingdom
| | - Martin Little
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - James R. Platt
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Arvind Tripathy
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | | | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom
| | | | - Liza Benny
- UK Health Security Agency, London, United Kingdom
| | | | | | - Vinton Cheng
- University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - James Clark
- Imperial College London, London, United Kingdom
| | | | - Kate Gerrand
- UK Health Security Agency, London, United Kingdom
| | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Simon Grumett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Anna Lydon
- Torbay and South Devon NHS Trust, Torquay, United Kingdom
| | - Hayley McKenzie
- University Hospital Southampton, Southampton, United Kingdom
| | | | - Jennifer Pascoe
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Vanessa Potter
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | | | - Anne S. Rigg
- Guy's and St Thomas' Hospitals NHS Trust, London, United Kingdom
| | | | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, United Kingdom
| | | | - René L. Roux
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ketan Shah
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Martin Sintler
- Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Harriet Taylor
- Oxford Medical School, University of Oxford, Oxford, United Kingdom
| | | | - Mark Tuthill
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarah Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tim Iveson
- Department of Oncology, Southampton University Hospitals, Southampton, United Kingdom
| | - Siow Ming Lee
- UCLH/CRUK Lung Cancer Centre of Excellence, London, United Kingdom
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Andrew S. Protheroe
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
| | | | - Tom Fowler
- William Harvey Research Institute, London, United Kingdom
| | | |
Collapse
|
9
|
Lee LYW, Ionescu MC, Starkey T, Little M, Tilby M, Tripathy AR, Mckenzie HS, Al-Hajji Y, Appanna N, Barnard M, Benny L, Burnett A, Cattell EL, Clark JJ, Khan S, Ghafoor Q, Panneerselvam H, Illsley G, Harper-Wynne C, Hattersley RJ, Lee AJ, Lomas O, Liu JK, McCauley A, Pang M, Pascoe JS, Platt JR, Patel G, Patel V, Potter VA, Randle A, Rigg AS, Robinson TM, Roques TW, Roux RL, Rozmanowski S, Taylor H, Tuthill MH, Watts I, Williams S, Beggs A, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fittall MW, Fowler T, Johnson P. COVID-19: Third dose booster vaccine effectiveness against breakthrough coronavirus infection, hospitalisations and death in patients with cancer: A population-based study. Eur J Cancer 2022; 175:1-10. [PMID: 36084618 PMCID: PMC9276646 DOI: 10.1016/j.ejca.2022.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE People living with cancer and haematological malignancies are at an increased risk of hospitalisation and death following infection with acute respiratory syndrome coronavirus 2. Coronavirus third dose vaccine boosters are proposed to boost waning immune responses in immunocompromised individuals and increase coronavirus protection; however, their effectiveness has not yet been systematically evaluated. METHODS This study is a population-scale real-world evaluation of the United Kingdom's third dose vaccine booster programme for cancer patients from 8th December 2020 to 7th December 2021. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years. A test-negative case-control design was used to assess the third dose booster vaccine effectiveness. Multivariable logistic regression models were fitted to compare risk in the cancer cohort relative to the general population. RESULTS The cancer cohort comprised of 2,258,553 tests from 361,098 individuals. Third dose boosters were evaluated by reference to 87,039,743 polymerase chain reaction coronavirus tests. Vaccine effectiveness against breakthrough infections, symptomatic infections, coronavirus hospitalisation and death in cancer patients were 59.1%, 62.8%, 80.5% and 94.5%, respectively. Lower vaccine effectiveness was associated with a cancer diagnosis within 12 months, lymphoma, recent systemic anti-cancer therapy (SACT) or radiotherapy. Patients with lymphoma had low levels of protection from symptomatic disease. In spite of third dose boosters, following multivariable adjustment, individuals with cancer remain at an increased risk of coronavirus hospitalisation and death compared to the population control (OR 3.38, 3.01, respectively. p < 0.001 for both). CONCLUSIONS Third dose boosters are effective for most individuals with cancer, increasing protection from coronavirus. However, their effectiveness is heterogenous and lower than the general population. Many patients with cancer will remain at the increased risk of coronavirus infections even after 3 doses. In the case of patients with lymphoma, there is a particularly strong disparity of vaccine effectiveness against breakthrough infection and severe disease. Breakthrough infections will disrupt cancer care and treatment with potentially adverse consequences on survival outcomes. The data support the role of vaccine boosters in preventing severe disease, and further pharmacological intervention to prevent transmission and aid viral clearance to limit the disruption of cancer care as the delivery of care continues to evolve during the coronavirus pandemic.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University of Oxford; Institute of Cancer and Genomic Sciences, University of Birmingham; Institute of Immunology and Immunotherapy, University of Birmingham.
| | | | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham
| | - Martin Little
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Arvind R Tripathy
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Hayley S Mckenzie
- Oncology Department, University Hospitals Southampton NHS Foundation Trust
| | | | | | | | | | | | - Emma L Cattell
- Department of Cancer, Taunton and Somerset NHS Foundation Trust
| | - James J Clark
- Department of Surgery and Cancer, Imperial College London
| | - Sam Khan
- Leicester Cancer Research Centre, University of Leicester
| | - Qamar Ghafoor
- University Hospitals Birmingham NHS Foundation Trust
| | | | | | | | | | - Alvin Jx Lee
- UCL Cancer Institute, University College London; University College London Hospitals NHS Trust
| | - Oliver Lomas
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Justin Kh Liu
- Leeds Institute of Medical Research at St James's, University of Leeds
| | | | | | - Jennifer S Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - James R Platt
- Leeds Institute of Medical Research at St James's, University of Leeds
| | - Grisma Patel
- Cancer Division, UCL Cancer Institute, University College London
| | | | - Vanessa A Potter
- Department of Oncology, University Hospital Coventry and Warwickshire
| | | | - Anne S Rigg
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust
| | | | - Tom W Roques
- Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - René L Roux
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | | | - Mark H Tuthill
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | - Andrew Beggs
- Institute of Cancer and Genomic Sciences, University of Birmingham
| | - Tim Iveson
- Cancer Sciences, University of Southampton
| | - Siow M Lee
- UCL Cancer Institute, University College London; University College London Hospitals NHS Trust; CRUK Lung Cancer Centre of Excellence, University College London
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust
| | | | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust
| | | | | | - Peter Johnson
- Department of Oncology, University Hospital Coventry and Warwickshire; Cancer Sciences, University of Southampton
| |
Collapse
|
10
|
Lee LYW, Starkey T, Ionescu MC, Little M, Tilby M, Tripathy AR, Mckenzie HS, Al-Hajji Y, Barnard M, Benny L, Burnett A, Cattell EL, Charman J, Clark JJ, Khan S, Ghafoor Q, Illsley G, Harper-Wynne C, Hattersley RJ, Lee AJX, Leonard PC, Liu JKH, Pang M, Pascoe JS, Platt JR, Potter VA, Randle A, Rigg AS, Robinson TM, Roques TW, Roux RL, Rozmanowski S, Tuthill MH, Watts I, Williams S, Iveson T, Lee SM, Middleton G, Middleton M, Protheroe A, Fittall MW, Fowler T, Johnson P. Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study. Lancet Oncol 2022; 23:748-757. [PMID: 35617989 PMCID: PMC9126559 DOI: 10.1016/s1470-2045(22)00202-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND People with cancer are at increased risk of hospitalisation and death following infection with SARS-CoV-2. Therefore, we aimed to conduct one of the first evaluations of vaccine effectiveness against breakthrough SARS-CoV-2 infections in patients with cancer at a population level. METHODS In this population-based test-negative case-control study of the UK Coronavirus Cancer Evaluation Project (UKCCEP), we extracted data from the UKCCEP registry on all SARS-CoV-2 PCR test results (from the Second Generation Surveillance System), vaccination records (from the National Immunisation Management Service), patient demographics, and cancer records from England, UK, from Dec 8, 2020, to Oct 15, 2021. Adults (aged ≥18 years) with cancer in the UKCCEP registry were identified via Public Health England's Rapid Cancer Registration Dataset between Jan 1, 2018, and April 30, 2021, and comprised the cancer cohort. We constructed a control population cohort from adults with PCR tests in the UKCCEP registry who were not contained within the Rapid Cancer Registration Dataset. The coprimary endpoints were overall vaccine effectiveness against breakthrough infections after the second dose (positive PCR COVID-19 test) and vaccine effectiveness against breakthrough infections at 3-6 months after the second dose in the cancer cohort and control population. FINDINGS The cancer cohort comprised 377 194 individuals, of whom 42 882 had breakthrough SARS-CoV-2 infections. The control population consisted of 28 010 955 individuals, of whom 5 748 708 had SARS-CoV-2 breakthrough infections. Overall vaccine effectiveness was 69·8% (95% CI 69·8-69·9) in the control population and 65·5% (65·1-65·9) in the cancer cohort. Vaccine effectiveness at 3-6 months was lower in the cancer cohort (47·0%, 46·3-47·6) than in the control population (61·4%, 61·4-61·5). INTERPRETATION COVID-19 vaccination is effective for individuals with cancer, conferring varying levels of protection against breakthrough infections. However, vaccine effectiveness is lower in patients with cancer than in the general population. COVID-19 vaccination for patients with cancer should be used in conjunction with non-pharmacological strategies and community-based antiviral treatment programmes to reduce the risk that COVID-19 poses to patients with cancer. FUNDING University of Oxford, University of Southampton, University of Birmingham, Department of Health and Social Care, and Blood Cancer UK.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University of Oxford, Oxford, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Martin Little
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Arvind R Tripathy
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hayley S Mckenzie
- Oncology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Youssra Al-Hajji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | | | - Emma L Cattell
- Department of Cancer, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Jackie Charman
- National Disease Registration Service, NHS Digital, London, UK
| | - James J Clark
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sam Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Qamar Ghafoor
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Catherine Harper-Wynne
- Kent Oncology Centre, University of Kent and Kent and Medway Medical School, Maidstone, UK
| | - Rosie J Hattersley
- Department of Oncology, Torbay Hospital NHS Foundation Trust, Torquay, UK
| | - Alvin J X Lee
- UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK
| | - Pauline C Leonard
- Cancer Services, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Justin K H Liu
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Matthew Pang
- Department of Health and Social Care, London, UK
| | - Jennifer S Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James R Platt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Vanessa A Potter
- Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK
| | | | - Anne S Rigg
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim M Robinson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tom W Roques
- Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - René L Roux
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Mark H Tuthill
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Isabella Watts
- Department of Academic Oncology, Royal Free Hospital, London, UK
| | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tim Iveson
- Cancer Sciences, University of Southampton, Southampton, UK
| | - Siow Ming Lee
- UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK; CRUK Lung Cancer Centre of Excellence, University College London Hospitals NHS Trust and University College London, London, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Middleton
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Peter Johnson
- NHS England, London, UK; Cancer Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
11
|
Lee LYW, Rozmanowski S, Pang M, Charlett A, Anderson C, Hughes GJ, Barnard M, Peto L, Vipond R, Sienkiewicz A, Hopkins S, Bell J, Crook DW, Gent N, Walker AS, Peto TEA, Eyre DW. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectivity by Viral Load, S Gene Variants and Demographic Factors, and the Utility of Lateral Flow Devices to Prevent Transmission. Clin Infect Dis 2022; 74:407-415. [PMID: 33972994 PMCID: PMC8136027 DOI: 10.1093/cid/ciab421] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND How severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity varies with viral load is incompletely understood. Whether rapid point-of-care antigen lateral flow devices (LFDs) detect most potential transmission sources despite imperfect clinical sensitivity is unknown. METHODS We combined SARS-CoV-2 testing and contact tracing data from England between 1 September 2020 and 28 February 2021. We used multivariable logistic regression to investigate relationships between polymerase chain reaction (PCR)-confirmed infection in contacts of community-diagnosed cases and index case viral load, S gene target failure (proxy for B.1.1.7 infection), demographics, SARS-CoV-2 incidence, social deprivation, and contact event type. We used LFD performance to simulate the proportion of cases with a PCR-positive contact expected to be detected using 1 of 4 LFDs. RESULTS In total, 231 498/2 474 066 (9%) contacts of 1 064 004 index cases tested PCR-positive. PCR-positive results in contacts independently increased with higher case viral loads (lower cycle threshold [Ct] values), for example, 11.7% (95% confidence interval [CI] 11.5-12.0%) at Ct = 15 and 4.5% (95% CI 4.4-4.6%) at Ct = 30. B.1.1.7 infection increased PCR-positive results by ~50%, (eg, 1.55-fold, 95% CI 1.49-1.61, at Ct = 20). PCR-positive results were most common in household contacts (at Ct = 20.1, 8.7% [95% CI 8.6-8.9%]), followed by household visitors (7.1% [95% CI 6.8-7.3%]), contacts at events/activities (5.2% [95% CI 4.9-5.4%]), work/education (4.6% [95% CI 4.4-4.8%]), and least common after outdoor contact (2.9% [95% CI 2.3-3.8%]). Contacts of children were the least likely to test positive, particularly following contact outdoors or at work/education. The most and least sensitive LFDs would detect 89.5% (95% CI 89.4-89.6%) and 83.0% (95% CI 82.8-83.1%) of cases with PCR-positive contacts, respectively. CONCLUSIONS SARS-CoV-2 infectivity varies by case viral load, contact event type, and age. Those with high viral loads are the most infectious. B.1.1.7 increased transmission by ~50%. The best performing LFDs detect most infectious cases.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Rozmanowski
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Matthew Pang
- Department of Health and Social Care, UK Government, London, United Kingdom
| | | | | | | | - Matthew Barnard
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Leon Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | | | | | | | - John Bell
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Nick Gent
- Public Health England, London,United Kingdom
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - David W Eyre
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
12
|
Lee LYW, Rozmanowski S, Pang M, Charlett A, Anderson C, Hughes GJ, Barnard M, Peto L, Vipond R, Sienkiewicz A, Hopkins S, Bell J, Crook DW, Gent N, Walker AS, Peto TEA, Eyre DW. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectivity by Viral Load, S Gene Variants and Demographic Factors, and the Utility of Lateral Flow Devices to Prevent Transmission. Clin Infect Dis 2022; 74:407-415. [PMID: 33972994 DOI: 10.1101/2021.03.31.21254687] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND How severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity varies with viral load is incompletely understood. Whether rapid point-of-care antigen lateral flow devices (LFDs) detect most potential transmission sources despite imperfect clinical sensitivity is unknown. METHODS We combined SARS-CoV-2 testing and contact tracing data from England between 1 September 2020 and 28 February 2021. We used multivariable logistic regression to investigate relationships between polymerase chain reaction (PCR)-confirmed infection in contacts of community-diagnosed cases and index case viral load, S gene target failure (proxy for B.1.1.7 infection), demographics, SARS-CoV-2 incidence, social deprivation, and contact event type. We used LFD performance to simulate the proportion of cases with a PCR-positive contact expected to be detected using 1 of 4 LFDs. RESULTS In total, 231 498/2 474 066 (9%) contacts of 1 064 004 index cases tested PCR-positive. PCR-positive results in contacts independently increased with higher case viral loads (lower cycle threshold [Ct] values), for example, 11.7% (95% confidence interval [CI] 11.5-12.0%) at Ct = 15 and 4.5% (95% CI 4.4-4.6%) at Ct = 30. B.1.1.7 infection increased PCR-positive results by ~50%, (eg, 1.55-fold, 95% CI 1.49-1.61, at Ct = 20). PCR-positive results were most common in household contacts (at Ct = 20.1, 8.7% [95% CI 8.6-8.9%]), followed by household visitors (7.1% [95% CI 6.8-7.3%]), contacts at events/activities (5.2% [95% CI 4.9-5.4%]), work/education (4.6% [95% CI 4.4-4.8%]), and least common after outdoor contact (2.9% [95% CI 2.3-3.8%]). Contacts of children were the least likely to test positive, particularly following contact outdoors or at work/education. The most and least sensitive LFDs would detect 89.5% (95% CI 89.4-89.6%) and 83.0% (95% CI 82.8-83.1%) of cases with PCR-positive contacts, respectively. CONCLUSIONS SARS-CoV-2 infectivity varies by case viral load, contact event type, and age. Those with high viral loads are the most infectious. B.1.1.7 increased transmission by ~50%. The best performing LFDs detect most infectious cases.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Rozmanowski
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Matthew Pang
- Department of Health and Social Care, UK Government, London, United Kingdom
| | | | | | | | - Matthew Barnard
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Leon Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | | | | | | | - John Bell
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Nick Gent
- Public Health England, London,United Kingdom
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - David W Eyre
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
13
|
Booth S, Curley HM, Varnai C, Arnold R, Lee LYW, Campton NA, Cook G, Purshouse K, Aries J, Innes A, Cook LB, Tomkins O, Oram HS, Tilby M, Kulasekararaj A, Wrench D, Dolly S, Newsom‐Davies T, Pettengell R, Gault A, Moody S, Mittal S, Altohami M, Tillet T, Illingworth J, Mukherjee L, Apperly J, Ashcroft J, Rabin N, Carmichael J, Cazier J, Kerr R, Middleton G, Collins GP, Palles C. Key findings from the UKCCMP cohort of 877 patients with haematological malignancy and COVID-19: disease control as an important factor relative to recent chemotherapy or anti-CD20 therapy. Br J Haematol 2022; 196:892-901. [PMID: 34761389 PMCID: PMC8652610 DOI: 10.1111/bjh.17937] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
Patients with haematological malignancies have a high risk of severe infection and death from SARS-CoV-2. In this prospective observational study, we investigated the impact of cancer type, disease activity, and treatment in 877 unvaccinated UK patients with SARS-CoV-2 infection and active haematological cancer. The primary end-point was all-cause mortality. In a multivariate analysis adjusted for age, sex and comorbidities, the highest mortality was in patients with acute leukaemia [odds ratio (OR) = 1·73, 95% confidence interval (CI) 1·1-2·72, P = 0·017] and myeloma (OR 1·3, 95% CI 0·96-1·76, P = 0·08). Having uncontrolled cancer (newly diagnosed awaiting treatment as well as relapsed or progressive disease) was associated with increased mortality risk (OR = 2·45, 95% CI 1·09-5·5, P = 0·03), as was receiving second or beyond line of treatment (OR = 1·7, 95% CI 1·08-2·67, P = 0·023). We found no association between recent cytotoxic chemotherapy or anti-CD19/anti-CD20 treatment and increased risk of death within the limitations of the cohort size. Therefore, disease control is an important factor predicting mortality in the context of SARS-CoV-2 infection alongside the possible risks of therapies such as cytotoxic treatment or anti-CD19/anti-CD20 treatments.
Collapse
Affiliation(s)
- Stephen Booth
- Oxford NIHR Biomedical Research CentreDepartment of HaematologyChurchill HospitalOxfordUK
| | - Helen M. Curley
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Csilla Varnai
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Centre for Computational BiologyUniversity of BirminghamBirminghamUK
| | - Roland Arnold
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Lennard Y. W. Lee
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Department of OncologyOxford UniversityOxfordUK
| | - Naomi A. Campton
- Institute of Translational MedicineBirmingham Health PartnersBirminghamUK
| | - Gordon Cook
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
| | - Karin Purshouse
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | | | | | | | | | | | | | | | - David Wrench
- Guys and St Thomas' NHS Foundation TrustLondonUK
| | | | | | - Ruth Pettengell
- St Georges University Hospitals NHS Foundation TrustLondonUK
| | - Abigail Gault
- NCCC Northern Centre for Cancer CareThe Newcastle Upon Tyne NHS Foundation TrustNewcastleUK
| | - Sam Moody
- NCCC Northern Centre for Cancer CareThe Newcastle Upon Tyne NHS Foundation TrustNewcastleUK
| | | | | | | | - Jack Illingworth
- BarkingHavering and Redbridge University Hospitals NHS TrustEssexUK
| | | | | | - John Ashcroft
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
- Mid Yorkshire Hospitals NHS TrustWakefieldUK
| | - Neil Rabin
- University College London HospitalsLondonUK
| | - Jonathan Carmichael
- NIHR (Leeds) MIC, LeedsSt James's Teaching Hospital, University of LeedsLeedsUK
| | - Jean‐Baptiste Cazier
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Centre for Computational BiologyUniversity of BirminghamBirminghamUK
| | - Rachel Kerr
- Department of OncologyOxford UniversityOxfordUK
| | - Gary Middleton
- Institute of Immunology and ImmunotherapyUniversity of BirminghamEdgbastonBirminghamUK
| | - Graham P. Collins
- Oxford NIHR Biomedical Research CentreDepartment of HaematologyChurchill HospitalOxfordUK
| | - Claire Palles
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | | |
Collapse
|
14
|
Millen GC, Arnold R, Cazier JB, Curley H, Feltbower R, Gamble A, Glaser A, Grundy RG, Kirton L, Lee LYW, McCabe MG, Palles C, Phillips B, Stiller CA, Varnai C, Kearns P. COVID-19 in children with haematological malignancies. Arch Dis Child 2022; 107:186-188. [PMID: 34301621 PMCID: PMC8785070 DOI: 10.1136/archdischild-2021-322062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with cancer are not at increased risk of severe SARS-CoV-2 infection; however, adults with haematological malignancies have increased risk of severe infections compared with non-haematological malignancies. METHODS We compared patients with haematological and non-haematological malignancies enrolled in the UK Paediatric Coronavirus Cancer Monitoring Project between 12 March 2020 and 16 February 2021. Children who received stem cell transplantation were excluded. RESULTS Only 2/62 patients with haematological malignancy had severe/critical infections, with an OR of 0.5 for patients with haematological compared with non-haematological malignancies. INTERPRETATION Children with haematological malignancies are at no greater risk of severe SARS-CoV-2 infection than those with non-haematological malignancies.
Collapse
Affiliation(s)
- Gerard Cathal Millen
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Helen Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
| | - Ashley Gamble
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Richard G Grundy
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
- School of Medicine, University of Nottingham Children's Brain Tumour Research Centre, Nottingham, UK
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Martin G McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
- Paediatric Oncology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Csilla Varnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
15
|
Várnai C, Palles C, Arnold R, Curley HM, Purshouse K, Cheng VWT, Booth S, Campton NA, Collins GP, Hughes DJ, Kulasekararaj AG, Lee AJX, Olsson-Brown AC, Sharma-Oates A, Van Hemelrijck M, Lee LYW, Kerr R, Middleton G, Cazier JB. Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19. JAMA Netw Open 2022; 5:e220130. [PMID: 35188551 PMCID: PMC8861846 DOI: 10.1001/jamanetworkopen.2022.0130] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. Objective To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. Design, Setting, and Participants The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. Exposures SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. Main Outcomes and Measures The primary end point was all-cause mortality within the primary hospitalization. Results Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19-related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). Conclusions and Relevance The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed.
Collapse
Affiliation(s)
- Csilla Várnai
- Centre for Computational Biology, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Helen M. Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Vinton W. T. Cheng
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Stephen Booth
- Oxford NIHR Biomedical Research Centre, Department of Haematology, Churchill Hospital, Oxford, United Kingdom
| | - Naomi A. Campton
- Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom
| | - Graham P. Collins
- Oxford NIHR Biomedical Research Centre, Department of Haematology, Churchill Hospital, Oxford, United Kingdom
| | - Daniel J. Hughes
- Department of Cancer Imaging, King’s College London, London, United Kingdom
| | | | - Alvin J. X. Lee
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Anna C. Olsson-Brown
- The Clatterbridge Cancer Centre, Wirral, United Kingdom
- The University of Liverpool, Liverpool, United Kingdom
| | - Archana Sharma-Oates
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Lennard Y. W. Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Rachel Kerr
- Department of Oncology, Oxford University, Oxford, United Kingdom
| | - Gary Middleton
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Jean-Baptiste Cazier
- Centre for Computational Biology, University of Birmingham, Birmingham, United Kingdom
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Cancer Research UK Birmingham Centre, University of Birmingham, United Kingdom
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| |
Collapse
|
16
|
Mistry DA, Wang JY, Moeser ME, Starkey T, Lee LYW. A systematic review of the sensitivity and specificity of lateral flow devices in the detection of SARS-CoV-2. BMC Infect Dis 2021; 21:828. [PMID: 34407759 PMCID: PMC8371300 DOI: 10.1186/s12879-021-06528-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lateral flow devices (LFDs) are viral antigen tests for the detection of SARS-CoV-2 that produce a rapid result, are inexpensive and easy to operate. They have been advocated for use by the World Health Organisation to help control outbreaks and break the chain of transmission of COVID-19 infections. There are now several studies assessing their accuracy but as yet no systematic review. Our aims were to assess the sensitivity and specificity of LFDs in a systematic review and summarise the sensitivity and specificity of these tests. METHODS A targeted search of Pubmed and Medxriv, using PRISMA principles, was conducted identifying clinical studies assessing the sensitivity and specificity of LFDs as their primary outcome compared to reverse transcriptase polymerase chain reaction (RT-PCR) for the detection of SARS-CoV-2. Based on extracted data sensitivity and specificity was calculated for each study. Data was pooled based on manufacturer of LFD and split based on operator (self-swab or by trained professional) and sensitivity and specificity data were calculated. RESULTS Twenty-four papers were identified involving over 26,000 test results. Sensitivity from individual studies ranged from 37.7% (95% CI 30.6-45.5) to 99.2% (95% CI 95.5-99.9) and specificity from 92.4% (95% CI 87.5-95.5) to 100.0% (95% CI 99.7-100.0). Operation of the test by a trained professional or by the test subject with self-swabbing produced comparable results. CONCLUSIONS This systematic review identified that the performance of lateral flow devices is heterogeneous and dependent on the manufacturer. Some perform with high specificity but a great range of sensitivities were shown (38.32-99.19%). Test performance does not appear dependent on the operator. Potentially, LFDs could support the scaling up of mass testing to aid track and trace methodology and break the chain of transmission of COVID-19 with the additional benefit of providing individuals with the results in a much shorter time frame.
Collapse
Affiliation(s)
- Dylan A Mistry
- Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | | | | | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lennard Y W Lee
- Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, UK
- University of Oxford, Oxford, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
17
|
Millen GC, Arnold R, Cazier JB, Curley H, Feltbower RG, Gamble A, Glaser AW, Grundy RG, Lee LYW, McCabe MG, Phillips RS, Stiller CA, Várnai C, Kearns PR. Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. Br J Cancer 2021; 124:754-759. [PMID: 33299130 PMCID: PMC7884399 DOI: 10.1038/s41416-020-01181-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children with cancer are frequently immunocompromised. While children are generally thought to be at less risk of severe SARS-CoV-2 infection than adults, comprehensive population-based evidence for the risk in children with cancer is unavailable. We aimed to produce evidence of the incidence and outcomes from SARS-CoV-2 in children with cancer attending all hospitals treating this population across the UK. METHODS Retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer through data collection from all hospitals providing cancer care to this population. Eligible patients tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). The primary end-point was death, discharge or end of active care for COVID-19 for those remaining in hospital. RESULTS Between 12 March 2020 and 31 July 2020, 54 cases were identified: 15 (28%) were asymptomatic, 34 (63%) had mild infections and 5 (10%) moderate, severe or critical infections. No patients died and only three patients required intensive care support due to COVID-19. Estimated incidence of hospital identified SARS-CoV-2 infection in children with cancer under 16 was 3%. CONCLUSIONS Children with cancer with SARS-CoV-2 infection do not appear at increased risk of severe infection compared to the general paediatric population. This is reassuring and supports the continued delivery of standard treatment.
Collapse
Affiliation(s)
- Gerard C Millen
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jean-Baptiste Cazier
- Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Helen Curley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics (LIDA), School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group (CCLG), Leicester, LE1 7GB, UK
| | - Adam W Glaser
- Leeds Institute for Data Analytics (LIDA), School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Professor of Paediatric Oncology and Late Effects Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Richard G Grundy
- Children's Cancer and Leukaemia Group (CCLG), Leicester, LE1 7GB, UK
- Children's Brain Tumour Research Centre, School of Medicine, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- National Cancer Registration and Analysis Service, Public Health England, London, SE1 8UG, UK
| | - Robert S Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, SE1 8UG, UK
| | - Csilla Várnai
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Pamela R Kearns
- Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
- Cancer Research UK Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
18
|
Best J, Starkey T, Chatterjee A, Fackrell D, Pettit L, Srihari N, Tween H, Olsson-Brown A, Cheng V, Hughes DJ, Lee AJX, Purshouse K, Arnold R, Uk Coronavirus Cancer Monitoring Project Team, Sivakumar S, Cazier JB, Lee LYW. Coronavirus Disease 2019: the Pivotal Role of UK Clinical Oncology and the UK Coronavirus Cancer Monitoring Project. Clin Oncol (R Coll Radiol) 2021; 33:e50-e53. [PMID: 32593552 PMCID: PMC7274595 DOI: 10.1016/j.clon.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- J Best
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - T Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - A Chatterjee
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - D Fackrell
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - L Pettit
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - H Tween
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - V Cheng
- Leeds Cancer Centre, Bexley Wing, St James's University Hospital, Leeds, UK
| | - D J Hughes
- Department of Cancer Imaging, Division of Cancer Studies, Guy's Campus, King's College London, London, UK
| | - A J X Lee
- University College London, UCL Cancer Institute, London, UK
| | - K Purshouse
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - R Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - S Sivakumar
- Department of Oncology, University of Oxford, Oxford, UK
| | - J-B Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - L Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| |
Collapse
|
19
|
Demetriou P, Abu-Shah E, Valvo S, McCuaig S, Mayya V, Kvalvaag A, Starkey T, Korobchevskaya K, Lee LYW, Friedrich M, Mann E, Kutuzov MA, Morotti M, Wietek N, Rada H, Yusuf S, Afrose J, Siokis A, Meyer-Hermann M, Ahmed AA, Depoil D, Dustin ML. Author Correction: A dynamic CD2-rich compartment at the outer edge of the immunological synapse boosts and integrates signals. Nat Immunol 2020; 22:99. [PMID: 33122852 DOI: 10.1038/s41590-020-00825-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Enas Abu-Shah
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.,Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Salvatore Valvo
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Sarah McCuaig
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Viveka Mayya
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.,Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA
| | - Audun Kvalvaag
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Elizabeth Mann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Mikhail A Kutuzov
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Matteo Morotti
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Nina Wietek
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Heather Rada
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Shamsideen Yusuf
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Jehan Afrose
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.,Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA.,Department of Medical Laboratory Sciences, CUNY Hunter College, New York, NY, USA
| | - Anastasios Siokis
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Michael Meyer-Hermann
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Ahmed Ashour Ahmed
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - David Depoil
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.,Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA.,Immunocore Ltd, Abingdon, Oxford, UK
| | - Michael L Dustin
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK. .,Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA.
| |
Collapse
|
20
|
Demetriou P, Abu-Shah E, Valvo S, McCuaig S, Mayya V, Kvalvaag A, Starkey T, Korobchevskaya K, Lee LYW, Friedrich M, Mann E, Kutuzov MA, Morotti M, Wietek N, Rada H, Yusuf S, Afrose J, Siokis A, Meyer-Hermann M, Ahmed AA, Depoil D, Dustin ML. A dynamic CD2-rich compartment at the outer edge of the immunological synapse boosts and integrates signals. Nat Immunol 2020; 21:1232-1243. [PMID: 32929275 PMCID: PMC7611174 DOI: 10.1038/s41590-020-0770-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/28/2020] [Indexed: 12/18/2022]
Abstract
The CD2-CD58 recognition system promotes adhesion and signaling and counters exhaustion in human T cells. We found that CD2 localized to the outer edge of the mature immunological synapse, with cellular or artificial APC, in a pattern we refer to as a 'CD2 corolla'. The corolla captured engaged CD28, ICOS, CD226 and SLAM-F1 co-stimulators. The corolla amplified active phosphorylated Src-family kinases (pSFK), LAT and PLC-γ over T cell receptor (TCR) alone. CD2-CD58 interactions in the corolla boosted signaling by 77% as compared with central CD2-CD58 interactions. Engaged PD-1 invaded the CD2 corolla and buffered CD2-mediated amplification of TCR signaling. CD2 numbers and motifs in its cytoplasmic tail controlled corolla formation. CD8+ tumor-infiltrating lymphocytes displayed low expression of CD2 in the majority of people with colorectal, endometrial or ovarian cancer. CD2 downregulation may attenuate antitumor T cell responses, with implications for checkpoint immunotherapies.
Collapse
Affiliation(s)
| | - Enas Abu-Shah
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Salvatore Valvo
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Sarah McCuaig
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Viveka Mayya
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA
| | - Audun Kvalvaag
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Elizabeth Mann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Mikhail A Kutuzov
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Matteo Morotti
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Nina Wietek
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Heather Rada
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Shamsideen Yusuf
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Jehan Afrose
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA
- Department of Medical Laboratory Sciences, CUNY Hunter College, New York, NY, USA
| | - Anastasios Siokis
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Michael Meyer-Hermann
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany
- Institute for Biochemistry, Biotechnology and Bioinformatics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Ahmed Ashour Ahmed
- Ovarian Cancer Cell Laboratory, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - David Depoil
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA
- Immunocore Ltd, Abingdon, Oxford, UK
| | - Michael L Dustin
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.
- Skirball Institute of Biomolecular Medicine, New York University of School of Medicine, New York, NY, USA.
| |
Collapse
|
21
|
Lee LYW, Cazier JB, Starkey T, Briggs SEW, Arnold R, Bisht V, Booth S, Campton NA, Cheng VWT, Collins G, Curley HM, Earwaker P, Fittall MW, Gennatas S, Goel A, Hartley S, Hughes DJ, Kerr D, Lee AJX, Lee RJ, Lee SM, Mckenzie H, Middleton CP, Murugaesu N, Newsom-Davis T, Olsson-Brown AC, Palles C, Powles T, Protheroe EA, Purshouse K, Sharma-Oates A, Sivakumar S, Smith AJ, Topping O, Turnbull CD, Várnai C, Briggs ADM, Middleton G, Kerr R. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 2020; 21:1309-1316. [PMID: 32853557 PMCID: PMC7444972 DOI: 10.1016/s1470-2045(20)30442-3] [Citation(s) in RCA: 399] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK. METHODS We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case-fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models. FINDINGS 319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case-fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40-49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15-2·15; p<0·0043). Compared with the rest of the UKCCMP cohort, patients with leukaemia showed a significantly increased case-fatality rate (2·25, 1·13-4·57; p=0·023). After correction for age and sex, patients with haematological malignancies who had recent chemotherapy had an increased risk of death during COVID-19-associated hospital admission (OR 2·09, 95% CI 1·09-4·08; p=0·028). INTERPRETATION Patients with cancer with different tumour types have differing susceptibility to SARS-CoV-2 infection and COVID-19 phenotypes. We generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype. Our results could be useful to assist physicians in informed risk-benefit discussions to explain COVID-19 risk and enable an evidenced-based approach to national social isolation policies. FUNDING University of Birmingham and University of Oxford.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Oncology, University of Oxford, Oxford, UK; University Hospitals Birmingham, Birmingham, UK
| | - Jean-Baptiste Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah E W Briggs
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Vartika Bisht
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Stephen Booth
- Department of Haematology, University of Oxford, Oxford, UK
| | - Naomi A Campton
- Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - Vinton W T Cheng
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Graham Collins
- Department of Haematology, University of Oxford, Oxford, UK
| | - Helen M Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Anshita Goel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Hartley
- Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK
| | - Daniel J Hughes
- Department of Cancer Imaging, King's College London, London, UK
| | - David Kerr
- Nuffield Division of Clinical and Laboratory Services, University of Oxford, Oxford, UK
| | - Alvin J X Lee
- UCL Cancer Institute, University College London, London, UK
| | - Rebecca J Lee
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Chris P Middleton
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Nirupa Murugaesu
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Tom Newsom-Davis
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Emily A Protheroe
- University of Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Chris D Turnbull
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Csilla Várnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
| | - Rachel Kerr
- Department of Oncology, University of Oxford, Oxford, UK
| |
Collapse
|
22
|
Lee LYW, Hill T, Topping O, Tilby M, Baker M, Greig J, Isherwood L, Miller R, Petrenko Y, Desai R, Field A, Kennedy B, Khan S, Kountourou A, Ndlovu S, Starkey T, Storey F, Turner L, Vaughan-Williams W, Moyler S, Preston H, Latty B, Walker S, Henderson DR, Thompson J, Jones N, Ghafoor Q, Pascoe J, Williams S, Middleton G. Utility of COVID-19 Screening in Cancer Patients. Cancer Cell 2020; 38:306-307. [PMID: 32730750 PMCID: PMC7380207 DOI: 10.1016/j.ccell.2020.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Lennard Y W Lee
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK.
| | - Thomas Hill
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Topping
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael Tilby
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Baker
- University of Birmingham Medical School, University of Birmingham, UK
| | - Julian Greig
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Robert Miller
- University of Birmingham Medical School, University of Birmingham, UK
| | - Yuriy Petrenko
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruchi Desai
- University of Birmingham Medical School, University of Birmingham, UK
| | - Alice Field
- University of Birmingham Medical School, University of Birmingham, UK
| | - Bethany Kennedy
- University of Birmingham Medical School, University of Birmingham, UK
| | - Shahbano Khan
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Sandisile Ndlovu
- University of Birmingham Medical School, University of Birmingham, UK
| | - Thomas Starkey
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Francesca Storey
- University of Birmingham Medical School, University of Birmingham, UK
| | - Lucy Turner
- University of Birmingham Medical School, University of Birmingham, UK
| | | | - Surrinder Moyler
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Preston
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Beverley Latty
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sharon Walker
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Daniel R Henderson
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joyce Thompson
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicola Jones
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Qamar Ghafoor
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jenny Pascoe
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Williams
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Middleton
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK.
| | | |
Collapse
|
23
|
Pickles OJ, Lee LYW, Starkey T, Freeman-Mills L, Olsson-Brown A, Cheng V, Hughes DJ, Lee A, Purshouse K, Middleton G. Immune checkpoint blockade: releasing the breaks or a protective barrier to COVID-19 severe acute respiratory syndrome? Br J Cancer 2020; 123:691-693. [PMID: 32546835 PMCID: PMC7296191 DOI: 10.1038/s41416-020-0930-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
The rapid emergence of COVID-19 has sent shockwaves through healthcare systems globally, with cancer patients at increased risk. The interplay of the virus and host immune system has been implicated in the development of ARDS. Immunotherapy agents have the potential to adversely potentiate this phenomenon, requiring careful real-world observation.
Collapse
Affiliation(s)
- Oliver J Pickles
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Luke Freeman-Mills
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Anna Olsson-Brown
- Clatterbridge Cancer Centre, Bebington, Wirral, CH63 4JY, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GL, UK
| | - Vinton Cheng
- Leeds Cancer Centre, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Daniel J Hughes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alvin Lee
- UCL Cancer Institute, University College London, London, WC1E 6BT, UK
| | - Karin Purshouse
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, EH4 2XR, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
24
|
Turnbull CD, Lee LYW, Starkey T, Sen D, Stradling J, Petousi N. Transcriptomics Identify a Unique Intermittent Hypoxia-mediated Profile in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2020; 201:247-250. [PMID: 31517507 DOI: 10.1164/rccm.201904-0832le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chris D Turnbull
- Oxford University Hospitals NHS Foundation TrustOxford, United Kingdom.,NIHR Biomedical Research Centre University of OxfordOxford, United Kingdomand
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences University of BirminghamBirmingham, United Kingdom
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences University of BirminghamBirmingham, United Kingdom
| | - Dushendree Sen
- Oxford University Hospitals NHS Foundation TrustOxford, United Kingdom
| | - John Stradling
- Oxford University Hospitals NHS Foundation TrustOxford, United Kingdom.,NIHR Biomedical Research Centre University of OxfordOxford, United Kingdomand
| | - Nayia Petousi
- Oxford University Hospitals NHS Foundation TrustOxford, United Kingdom.,NIHR Biomedical Research Centre University of OxfordOxford, United Kingdomand
| |
Collapse
|
25
|
Lee LYW, Starkey T, Sivakumar S, Fotheringham S, Mozolowski G, Shearwood V, Palles C, Camilleri P, Church D, Kerr R, Kerr D. ToxNav germline genetic testing and PROMinet digital mobile application toxicity monitoring: Results of a prospective single-center clinical utility study-PRECISE study. Cancer Med 2019; 8:6305-6314. [PMID: 31486228 PMCID: PMC6797583 DOI: 10.1002/cam4.2529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION In this study (PRECISE), we assess the clinical utility of a germline DNA sequencing-based test (ToxNav) for mutations in DPYD and ENOSF1 genes to alter clinician-prescribed fluoropyrimidine doses and the use of a digital application (PROMinet) to record patient-reported chemotherapy toxicity. MATERIALS AND METHODS Adult patients with a histological diagnosis of colorectal cancer (CRC) who consented to fluoropyrimidine-based chemotherapy were recruited prospectively and given a digital application to monitor and record associated toxicities. Patient samples were analyzed for 18 germline coding variants in DPYD and 1 ENOSF1 variant. RESULTS Genetic testing was performed for 60 patients and identified one patient at increased risk of fluoropyrimidine-based toxicities. Uptake of genetic testing was high and results were available on average 17 days from initial clinical encounter. Patient-reported chemotherapy toxicity identified differences in 5-fluorouracil vs capecitabine regime profiles and identified profiles associated with subsequent need for chemotherapy dose reduction and hospital admission. DISCUSSION The PRECISE clinical trial demonstrated that a germline DNA sequencing-based test can provide clinically relevant information to alter clinicians' fluoropyrimidine prescription. The study also obtained high volume, high granularity patient-reported toxicity data that might allow the improvement and personalization of chemotherapy management.
Collapse
Affiliation(s)
- Lennard Y. W. Lee
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Thomas Starkey
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | | | | | | | | | - Claire Palles
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | | | - David Church
- Department of OncologyUniversity of OxfordOxfordUK
| | - Rachel Kerr
- Department of OncologyUniversity of OxfordOxfordUK
| | - David Kerr
- Oxford Cancer BiomarkersOxford Science ParkOxfordUK
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| |
Collapse
|
26
|
Lee LYW, Woolley C, Starkey T, Biswas S, Mirshahi T, Bardella C, Segditsas S, Irshad S, Tomlinson I. Serum- and Glucocorticoid-induced Kinase Sgk1 Directly Promotes the Differentiation of Colorectal Cancer Cells and Restrains Metastasis. Clin Cancer Res 2019; 25:629-640. [PMID: 30322876 PMCID: PMC6339518 DOI: 10.1158/1078-0432.ccr-18-1033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/22/2018] [Accepted: 10/10/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The molecular events that determine intestinal cell differentiation are poorly understood and it is unclear whether it is primarily a passive event or an active process. It is clinically important to gain a greater understanding of the process, because in colorectal cancer, the degree of differentiation of a tumor is associated with patient survival. SGK1 has previously been identified as a gene that is principally expressed in differentiated intestinal cells. In colorectal cancer, there is marked downregulation of SGK1 compared with normal tissue.Experimental Design: An inducible SGK1 viral overexpression system was utilized to induce reexpression of SGK1 in colorectal cancer cell lines. Transcriptomic and phenotypic analyses of these colorectal cancer lines was performed and validation in mouse and human cohorts was performed. RESULTS We demonstrate that SGK1 is upregulated in response to, and an important controller of, intestinal cell differentiation. Reexpression of SGK1 in colorectal cancer cell lines results in features of differentiation, decreased migration rates, and inhibition of metastasis in an orthotopic xenograft model. These effects may be mediated, in part, by SGK1-induced PKP3 expression and increased degradation of MYC. CONCLUSIONS Our results suggest that SGK1 is an important mediator of differentiation of colorectal cells and may inhibit colorectal cancer metastasis.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Connor Woolley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sujata Biswas
- Cancer Cell Biology Group, Oxford Centre for Cancer Gene Research, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Tia Mirshahi
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chiara Bardella
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stefania Segditsas
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shazia Irshad
- Molecular Mechanisms of Colorectal Cancer Group, Nuffield Department of Medicine, Oxford, United Kingdom
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
27
|
Affiliation(s)
- Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Summaya Mohammad
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Siow-Ming Lee
- Department of Oncology, University College London Hospitals, London, UK.,Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
| |
Collapse
|
28
|
McKean D, Thomee E, Papanikitas J, Lee LYW, Yoong P, Yanny S, Teh JL. Polyarticular extension of pigmented villonodular synovitis to contiguous joints via pigmented villonodular tenosynovitis. BJR Case Rep 2016; 2:20150404. [PMID: 30363581 PMCID: PMC6180899 DOI: 10.1259/bjrcr.20150404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
Pigmented villonodular synovitis is an uncommon benign neoplastic process that affects synovial-lined joints, bursae and tendon sheaths. We describe polyarticular extension of pigmented villonodular synovitis across joints secondary to pigmented villonodular tenosynovitis. Given that treatment is required to prevent progressive destruction of the involved joint, tendon or bursa, radiologists must be vigilant for diffuse polyarticular or extrasynovial involvement to optimize patient care and initiate appropriate therapy.
Collapse
Affiliation(s)
- David McKean
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Eeke Thomee
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Joseph Papanikitas
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Philip Yoong
- Department of Radiology, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Sarah Yanny
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - James L Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| |
Collapse
|
29
|
Lee LYW, Yap H, Sampson S, Ford B, Hayman G, Marsh J, Bansal AS. IgG4- related disease as a rare cause of tubulointerstitial nephritis. J Clin Immunol 2014; 34:548-50. [PMID: 24789687 DOI: 10.1007/s10875-014-0049-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/15/2014] [Indexed: 12/24/2022]
Abstract
Isolated IgG4 tubulointerstitial nephritis (TIN) is a rare disorder characterized by raised serum IgG4 levels and histological findings of dense lymphoplasmacytic infiltrates rich in IgG4 positive plasma cells. We report a case of isolated IgG4 TIN that presented with acute kidney injury in an 84 year old man with a polyclonal increase in his total IgG and a raised IgE of 381 kUA/L but without evidence of systemic autoimmunity. We draw a parallel with IgG4-related autoimmune pancreatitis and show raised levels of circulating regulatory T cells. Importantly the plasma levels of the T regulatory cell cytokine, IL10, the TH1 cytokines IL12 and IFNγ, the proinflammatory TNF α and immune regulatory IL27 were all highly raised. Furthermore, the level of IL21 that promotes IgG4 production was also very significantly elevated. These results suggest efforts of the immune system to reduce inflammation and suppress an exaggerated Th2 response. A raised serum IgG in the setting of acute kidney injury and in the absence of autoimmunity and chronic infection should encourage an assessment of the IgG subclasses. Prompt steroid treatment of those with a raised IgG4 may reduce ongoing renal damage.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Wellcome Trust for Human Genetics, University of Oxford, Roosevelt Drive, OX3 7BN, London, United Kingdom,
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
A 42-year-old man who was being treated for pneumonia developed severe, sudden-onset abdominal pain with features of shock and peritonism. The clinical picture combined with radiological investigations raised suspicion of a bowel perforation necessitating urgent surgical review and emergency laparotomy. This diagnosed a jejunal perforation with abnormal lymph nodes. Histological examination confirmed diffuse large B-cell lymphoma. The patient was subsequently started on a course of chemotherapy. While gastrointestinal perforation secondary to antilymphoma treatment is a well-recognised complication, primary perforation caused by the lymphoma itself must always be considered.
Collapse
Affiliation(s)
- V Santharam
- Department of General Surgery, Milton Keynes General Hospital, Milton Keynes, Bucks, UK
| | | | | |
Collapse
|
31
|
Lee LYW, Gardezi AS, Santharam V, Boyd J, Lanzon-Miller S. Effect of azathioprine intolerance on outcomes of inflammatory bowel disease: a cross-sectional study. Frontline Gastroenterol 2014; 5:40-43. [PMID: 28839749 PMCID: PMC5369706 DOI: 10.1136/flgastro-2013-100348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Azathioprine is well established for the maintenance of remission in patients with inflammatory bowel disease (IBD). However, a significant proportion of patients are intolerant to azathioprine. It is not clear if intolerance of azathioprine is a marker of poor prognosis for patients who will have a more aggressive disease or be more likely to require surgery. OBJECTIVE To determine if intolerance to azathioprine is a marker of poor prognosis, indicating patients who have a more aggressive disease course, and to analyse the risk factors and causes of intolerance. METHODS A cross-sectional study using the Milton Keynes Hospital IBD database was performed to compare azathioprine-intolerant and azathioprine-tolerant patients. RESULTS Two hundred and thirty-nine patients met the inclusion criteria comprising 141 patients with Crohn's disease (CD) and 98 patients with ulcerative colitis (UC). Overall, 28.0% of patients were intolerant to azathioprine. Risk factors for intolerance were female sex and age 50-70 years. Common reasons for intolerance were nausea and vomiting (34.3%), deranged liver function tests (28.4%) and headaches (11.9%). In patients with UC, there was no statistical difference in the disease activity scores between those who were azathioprine intolerant versus tolerant. In patients with CD, azathioprine intolerance was associated with significantly worse disease activity; 25% fewer patients were in clinical remission and 20% more had moderate/severe disease. Rates of surgery were similar between the groups for both UC/CD. CONCLUSIONS We conclude that azathioprine intolerance acts as a surrogate marker for patients with CD who in future have poorer symptom control. Azathioprine intolerance marks out a group of patients with CD in whom increased vigilance of symptom control and early escalation of treatment is required.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, UK
| | - Anjum Syed Gardezi
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, UK
| | - Vidya Santharam
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, UK
| | - Jason Boyd
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, UK
| | - Sandro Lanzon-Miller
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Standing Way, Milton Keynes, UK
| |
Collapse
|
32
|
Abstract
A 47-year-old woman with a 36-month history of Crohn's disease with one previous bowel resection treated with azathioprine was found to have a persistently raised mean corpuscular volume (MCV) on routine complete blood count testing. Despite vitamin B12 replacement, her MCV remained elevated. A bone marrow biopsy was performed, which demonstrated myelodysplastic syndrome. Macrocytosis is a common abnormality in patients with Crohn's disease, most commonly due to vitamin B12 deficiency and secondarily due to bacterial overgrowth. However, it is important to recognise that myelodysplastic syndrome is a common under-reported complication of azathioprine therapy. One-third of cases progress to acute myeloid leukaemia with poor prognosis. In patients with suspected myelodysplastic syndrome, azathioprine therapy should be immediately discontinued.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Department of Gastroenterology, Milton Keynes NHS Foundation Trust, Milton Keynes, UK.
| | | | | |
Collapse
|
33
|
Lee LYW, Akhtar MM, Kirresh O, Gibson T. Interstitial keratitis and sensorineural hearing loss as a manifestation of rheumatoid arthritis: clinical lessons from a rare complication. BMJ Case Rep 2012; 2012:bcr-2012-007324. [PMID: 23242087 DOI: 10.1136/bcr-2012-007324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cogan's syndrome or non-syphilitic interstitial keratitis with vestibule-auditory dysfunction is a serious and under-recognised complication of rheumatoid arthritis. It is an autoimmune condition characterised by inflammatory infiltrates on the cornea and extensive vestibulocochlear damage. If left untreated, patients progress to develop profound hearing loss. We present a case that was incorrectly diagnosed and treated as conjunctivitis by several emergency departments prior to being correctly recognised as Cogan's syndrome.
Collapse
Affiliation(s)
- Lennard Y W Lee
- Department of Rheumatology, Guy's & St Thomas's NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|