In the time of COVID-19: challenges, successes, and lessons learned from studies in cancer patients.

The secret of making progress is just to get started

—Mark Twain.

Introduction

The COVID-19 pandemic presented the research community with an urgent need to quickly generate evidence on a novel viral pathogen, SARS-CoV-2, capable of spreading rapidly and inflicting severe harm to population health and the global economy. In early 2020, an unprecedented number of research endeavors were launched in the United States and around the globe to understand the biology of SARS-CoV-2; the human immunologic response to infection; the short- and long-term effects of viral infection on human health; and its epidemiologic, social, and economic impacts. In parallel, clinical trials were launched to evaluate the safety and efficacy of novel vaccines and treatments. The purpose of this report is to bring forward the many practical challenges and lessons learned from US-based prospective cohort studies in patients with cancer, with subsequent efforts to pool data through a federated consortium. This information is of value to the research community at the interface of virology, immunology, and oncology and is expected to inform future pandemic preparedness, leading to optimized infrastructure development for prospective observational studies in general.

Background

In early 2020, the US National Cancer Institute (NCI) in partnership with the National Institute of Allergy and Infectious Diseases established the Serological Sciences Network (SeroNet) for COVID-19 as the nation’s largest coordinated effort to “expand the nation’s capacity for SARS-CoV-2 serologic testing on a population-level and advance research on the immune response to SARS-CoV-2 infection and vaccination among diverse and vulnerable populations.” SeroNet was supported by appropriations from the Paycheck Protection Program and Health Care Enhancement Act of April 24, 2020 (H.R. 266 1-3 ). The immediate response from the US Congress to approve the availability of research funding was unprecedented ( Figure 1 ). The posted date of the SeroNet funding announcement was June 8, 2020—178 days after the first case of SARS-CoV-2 was reported and 89 days after the World Health Organization declared COVID-19 a pandemic. Applications were due July 22, 2020; scientific review commenced in August 2020, and funding for awardees became available within a few months. The rapid availability of funding enabled the acceleration of science in unprecedented ways, bringing together research sectors that had rarely collaborated previously. This included dynamic partnerships among virology and immunology scientists, health communication researchers, epidemiologists, and the clinical sciences of infectious disease, hematology, oncology, immunology, pathology, laboratory medicine, and virtually every organ-based clinical subspecialty.

SeroNet’s mandates included (1) the engagement of multidisciplinary investigative and clinical experts from across the United States to generate knowledge on the immunology and epidemiology of SARS-CoV-2; (2) the development of SARS-CoV-2 serological technologies including standardization of serological assays, developing quality control standards, increasing national capacity for testing, and improving representation in population serosurveillance; and (3) supporting a transgovernmental effort to evaluate SARS-CoV-2 serology assays entering the market. Under the SeroNet umbrella, 8 U54 Serologic Centers of Excellence, 13 U01 research programs, and 4 capacity-building centers were funded at academic and research institutions across the United States. SeroNet also provided funding to the Fredrick National Laboratory for Cancer Research (FNLCR) to coordinate programmatic efforts, especially related to serology standards and reagents. 4 From the outset and by design, 10% of the SeroNet budget was set aside for emergent multi-institutional collaborative activities. The network created data sharing protocols to enable future integrative data pooling analyses. Centralized efforts by leadership at NCI and FNLCR established operational working groups focused on (1) data submission, access, and integration; (2) serological assays and materials; (3) cellular and molecular assays; and (4) epidemiologic study design. 1 , 3 , 5 This governance architecture built a vibrant, collaborative SeroNet community organized around specific projects.

Several SeroNet awardee institutions sought to launch a cohort study beginning in 2020 and 2021 with longitudinal assessments, including patient surveys, biospecimen collection, and/or data extraction from electronic health records. There was a particular emphasis on the systematic enrollment of individuals considered at the time to be high risk, including occupational cohorts like health-care workers and first responders; vulnerable populations such as children and underserved populations; and immunocompromised populations, including individuals with cancer, autoimmune diseases, organ and hematopoietic stem cell transplant recipients, persons living with HIV, and those receiving treatment with specific immunosuppressing agents.

Challenges faced by patients with cancer

Many of the SeroNet cohorts focused on enrolling adult patients with cancer ( Table 1 ). Early reports indicated that patients with cancer were at severe risk for COVID-19 mortality. 6 Patients with hematologic cancers, including transplant recipients, were of particular concern because of the need for immune cell depleting and immune-targeted therapies. 7 Several studies reported these patients had a 1.5- to 3.3-fold increased risk of developing severe COVID-19. 8 , 9 Patients with respiratory cancers (ie, thoracic) were also highly susceptible, owing to the shared target organ of the pathogen and cancer. 10 , 11 As SARS-CoV-2 spread to new regions of the country, mandatory and recommended travel restrictions and shut downs placed additional stress on patients with cancer. For example, traveling to clinic appointments posed potential risk from human contact, particularly at hospitals and clinics overrun by COVID-19 patients. Even when vaccines became available, it was unclear whether there would be adverse interactions with cancer treatments or suboptimal vaccine response, and questions abounded as to whether vaccines and anticancer treatments should be given concurrently. In short, observational studies in patients with cancer were immediately needed to collect data on COVID-19 and cancer-related outcomes.

Challenges in designing collaborative cohort studies during a pandemic

Whether funded by SeroNet or conducted independently, institutions faced challenges in rapidly designing and launching prospective cohort studies summarized below.

Regulatory

In the best of circumstances, obtaining necessary institutional review board (IRB) approval for human subjects research can be time consuming, depending on the complexity of the study and institutional practices. 12 The novelty of SARS-CoV-2—its then unknown biology, high risk to personnel, and unprecedentedly severe impact on daily life—contributed to even greater caution by IRB members. Standard operating procedures for specimen collection and handling also took time to evolve, including lack of consensus on whether biosafety level 2 or more restrictive facilities were required for SARS-CoV-2–related research studies. Many SeroNet cohorts were able to work with their IRB committees and open their studies to enrollment within a few months following the release of funding, however, others experienced varying degrees of delays related to addressing these concerns. Consequently, most of the SeroNet cohort studies suffered from limited accrual before December 2020. This meant that these studies missed or had limited opportunity to collect invaluable data and samples for research on humans naïve to the virus and/or vaccine. Following the December 2020 implementation of vaccines, there were further delays in obtaining IRB approvals of revised protocols to study vaccine efficacy. The time to obtain approval for these protocol amendments often left researchers with the sense that they were “chasing the tail of the pandemic”—in other words, that research efforts were lagging the public health and clinical realities faced by patients, physicians, and the public.

Institutional

Understandably, especially early in the pandemic and in hard-hit communities, many institutions devoted medical personnel almost exclusively to clinical support for hospitals. As a result, various activities, including research operations, patient recruitment, and data collection, were significantly hindered at numerous hospital-based institutions. Local, state, and federal guidelines for isolation and social distancing also impacted regions of the United States in varying ways. In New York City and other locations, it was considered a risk for non–COVID-19 patients to visit the clinic, resulting in slowed accrual or halting of all clinical studies, whether related or unrelated to COVID-19. For patients with cancer, at the peak of the pandemic, many follow-up visits were suspended or conducted remotely, limiting opportunity for recruitment and enrollment into research studies. Fortunately, in most cases, recognition by institutional leadership to appropriately prioritize SeroNet cohort enrollment and data collection in the context of the COVID-19 pandemic was instrumental in the ability to staff research teams responsible for identifying, consenting, and obtaining data from eligible participants. However, the shift from in-person work to remote work (where feasible) required redesigning recruitment and enrollment processes performed by research staff. Moreover, workforce turnover during this time (the “great resignation” 13 , 14 ) put research programs at risk of being understaffed, constituting a further threat to the conduct of these studies.

Study design

Each SeroNet institution essentially operated independently, and although studies share similar design features ( Table 1 ), differences in methodology proved to be a challenge for subsequent interinstitutional validation of results through pooled data harmonization efforts. In particular, clinical data collected differed within and across study cohorts, as did the depth and breadth of information collected. Basic demographic, broad clinical definitions, and vaccination details (timing, type) were largely synonymous across study groups, but other variables were often collected in ways that hindered harmonization. First, blood collection timepoints (and hence, serologic testing data) were not necessarily the same across institutions, although 3-month intervals were common. Second, driven by the need to rapidly develop clinically applicable testing methodologies to assess serological responses, resultant assays were often distinct at different sites and proved surprisingly challenging to integrate despite early efforts for the Serological Assays and Materials group to standardize test reporting. Third, the details of cancer treatment information collected and the timing of such treatment relative to immunologic landmarks (vaccinations, boosters, infections) lacked coordination, as did the extent of data collected on cancer treatment side effects and COVID-19 symptoms, severity, and COVID-19–related treatments. Lastly, surveys for self-reported patient data had been designed prior to the establishment of the pooling study and varied across institutions. It was not possible to go back and survey study participants a second time at the different institutions with a common set of questions.

Changing research priorities

The urgency of the situation, the pace of scientific evolution, and the changing public health landscape presented additional unique challenges for research. In December 2020, less than 3 months after initiation of SeroNet, vaccines became available under US Food and Drug Administration Emergency Use Authorization. This critical event shifted research questions from a focus on infection risk to vaccine response in patients with cancer, requiring changes in protocols for data collection. Given the time-sensitive nature, there was again no opportunity for a deliberate initial phase to standardize research protocols and harmonize variable definitions across studies. This resulted in further discrepancies in survey instruments, clinical metadata specifications, biospecimen collection protocols, and data collection timepoints. Patient surveys were an example of such evolution. These initially focused on collecting data at the time of enrollment on patient demographics, lifestyle risk factors, medical histories, and occupational exposures as well as questions on SARS-CoV-2 infection and its adverse outcomes. Once vaccines were available, there was a need to obtain information on vaccine history, hesitancy, and adverse events from vaccinations. Questionnaires also evolved to capture the effects of the pandemic on general and specialized health care and access to diagnosis and treatment, as well as patients’ psychosocial well-being, including mental health and social determinants of outcomes. As surveys evolved independently based on the research goals of each institution, post hoc harmonization of patient self-reported data across SeroNet institutions was a major challenge.

Furthermore, for studies among patients with cancer, there were additional considerations that complicated decisions regarding study design: (1) guidelines for immunizations frequently changed, and booster doses were introduced at variable times; (2) vaccination was not generally performed within cancer clinics; and (3) it was unknown how different cancer treatments (chemotherapies, immunotherapies, small molecule inhibitors, radiotherapy, transplantation, steroids, etc.) should be administered relative to the time of immunizations (or vice versa). Many cancer treatments modify the immune system, including immune checkpoint inhibitors, chimeric antigen receptor T-cell therapy, and B-cell targeted treatments. 15 However, at no point were guidelines or recommendations promulgated for temporary suspension of cancer treatment in relation to the timing of COVID-19 vaccination. Therefore, blood specimens for SARS-CoV-2 research were often collected on a pragmatic and ad hoc basis, usually in alignment with clinical visits, given the unknowns about the host immunologic response to vaccination in immunocompromised patients and the urgency to at least obtain some data (and biospecimens).

In May 2023, the national research priorities changed dramatically again. The pandemic was declared over by the World Health Organization and the US Public Health Emergency ended. Scientific journals went from publishing COVID-19–related manuscripts at a rapid pace and in large numbers ( Figure 2 ) to diminished editorial interest in publishing COVID-19–related clinical research. Consequently, deciding on the length of time for follow-up in these cohorts prior to compiling results for publication continues to be a challenge. In truth, COVID-19 research remains very relevant, with an ever growing number of immunocompromised individuals having been infected with this virus (including >10 million cancer survivors in the United States 16 ), the continued possibility of emergence of variants with heightened morbidity and mortality compared with variants in circulation at the time of writing, and the continuing need to understand the long-term sequelae of SARS-CoV-2 infection. However, with limited resources, the question is how best to position these studies to continue to answer relevant public health questions.

Lessons learned and recommendations for preparedness for the next pandemic

After any major inflection point in society, we are granted an opportunity for retrospection and self-improvement. Here, we share our thoughts on lessons learned from our small corner of the COVID-19 crisis with some specific recommendations that could inform not just our response to the next pandemic but how the US scientific enterprise can be enhanced. Concepts presented here are summarized in Table 2 . Examples of how these lessons were applied, and the benefits therefrom, are drawn from the more than 500 publications attributed to the SeroNet consortium to date ( https://frederick.cancer.gov/initiatives/seronet ; accessed February 8, 2025).

Collaboration

Develop and sustain a culture of collaboration across all stakeholders

Collaboration is crucial to solving our most pressing global challenges. The pandemic showed the importance of multidisciplinary collaboration among scientists, government stakeholders, and community members joining forces in a concerted effort to address urgent and rapidly evolving situations. COVID-19 brought together scientists and clinicians across a vast array of fields who had never worked together, including virologists, immunologists, cancer experts, epidemiologists, behavioral scientists, statisticians, infectious disease specialists, clinical investigators across essentially all specialties and subspecialties, and health policy makers. Individual investigators at different academic institutions and their regulatory and legal administrative support teams approached collaborative opportunities between institutions with unprecedented openness and alacrity. For example, collaborations between multiple health systems across the country were quickly able to examine the host immune response to SARS-CoV-2 infection, both in community and health-care workers 17 and in patients hospitalized with COVID-19. 18 These initial publications were then followed by additional reports focusing on patients with cancer. 10 , 19-24 We believe that this demonstration of collaborative openness is a model for future research efforts, whether pandemic related or otherwise. Furthermore, SeroNet’s funding mandate that 10% of the budget be applied to collaborations ensured that more timely and bold scientific collaborative ideas could be pursued without additional funding delays. We recommend that funding agencies and the research community continue this willingness to shift from research “in silos” to a collaborative approach in accordance with this successful model.

Streamlining

Enable and promote efficiency in scientific review and study execution

On January 25, 2021, then NIH director Dr Francis Collins said that during the COVID pandemic, “we did science in ways that people did not think we could, driven by this sense of urgency, which we all say that every day counts.” First, the pandemic highlighted the urgent need to streamline complex scientific review processes and administrative procedures to ease burdens on clinical research and to address novel research questions in a timely fashion. None of these cancer cohort studies or pooled meta-analyses would have been successfully launched without the speedy availability of funding. Second, the swift change in the conduct of scientific review from a process typically taking years to less than 5 months from initial notice of the funding opportunity to awarding of research grants was groundbreaking. A dramatic example of this rapid mobilization of research support was the ability of SeroNet institutions to immediately investigate biospecimens for the presence of neutralizing antibodies to SARS-CoV-2 infection from the very onset of the pandemic, 25-27 providing timely information to inform the introduction of the COVID-19 vaccine in December 2020. Detailed studies of the T-cell immunologic response in patients who had experienced COVID-19 illness also was published quickly after initiation of SeroNet funding. 28

Knowing that this speed is possible calls into question why research proposals often take multiple rounds of submissions, which could lead relevant questions to go unanswered or answered years after their clinical or public health relevance has waned. The pandemic required that the science be immediately relevant, and the NIH along with several other global governmental, public, and private entities responded accordingly. To retain this capability for future emergent situations (starting with but not limited to pandemics), we must embrace the efficiencies and timeliness in funding and implementation demonstrated for the COVID-19 pandemic. Agility must also be sustained to enable adaptation to potential problems in the performance of the research and for the alternative solutions that can be brought forth.

Adaptation

Account for the evolving nature of science and “sunset” ideas as needed

Life and science are constantly and rapidly evolving. One lesson learned in the pandemic was the value of reconsidering research priorities and adjusting study design procedures to address newly relevant questions in real time, even after the research funding has been awarded. When research aligns with public health interests, engagement is high, and recruitment of participants into research studies is highly feasible. From our experience, there was a declining public interest in participation in COVID-19–related research as they adjusted to the new normal of co-existing with the pathogen, while others, such as the immunocompromised and people suffering from long COVID (postacute sequelae of COVID-19), felt that the world left them behind. Fortunately, the SeroNet funding mechanism anticipated the importance of reevaluation of research priorities and required submission of updated research aims for administrative and scientific review 2 years postaward (in 2022). As a result, many research projects shifted scientific aims to maintain innovation and relevancy while retaining a focus on COVID-19 and oncology. Indeed, a critical pivot for the prospective cohort studies was the evaluation of the host immune response to COVID-19 vaccines, 20 , 29-31 noting that the COVID-19 vaccine was deployed after the funding for SeroNet was already committed. Investigators were also able to incorporate into their research programs post hoc study of long COVID-19/postacute sequelae of COVID-19, 32 patient symptomatology after vaccination, 19 , 33 and study of vaccine outcomes across populations such as patients with asthma. 34 Flexibility and nimbleness, including substantive restructuring of research aims on a postaward basis, are actions that are critically needed in times of crisis.

Infrastructure

Promote the adoption of best practices, common methodologies, and standard reagents

Considerable effort was needed to build the data study architecture for these cohorts, incorporating new data elements essentially from scratch, given the novelty of the SARS-CoV-2 pathogen. In the future, to avoid duplication of the enormous efforts of establishing operating procedures for diagnosis and treatment of a novel infectious pathogen, we recommend the formation of a national panel to assess the elements essential to conducting multi-institutional real-world studies of an emerging pathogen, drawing on our collective experience from this pandemic and from other new pathogens that have entered the human population. Having robust recommendations for the structure and activation of multi-institutional studies in place for the next event will enable a swift response while facilitating increased data harmonization across multiple centers. Ideally, this should be a standing panel with flexible multidisciplinary membership, which can periodically review evidence and develop consensus statements that provide guidance on assays and reporting standards (eg, universal units), common data elements and data models, survey content (eg, Patient-Reported Outcomes Measurement Information System tools), data collection timepoints, and methods for electronic medical records linkage and data extraction. With these structures in place, this panel would be able to provide specific guidance to research centers at the outset of the next crisis and more effectively facilitate broad, cross-institutional research appropriate for the new situation. Of note, any instruments developed at the national level must be freely available and easily used at academic sites, without unnecessary programming requirements. Critically, any version of such a panel must not be positioned as a hurdle or barrier to swift responsiveness or become bogged down in unnecessary bureaucracy. It should be developed solely to enable efficiency and productivity, with the recognition that there will always be unknown variables and unique idiosyncrasies to any emergent crises that will require unhindered scientific inventiveness.

In our experience, the FNLCR, reacting in the moment, was instrumental in making critical SARS-CoV-2 reagents and serology standards available to the SeroNet community. The human SARS-CoV-2 serology standard was distributed to SeroNet members to serve as a calibration standard for laboratories conducting SARS-CoV-2 serology testing. 4 The availability of such a standard served to enable cross-institutional comparisons of multiple studies, including different candidate SARS-CoV-2 vaccines. The FNLCR also facilitated the sharing and distribution of key reagents for serology assays, such as different spike and receptor-binding domain proteins, that were integral in assay comparisons, and several reports were published. 35-37 Collectively, this coordinated effort facilitated the adoption of standard reagents and best practices to ensure that clinical science was rigorous and comparable across laboratories and institutions.

Data sharing

Enable access to current data for qualified investigators

Data sharing is essential for reproducibility, replication of findings, pooled analyses in consortia efforts, and maximizing value to address multiple lines of research. Therefore, promoting a culture in epidemiologic research that follows Findable, Accessible, Interoperable, Reusable (FAIR) principles is crucial. 38 First, the requirement that SeroNet-sponsored studies be published in open access journals ensures rapid and ready access to research results. Second, SeroNet mandated that datasets generated by awardees be deposited within the Immunology Database and Analysis Portal, an open access resource supported by National Institute of Allergy and Infectious Diseases, that promoted the concept of FAIRness enabling the pooling of project efforts here. 39 In SeroNet, the Data Submission, Access, and Integration Working Group in conjunction with FNLCR worked with Immunology Database and Analysis Portal to create a SeroNet-specific portal to facilitate finding of relevant SeroNet data and resources. Furthermore, NCI required a master collaboration agreement at the outset of SeroNet; there was no need for additional regulatory approvals (specifically, no data use agreements). We therefore could initiate parallel data harmonization and analyses across centers. The master collaboration agreement previously signed by each institution enabled sharing of data and biospecimens within SeroNet and specifically for this pooling project. Importantly, the supplemental SeroNet funding provided each contributing site with the resources to support dedicated staff to prepare analytic datasets, including the performance of data cleaning and statistical analyses. This master collaboration agreement architecture for the consortium was highly successful in facilitating cross-institutional collaboration and data sharing.

Future preparedness

Preserving architecture while downsizing

Funding authorizations are by their very nature time limited. At some point, any given public health emergency will come to an end, with stand-down of much that was built to address a pandemic. Developing and executing the SeroNet initiative and its research projects were costly; however, it will be more costly to put it together again than to maintain it. We recommend consideration by the relevant federal agencies of the essential components of the pandemic response that must be maintained regarding funding streams postpandemic. Although support of the national public health laboratory network is self-evident, the successes of SeroNet argue strongly for the assessment of the essential components of the national community of research institutions and their many partners in the broader community that should also be maintained between pandemics. Conserving an appropriate amount of infrastructure can have several enduring benefits. First, a pandemic can have a long-lasting effect that requires investigation. Data streams, biospecimens, and most importantly, engagement with study participants are irreplaceable. Second, rapid and proactive responsiveness to the next pandemic will greatly benefit from an organized framework of tools, plans, and facilities, if they are structured to promote efficiency. It is a recurring theme in human history to downplay or even willfully forget the enormous impacts of pandemics and other crises. Lessons learned should be lessons remembered.

Conclusions

Conducting research during an emergency public health environment is enormously difficult but can achieve stunning successes. Unexpected multidisciplinary collaborations can come together quickly and yield discoveries at an unprecedented pace. At the same time, the rapidly evolving circumstances of the pandemic required changes in the scientific culture of how we plan studies, consent and enroll study participants, obtain data and specimens, conduct the studies, and manage the overall scientific progress of these studies. Despite these unprecedented challenges and changes, research initiatives in response to the COVID-19 pandemic demonstrated that rapid authorization and distribution of research funding can succeed in quickly setting up prospective cohort studies under an umbrella initiative such as SeroNet. SeroNet’s successful effort in cross-institutional research demonstrates the importance of robust, repeatable collaborative frameworks; a willingness to pivot and adapt based on rapidly evolving scientific and public health objectives; and the creation of structures that facilitate and enable collection, harmonization, and analysis of data across institutions. This experience also demonstrates the challenges and the need for the scientific community, from funders and research institutions to participants, to be ready to act when the next public health emergency, unfortunately but inevitably, arises.

Acknowledgments

The authors are grateful to all the study participants and the many collaborators and staff supporting SeroNet studies. Our thanks also are given to the leadership of the SeroNet consortium at the National Cancer Institute and the Frederick National Laboratory for Cancer Research. We also thank Lily Armstrong-Davies, Mount Sinai Medical Illustrations, for assistance with the graphics.

Contributor Information

Philip C Mack, Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

James M Crawford, Department of Pathology and Laboratory Medicine, Northwell Health, New Hyde Park, NY, United States.

Andres Chang, Department of Hematology and Medical Oncology, Winship Cancer Institute and Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States.

Anna Yin, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

Sabra L Klein, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

Patrick Shea, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

Fred R Hirsch, Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

David Zidar, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States.

Viviana Simon, Department of Pathology and the Institute for Translational Epidemiology at the Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Charles Gleason, Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Russell McBride, Department of Pathology and the Institute for Translational Epidemiology at the Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Carlos Cordon-Cardo, Department of Pathology and the Institute for Translational Epidemiology at the Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Jennifer VanOudenhove, Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States.

Stephanie Halene, Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States.

F Eun-Hyung Lee, Lowance Center for Human Immunology, Department of Medicine, Emory University, Atlanta, GA, United States.

Nicholas Mantis, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, United States.

Lawrence H Kushi, Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States.

Daniela Weiskopf, Center for Vaccine Innovation, La Jolla Institute for Immunology, La Jolla, CA, United States; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States.

Akil Merchant, Division of Hematology and Cellular Therapy, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Karen L Reckamp, Division of Hematology and Cellular Therapy, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Jacek Skarbinski, Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States; Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States.

Jane C Figueiredo, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Computational Biomedicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Author contributions

Philip C. Mack (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Supervision, Writing—original draft, Writing—review & editing), James M. Crawford (Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Supervision, Writing—original draft, Writing—review & editing), Andres Chang (Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing—original draft, Writing—review & editing), Anna Yin (Data curation, Formal analysis, Methodology, Project administration, Validation, Writing—original draft, Writing—review & editing), Sabra L. Klein (Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—review & editing), Patrick Shea (Data curation, Investigation, Project administration, Writing—review & editing), Fred R. Hirsch (Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—review & editing), David Zidar (Data curation, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing—original draft, Writing—review & editing), Viviana Simon (Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—review & editing), Charles Gleason (Data curation, Investigation, Writing—review & editing), Russell McBride (Conceptualization, Funding acquisition, Investigation, Resources, Writing—review & editing), Carlos Cordon-Cardo (Investigation, Writing—review & editing), Jennifer Van Oudenhove (Data curation, Formal analysis, Investigation, Project administration, Resources, Validation, Writing—review & editing), Stephanie Halene (Conceptualization, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—review & editing), F. Eun-Hyung Lee (Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—original draft, Writing—review & editing), Nicholas Mantis (Writing—review & editing), Lawrence H. Kushi (Investigation, Writing—review & editing), Daniela Weiskopf (Writing—review & editing), Akil A. Merchant (Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing—review & editing), Karen L. Reckamp (Funding acquisition, Investigation, Resources, Writing—review & editing), Jacek Skarbinski (Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Visualization, Writing—original draft, Writing—review & editing), and Jane Figueiredo (Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing—original draft, Writing—review & editing).

Funding

Funding for the SeroNet cohorts was provided by the US National Cancer Institute: (U54CA260591, U01CA260584, U01CA260469, U54CA260543, U54CA260560, U54CA260563, U01CA260541, U01CA261277, U01CA261277, U01CA260526, U01CA261276, U01CA260539, U01CA260513, U01CA260507, U01CA260462, 3UG1CA189850-09S1, CBC 21X089, CBC21X090, CBC21X091, CBC21X092). A.C. is partly supported by the CLL Society Young Investigator Award and the K12CA237806 from the Emory K12 Clinical Oncology Training Program.

Conflicts of interest

No conflicts of interest.

Data availability

This commentary contains no primary data. The data on which the commentary is based are publicly available on ImmPort ( https://www.immport.org/shared/home ).

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Associated Data

Data Availability Statement

This commentary contains no primary data. The data on which the commentary is based are publicly available on ImmPort ( https://www.immport.org/shared/home ).