Interplay of Immunosuppression and Immunotherapy among Patients with Cancer and COVID-19

Ziad Bakouny, Chris Labaki, Punita Grover, Joy Awosika, Shuchi Gulati, Chih Yuan Hsu, Saif I. Alimohamed, Babar Bashir, Stephanie Berg, Mehmet A. Bilen, Daniel Bowles, Cecilia Castellano, Aakash Desai, Arielle Elkrief, Omar E. Eton, Leslie A. Fecher, Daniel Flora, Matthew D. Galsky, Margaret E. Gatti-Mays, Alicia GesenhuesMichael J. Glover, Dharmesh Gopalakrishnan, Shilpa Gupta, Thorvardur R. Halfdanarson, Brandon Hayes-Lattin, Mohamed Hendawi, Emily Hsu, Clara Hwang, Roman Jandarov, Chinmay Jani, Douglas B. Johnson, Monika Joshi, Hina Khan, Shaheer A. Khan, Natalie Knox, Vadim S. Koshkin, Amit A. Kulkarni, Daniel H. Kwon, Sara Matar, Rana R. McKay, Sanjay Mishra, Feras A. Moria, Amanda Nizam, Nora L. Nock, Taylor K. Nonato, Justin Panasci, Lauren Pomerantz, Andrew J. Portuguese, Destie Provenzano, Matthew Puc, Yuan J. Rao, Terence D. Rhodes, Gregory J. Riely, Jacob J. Ripp, Andrea V. Rivera, Erika Ruiz-Garcia, Andrew L. Schmidt, Adam J. Schoenfeld, Gary K. Schwartz, Sumit A. Shah, Justin Shaya, Suki Subbiah, Lisa M. Tachiki, Matthew D. Tucker, Melissa Valdez-Reyes, Lisa B. Weissmann, Michael T. Wotman, Elizabeth M. Wulff-Burchfield, Zhuoer Xie, Yuanchu James Yang, Michael A. Thompson, Dimpy P. Shah, Jeremy L. Warner, Yu Shyr, Toni K. Choueiri, Trisha M. Wise-Draper

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Importance: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective: To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included 12046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures: Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures: The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results: The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance: This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration: Identifier: NCT04354701.

Original languageEnglish (US)
Pages (from-to)128-134
Number of pages7
JournalJAMA Oncology
Issue number1
StatePublished - Jan 19 2023

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© 2023 American Medical Association. All rights reserved.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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