COVID-19 Vaccine Effectiveness in Patients With Hematologic Malignancies: A Nationwide Cohort Study

Quincy Hofsink; Birgit I Lissenberg-Witte; Sabine Haggenburg; Abraham Goorhuis; Mette D Hazenberg; Caroline E Rutten; Paul den Tex; Elisabeth G E de Vries; Astrid A M van der Veldt; Jeanet M Kemmeren; Nicolette F de Keizer; Peter C Huijgens; Avinash G Dinmohamed; Annika van Roon; Joyce Pijpers; Caren van Roekel; Susan van den Hof; Susan J M Hahné; Brechje de Gier; Jarom Heijmans; Inger S Nijhof

doi:10.1093/infdis/jiaf523

COVID-19 Vaccine Effectiveness in Patients With Hematologic Malignancies: A Nationwide Cohort Study

J Infect Dis. 2026 Feb 18;233(2):e363-e372. doi: 10.1093/infdis/jiaf523.

Authors

Quincy Hofsink^{1

2

3}, Birgit I Lissenberg-Witte⁴, Sabine Haggenburg^{1

2

3}, Abraham Goorhuis⁵, Mette D Hazenberg^{1

2

3

6}, Caroline E Rutten¹, Paul den Tex^{1

2

3}, Elisabeth G E de Vries⁷, Astrid A M van der Veldt⁸, Jeanet M Kemmeren⁹, Nicolette F de Keizer^{10

11}, Peter C Huijgens¹², Avinash G Dinmohamed^{1

3

12

13}, Annika van Roon⁹, Joyce Pijpers⁹, Caren van Roekel⁹, Susan van den Hof⁹, Susan J M Hahné⁹, Brechje de Gier⁹, Jarom Heijmans^{1

14}, Inger S Nijhof^{15

16}

Affiliations

¹ Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
² Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands.
³ Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
⁴ Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
⁵ Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Hematopoiesis, Sanquin Research, Amsterdam, The Netherlands.
⁷ Department of Medical Oncology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
⁸ Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
⁹ Center for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
¹⁰ National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands.
¹¹ Department of Medical Informatics, Amsterdam Public Health Institute, Quality of Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹² Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
¹³ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
¹⁴ Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹⁵ Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
¹⁶ Department of Internal Medicine-Hematology, St. Antonius Hospital, Nieuwegein, The Netherlands.

Abstract

Background: In patients with hematologic malignancies, COVID-19 vaccine effectiveness is unknown and determinants of severe COVID-19 lack granularity.

Methods: To identify determinants of SARS-CoV-2 infection outcome we conducted a population-based, nationwide cohort study, including all adult Dutch residents who tested positive for SARS-CoV-2 between 1 June 2020, and 31 March 2022. Individuals were classified as having a (history of) hematologic malignancy, solid malignancy, or no malignancies. Primary outcome was severe COVID-19, defined as COVID-19-related hospitalization or death following first SARS-CoV-2 infection.

Results: Among 4 649 341 included individuals, those with hematologic malignancies were at highest risk of severe COVID-19. Vaccine effectiveness against severe COVID-19 in patients with hematologic malignancies was up to 74% (95% CI, 60% to 83%), depending on the SARS-CoV-2 variant period, the number of received vaccinations, and the time interval since vaccination. Risk of severe COVID-19 was highest for patients with recently diagnosed hematologic malignancies and declined over time, except for patients with chronic hematologic malignancies. Risk of severe COVID-19 tended to be higher in patients on tumor-specific treatment such as CD38 and CD20 antibodies, proteasome inhibitors, and protein kinase inhibitors.

Conclusions: COVID-19 vaccination lowered the risk of severe COVID-19 in SARS-CoV-2-infected patients with hematologic malignancies, although these patients remained at elevated risk compared with others. Determinants of severe COVID-19 included type of malignancy, time interval between malignancy diagnosis and SARS-CoV-2 infection, and treatment. These data can guide healthcare professionals in designing additional prevention and therapeutic strategies against respiratory virus infections for patients with hematologic malignancies.

Keywords: COVID-19; cohort study; hematologic malignancies; severe outcomes; vaccine effectiveness.

MeSH terms

Adult
Aged
Aged, 80 and over
COVID-19 Vaccines* / administration & dosage
COVID-19 Vaccines* / immunology
COVID-19* / complications
COVID-19* / epidemiology
COVID-19* / prevention & control
Cohort Studies
Female
Hematologic Neoplasms* / complications
Hematologic Neoplasms* / immunology
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
Netherlands / epidemiology
SARS-CoV-2 / immunology
Vaccination
Vaccine Efficacy*
Young Adult

Substances

COVID-19 Vaccines

Abstract

MeSH terms

Substances

Grants and funding