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Cavic G, Almonte AA, Hicks SM, Neeman T, Wang JW, Brew S, Choi PY, Cockburn I, Gardiner EE, Yip D, Fahrer AM, Kanjanapan Y. Response to COVID-19 vaccination in patients on cancer therapy: Analysis in a SARS-CoV-2-naïve population. Asia Pac J Clin Oncol 2024. [PMID: 38221764 DOI: 10.1111/ajco.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/02/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cancer patients have increased morbidity and mortality from COVID-19, but may respond poorly to vaccination. The Evaluation of COVID-19 Vaccination Efficacy and Rare Events in Solid Tumors (EVEREST) study, comparing seropositivity between cancer patients and healthy controls in a low SARS-CoV-2 community-transmission setting, allows determination of vaccine response with minimal interference from infection. METHODS Solid tumor patients from The Canberra Hospital, Canberra, Australia, and healthy controls who received COVID-19 vaccination between March 2021 and January 2022 were included. Blood samples were collected at baseline, pre-second vaccine dose and at 1, 3 (primary endpoint), and 6 months post-second dose. SARS-CoV-2 anti-spike-RBD (S-RBD) and anti-nucleocapsid IgG antibodies were measured. RESULTS Ninety-six solid tumor patients and 20 healthy controls were enrolled, with median age 62 years, and 60% were female. Participants received either AZD1222 (65%) or BNT162b2 (35%) COVID-19 vaccines. Seropositivity 3 months post vaccination was 87% (76/87) in patients and 100% (20/20) in controls (p = .12). Seropositivity was observed in 84% of patients on chemotherapy, 80% on immunotherapy, and 96% on targeted therapy (differences not satistically significant). Seropositivity in cancer patients increased from 40% (6/15) after first dose, to 95% (35/37) 1 month after second dose, then dropped to 87% (76/87) 3 months after second dose. CONCLUSION Most patients and all controls became seropositive after two vaccine doses. Antibody concentrations and seropositivity showed a decrease between 1 and 3 months post vaccination, highlighting need for booster vaccinations. SARS-CoV-2 infection amplifies S-RBD antibody responses; however, cannot be adequately identified using nucleocapsid serology. This underlines the value of our COVID-naïve population in studying vaccine immunogenicity.
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Affiliation(s)
- George Cavic
- Research School of Biology, Australian National University, Canberra, Australia
| | - Andrew A Almonte
- Research School of Biology, Australian National University, Canberra, Australia
| | - Sarah M Hicks
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, Australian National University, Canberra, Australia
| | - Jo-Wai Wang
- Research School of Biology, Australian National University, Canberra, Australia
| | - Sue Brew
- Medical Oncology Clinical Trials Unit, The Canberra Hospital, Canberra, Australia
| | - Philip Y Choi
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
| | - Ian Cockburn
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Elizabeth E Gardiner
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
- Department of Haematology, The Canberra Hospital, Canberra, Australia
| | - Aude M Fahrer
- Research School of Biology, Australian National University, Canberra, Australia
- Faculty of Science and Technology, University of Canberra, Canberra, Australia
| | - Yada Kanjanapan
- Department of Medical Oncology, The Canberra Hospital, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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Piubelli C, Valerio M, Verzè M, Nicolis F, Mantoan C, Zamboni S, Perandin F, Rizzi E, Tais S, Degani M, Caldrer S, Gobbi FG, Bisoffi Z, Gori S. Humoral Effect of SARS-CoV-2 mRNA vaccination with booster dose in solid tumor patients with different anticancer treatments. Front Oncol 2023; 13:1089944. [PMID: 36910621 PMCID: PMC9992722 DOI: 10.3389/fonc.2023.1089944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Cancer patients are at risk for serious complications in case of SARS-CoV-2 infection. In these patients SARS-CoV-2 vaccination is strongly recommended, with the preferential use of mRNA vaccines. The antibody response in cancer patients is variable, depending on the type of cancer and antitumoral treatment. In solid tumor patients an antibody response similar to healthy subjects has been confirmed after the second dose. Only few studies explored the duration of immunization after the two doses and the effect of the third dose. Methods In our study we explored a cohort of 273 solid tumor patients at different stages and treated with different anticancer therapies. Results and Discussion Our analysis demonstrated that the persistence of the neutralizing antibody and the humoral response after the booster dose of vaccine was not dependent on either the tumor type, the stage or type of anticancer treatment.
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Affiliation(s)
- Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Matteo Valerio
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Matteo Verzè
- Medical Direction Unit, Medical Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Fabrizio Nicolis
- Medical Direction Unit, Medical Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Carlotta Mantoan
- Nurse Direction Unit, Nurse Direction, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Sonia Zamboni
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Francesca Perandin
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Eleonora Rizzi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Stefano Tais
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Monica Degani
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Sara Caldrer
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Federico Giovanni Gobbi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Zeno Bisoffi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
| | - Stefania Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Vr, Italy
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Cancer Patients and the COVID-19 Vaccines: Considerations and Challenges. Cancers (Basel) 2022; 14:cancers14225630. [PMID: 36428722 PMCID: PMC9688380 DOI: 10.3390/cancers14225630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
Few guidelines exist for COVID-19 vaccination amongst cancer patients, fostering uncertainty regarding the immunogenicity, safety, and effects of cancer therapies on vaccination, which this review aims to address. A literature review was conducted to include the latest articles covering the immunogenicity and safety of COVID-19 vaccination in patients with solid and hematologic cancers receiving various treatments. Lower seropositivity following vaccination was associated with malignancy (compared to the general population), and hematologic malignancy (compared to solid cancers). Patients receiving active cancer therapy (unspecified), chemotherapy, radiotherapy, and immunosuppressants generally demonstrated lower seropositivity compared to healthy controls; though checkpoint inhibition, endocrine therapy, and cyclin dependent kinase inhibition did not appear to affect seropositivity. Vaccination appeared safe and well-tolerated in patients with current or past cancer and those undergoing treatment. Adverse events were comparable to the general population, but inflammatory lymphadenopathy following vaccination was commonly reported and may be mistaken for malignant etiology. Additionally, radiation recall phenomenon was sporadically reported in patients who had received radiotherapy. Overall, while seropositivity rates were decreased, cancer patients showed capacity to generate safe and effective immune responses to COVID-19 vaccination, thus vaccination should be encouraged and hesitancy should be addressed in this population.
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La Verde N, Riva A, Cona MS, Gabrieli A, Cattaneo M, Fasola C, Lipari G, De Stradis C, Favorito V, Lombardi Stocchetti B, Chizzoniti D, Covizzi A, Rulli E, Galli F, Ruggieri L, Gambaro A, Ferrario S, Dalu D, Tarkowski MS. Immunogenicity of two doses of BNT162b2 and mRNA-1273 vaccines for solid cancer patients on treatment with or without a previous SARS-CoV-2 infection. Int J Cancer 2022; 152:661-671. [PMID: 36056571 PMCID: PMC9538813 DOI: 10.1002/ijc.34273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 02/01/2023]
Abstract
Previous studies on the immunogenicity of SARS-CoV-2 mRNA vaccines showed a reduced seroconversion in cancer patients. The aim of our study is to evaluate the immunogenicity of two doses of mRNA vaccines in solid cancer patients with or without a previous exposure to the virus. This is a single-institution, prospective, nonrandomized study. Patients in active treatment and a control cohort of healthy people received two doses of BNT162b2 (Comirnaty, BioNTech/Pfizer, The United States) or mRNA-1273 (Spikevax, Moderna). Vaccine was administered before starting anticancer therapy or on the first day of the treatment cycle. SARS-CoV-2 antibody levels against S1, RBD (to evaluate vaccine response) and N proteins (to evaluate previous infection) were measured in plasma before the first dose and 30 days after the second one. From January to June 2021, 195 consecutive cancer patients and 20 healthy controls were enrolled. Thirty-one cancer patients had a previous exposure to SARS-CoV-2. Cancer patients previously exposed to the virus had significantly higher median levels of anti-S1 and anti-RBD IgG, compared to healthy controls (P = .0349) and to cancer patients without a previous infection (P < .001). Vaccine type (anti-S1: P < .0001; anti-RBD: P = .0045), comorbidities (anti-S1: P = .0274; anti-RBD: P = .0048) and the use of G-CSF (anti-S1: P = .0151) negatively affected the antibody response. Conversely, previous exposure to SARS-CoV-2 significantly enhanced the response to vaccination (anti-S1: P < .0001; anti-RBD: P = .0026). Vaccine immunogenicity in cancer patients with a previous exposure to SARS-CoV-2 seems comparable to that of healthy subjects. On the other hand, clinical variables of immune frailty negatively affect humoral immune response to vaccination.
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Affiliation(s)
- Nicla La Verde
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Agostino Riva
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly,Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Maria Silvia Cona
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Arianna Gabrieli
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Monica Cattaneo
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Cinzia Fasola
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Giuseppe Lipari
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Claudia De Stradis
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Valentina Favorito
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | | | - Davide Chizzoniti
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Alice Covizzi
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Eliana Rulli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Francesca Galli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Lorenzo Ruggieri
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Anna Gambaro
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Sabrina Ferrario
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Davide Dalu
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Maciej S. Tarkowski
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
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Terpos E, Liontos M, Fiste O, Zagouri F, Briasoulis A, Sklirou AD, Markellos C, Skafida E, Papatheodoridi A, Andrikopoulou A, Koutsoukos K, Kaparelou M, Iconomidou VA, Trougakos IP, Dimopoulos MA. SARS-CoV-2 Neutralizing Antibodies Kinetics Postvaccination in Cancer Patients under Treatment with Immune Checkpoint Inhibition. Cancers (Basel) 2022; 14:cancers14112796. [PMID: 35681774 PMCID: PMC9179468 DOI: 10.3390/cancers14112796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Solid tumor patients under active anticancer treatment are peculiarly affected by COVID-19 infection, given not only its ominous outcomes but also the need of disruptions of their rather strict therapeutic scheme. Thus, they have been globally prioritized for both primary and booster vaccinations. The existing data with respect to the seroconversion rate of neutralizing antibodies (NAbs) among them, after vaccination, remain nevertheless obscure. Therefore, we prospectively evaluated the long-term humoral immunity dynamics for up to one month after the third dose in patients with solid malignancies receiving immunotherapy. Further research is required to assess the incremental benefit of booster doses and to optimize the vaccination schedule across different types of cancer and diverse systemic therapies. Abstract Considering that COVID-19 could adversely affect cancer patients, several countries have prioritized this highly susceptible population for vaccination. Thus, rapidly generating evidence on the efficacy of SARS-CoV-2 vaccination in the subset of patients with cancer under active therapy is of paramount importance. From this perspective, we launched the present prospective observational study to comprehensively address the longitudinal dynamics of immunogenicity of both messenger RNA (mRNA) and viral vector-based vaccines in 85 patients treated with immune checkpoint inhibitors (ICIs) for a broad range of solid tumors. Despite the relatively poor humoral responses following the priming vaccine inoculum, the seroconversion rates significantly increased after the second dose. Waning vaccine-based immunity was observed over the following six months, yet the administration of a third booster dose remarkably optimized antibody responses. Larger cohort studies providing real-world data with regard to vaccines effectiveness and durability of their protection among cancer patients receiving immunotherapy are an increasing priority.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
- Correspondence:
| | - Michalis Liontos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Oraianthi Fiste
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Aimilia D. Sklirou
- Section of Cell Biology and Biophysics, Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 15701 Athens, Greece; (A.D.S.); (V.A.I.); (I.P.T.)
| | - Christos Markellos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Efthymia Skafida
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Alkistis Papatheodoridi
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Angeliki Andrikopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Konstantinos Koutsoukos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Maria Kaparelou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
| | - Vassiliki A. Iconomidou
- Section of Cell Biology and Biophysics, Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 15701 Athens, Greece; (A.D.S.); (V.A.I.); (I.P.T.)
| | - Ioannis P. Trougakos
- Section of Cell Biology and Biophysics, Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, 15701 Athens, Greece; (A.D.S.); (V.A.I.); (I.P.T.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, 11528 Athens, Greece; (M.L.); (O.F.); (F.Z.); (A.B.); (C.M.); (E.S.); (A.P.); (A.A.); (K.K.); (M.K.); (M.-A.D.)
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Nelli F, Fabbri A, Panichi V, Giannarelli D, Topini G, Giron Berrios JR, Virtuoso A, Marrucci E, Mazzotta M, Schirripa M, Signorelli C, Chilelli MG, Primi F, Silvestri MA, Ruggeri EM. Peripheral lymphocyte subset counts predict antibody response after SARS-CoV-2 mRNA-BNT162b2 vaccine in cancer patients: results from the Vax-On-Profile study. Int Immunopharmacol 2022; 108:108774. [PMID: 35461110 PMCID: PMC9008127 DOI: 10.1016/j.intimp.2022.108774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022]
Abstract
Background The adaptive immune response following COVID-19 vaccination is essential for humoral immunogenicity and clinical protection against symptomatic infections. We present the results of circulating lymphocyte profiling and their correlation with antibody response in cancer patients tested serologically six months after receiving a two-dose schedule of mRNA-BNT162b2 vaccine. Methods Absolute counts of lymphocyte subsets were determined using peripheral blood immunophenotyping. We collected samples for flow cytometry analysis alongside quantitative detection of IgG antibodies against the receptor-binding domain (RBD) of the SARS-CoV-2 Spike protein (S1). An IgG titer ≥ 50 AU/mL defined a positive seroconversion response. Results 311 patients were evaluable for lymphocyte profiling and serologic testing. A preliminary multivariate analysis revealed that cytotoxic chemotherapy was the most consistent factor associated with lower counts of all lymphocyte subpopulations. T helper and B cells were found to be useful in predicting the occurrence of a positive seroconversion response using ROC curve analysis. A significant positive linear correlation was shown when anti-RBD-S1 IgG titers were compared to these lymphocyte subset counts. Univariate analysis indicated that antibody titers and seroconversion rates were significantly improved in the high-level T and B cell subgroups. Multivariate analysis confirmed these significant interactions, as well as the negative predictive value of immunosuppressive corticosteroid therapy. Conclusions These findings suggest that simple and widely available peripheral counts of T helper and B cells correlate with humoral response to mRNA-BNT162b2 vaccine in actively treated cancer patients. Upon validation, our results could provide additional insights into the predictive assessment of vaccination efficacy.
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Ma Y, Liu N, Wang Y, Zeng J, Hu YY, Hao W, Shi H, Zhu P, Lv J, Fan W, Wang X. Immune checkpoint blocking impact and nomogram prediction of COVID-19 inactivated vaccine seroconversion in patients with cancer: a propensity-score matched analysis. J Immunother Cancer 2021; 9:jitc-2021-003712. [PMID: 34845005 PMCID: PMC8634011 DOI: 10.1136/jitc-2021-003712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with cancer on active immune checkpoint inhibitors therapy were recommended to seek prophylaxis from COVID-19 by vaccination. There have been few reports to date to discuss the impact of progression cell death-1 blockers (PD-1B) on immune or vaccine-related outcomes, and what risk factors that contribute to the serological status remains to be elucidated. The study aims to find the impact of PD-1B on vaccination outcome and investigate other potential risk factors associated with the risk of seroconversion failure. METHODS Patients with active cancer treatment were retrospectively enrolled to investigate the interaction effects between PD-1B and vaccination. Through propensity score matching of demographic and clinical features, the seroconversion rates and immune/vaccination-related adverse events (irAE and vrAE) were compared in a head-to-head manner. Then, a nomogram predicting the failure risk was developed with variables significant in multivariate regression analysis and validated in an independent cohort. RESULTS Patients (n=454) receiving either PD-1B or COVID-19 vaccination, or both, were matched into three cohorts (vac+/PD-1B+, vac+/PD-1B-, and vac-/PD-1B+, respectively), with a non-concer control group of 206 participants. 68.1% (94/138), 71.3% (117/164), and 80.5% (166/206) were seropositive in vac+/PD-1B+cohort, vac+/PD-1B- cohort, and non-cancer control group, respectively. None of irAE or vrAE was observed to be escalated in PD-1B treatment except for low-grade rash.The vaccinated patients with cancer had a significantly lower rate of seroconversion rates than healthy control. A nomogram was thus built that encompassed age, pathology, and chemotherapy status to predict the seroconversion failure risk, which was validated in an independent cancer cohort of 196 patients. CONCLUSION Although patients with cancer had a generally decreased rate of seroconversion as compared with the healthy population, the COVID-19 vaccine was generally well tolerated, and seroconversion was not affected in patients receiving PD-1B. A nomogram predicting failure risk was developed, including age, chemotherapy status, pathology types, and rheumatic comorbidity.
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Affiliation(s)
- Yifei Ma
- Department of Orthopedics & Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Nianqi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, People's Republic of China
| | - Youlong Wang
- Department of General Surgery, Hainan Hospital of PLA General Hospital, Sanya City, Hainan Province, People's Republic of China
| | - Jiling Zeng
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Ying-Ying Hu
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Wu Hao
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Huazheng Shi
- Department of Nuclear Medicine, Shanghai Universal Medical Imaging Center, Shanghai, People's Republic of China
| | - Pengfei Zhu
- Department of Clinical Laboratory, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Jun Lv
- Department of Infectious Diseases and Hepatology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
| | - Wei Fan
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Xinjia Wang
- Department of Orthopedics & Spine Surgery, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
- Department of Orthopedics, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
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