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Gröning R, Walde J, Ahlm C, Forsell MNE, Normark J, Rasmuson J. Intravenous immunoglobulin therapy for COVID-19 in immunocompromised patients: A retrospective cohort study. Int J Infect Dis 2024; 144:107046. [PMID: 38615825 DOI: 10.1016/j.ijid.2024.107046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVES To investigate the effectiveness of intravenous immunoglobulin (IVIG) as treatment for COVID-19 in immunocompromised patients. METHODS This retrospective study investigated outcomes for immunocompromised, vaccine non-responsive, patients that between September 2022 and April 2023 received IVIG as treatment for COVID-19 in the region of Västerbotten, Sweden. We analyzed clinical data, viral load, and anti-SARS-CoV-2 IgG binding and neutralization levels of patient serum samples and IVIG production batches. Primary and secondary outcomes were clinical cure and viral clearance, respectively. RESULTS Sixteen patients were analyzed. After a median COVID-19 duration of 4 weeks, a median 60 g IVIG infusion increased SARS-CoV-2 binding and neutralizing antibody levels, with broad in vitro activity against tested variants. The treatment resulted in abrogation of viremia in all patients and general improvement in 15 survivors that all met the primary endpoint. Thirteen patients met the secondary endpoint at follow-up after a median of four months. Two subjects with persistent SARS-CoV-2 carriage relapsed but were successfully retreated with IVIG. CONCLUSIONS Antibodies in IVIG efficiently neutralized several SARS-CoV-2 variants. Treatment with IVIG was associated with clinical cure and viral clearance in immunocompromised patients. Our data suggests that IVIG could be a novel treatment alternative for COVID-19 for this patient category.
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Affiliation(s)
- Remigius Gröning
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Jonatan Walde
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | | | - Johan Normark
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Johan Rasmuson
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
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2
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Konuma T, Hamatani-Asakura M, Nagai E, Adachi E, Kato S, Isobe M, Monna-Oiwa M, Takahashi S, Yotsuyanagi H, Nannya Y. Cellular and humoral immunogenicity against SARS-CoV-2 vaccination or infection is associated with the memory phenotype of T- and B-lymphocytes in adult allogeneic hematopoietic cell transplant recipients. Int J Hematol 2024:10.1007/s12185-024-03802-3. [PMID: 38842630 DOI: 10.1007/s12185-024-03802-3] [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: 10/06/2023] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
We conducted a cross-sectional study to evaluate cellular and humoral immunogenicity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination or infection and examine how lymphocyte subpopulations in peripheral blood correlate with cellular and humoral immunogenicity in adult allogeneic hematopoietic cell transplantation (HCT) recipients. The median period from SARS-CoV-2 vaccination or infection to sample collection was 110.5 days (range, 6-345 days). The median SARS-CoV-2 spike-specific antibody level was 1761 binding antibody units (BAU)/ml (range, 0 to > 11,360 BAU/ml). Enzyme-linked immunosorbent spot (ELISpot) assay of T cells stimulated with SARS-CoV-2 spike antigens showed that interferon-gamma (IFN-γ)-, interleukin-2 (IL-2)-, and IFN-γ + IL-2-producing T cells were present in 68.9%, 62.0%, and 56.8% of patients, respectively. The antibody level was significantly correlated with frequency of IL-2-producing T cells (P = 0.001) and IFN-γ + IL-2-producing T cells (P = 0.006) but not IFN-γ-producing T cells (P = 0.970). Absolute counts of CD8+ and CD4+ central memory T cells were higher in both IL-2- and IFN-γ + IL-2-producing cellular responders compared with non-responders. These data suggest that cellular and humoral immunogenicity against SARS-CoV-2 vaccination or infection is associated with the memory phenotype of T cells and B cells in adult allogeneic HCT recipients.
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Affiliation(s)
- Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan.
| | - Megumi Hamatani-Asakura
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Etsuko Nagai
- Department of Laboratory Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiko Kato
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Masamichi Isobe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Maki Monna-Oiwa
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Satoshi Takahashi
- Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuhito Nannya
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
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3
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Reimann P, Petzer V, Mündlein A, Hartmann B, Severgnini L, Winkler A, Lang T, Huynh M, Gasser K, Rüger J, Atzl M, Mink S, Fraunberger P, Schmidt S, Steiner N, Griesmacher A, Gunsilius E, Nachbaur D, Willenbacher W, Wolf D, Winder T, Benda MA. Efficacy and safety of tixagevimab/cilgavimab as passive immunisation against COVID-19 infections in patients with hematological malignancies. Ann Hematol 2024; 103:2123-2131. [PMID: 38436671 DOI: 10.1007/s00277-024-05671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
Monoclonal antibodies, as tixagevimab/cilgavimab, have been introduced as prophylaxis against COVID-19 infections in high-risk populations. However, data on efficacy are limited. This study investigates efficacy and tolerability of tixagevimab/cilgavimab in hematological patients under real-life conditions. Tixagevimab/cilgavimab was administered to 155 hematological patients (March-August 2022) at two Austrian centres. S/RBD-antibody assessments were performed before (T0), four weeks (T1), and six months (T2) after application. Side effects, the occurrence of COVID-19 infections, and the course of S/RBD-antibody titres were analysed retrospectively in relation to clinical variables. 155 hematological patients, who refused tixagevimab/cilgavimab, were included as a control group to compare the frequency of COVID-19 infections. Of all immunised patients (52.3% males; 91% triple vaccinated), 25.8% had a COVID-19 breakthrough infection (76% mild) compared to 43.9% in the control group. Patients with chronic lymphocytic leukaemia (CLL)/lymphoma were at highest risk of a COVID-19 infection (OR = 2.21; 95% CI 1.05-4.65; p = 0.037). After immunisation, a steep increase in median antibody levels (1193.4BAU/ml, IQR 0-2318.94) was observed in 67.8%, followed by a rapid decrease between T1 and T2 (465.95BAU/ml, IQR 0-1900.65.3) with the greatest declines in CLL/lymphoma (848.7BAU/ml, IQR 0-1949.6, p = 0.026). Side-effects occurred in 21.2% (CTCAE I/II). These real-world data indicate that S/RBD antibodies respond rapidly after passive immunisation in all hematological patients without safety concerns. Given the rapid decline in S/RBD antibodies, early booster immunisations should be considered for future scenarios in this vulnerable group.
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Affiliation(s)
- Patrick Reimann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Verena Petzer
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Axel Mündlein
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
| | - Bernd Hartmann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Luciano Severgnini
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Alex Winkler
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Theresia Lang
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Minh Huynh
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Klaus Gasser
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Julia Rüger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Michele Atzl
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Stefan Schmidt
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Normann Steiner
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Med. and Chem. Laboratory Diagnostics (ZIMCL) With Interdisciplinary Hematological Competence Centre (IHK), Medical University Innsbruck, Innsbruck, Austria
| | - Eberhard Gunsilius
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - David Nachbaur
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
- Syndena,GmbH Connect to Cure, Innsbruck, Austria
| | - Dominik Wolf
- Innsbruck University Hospital, Internal Medicine V: Haematology & Oncology, Innsbruck, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
- University of Zurich, Zurich, Switzerland
| | - Magdalena Anna Benda
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
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4
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Kalogriopoulos NA, Tei R, Yan Y, Ravalin M, Li Y, Ting A. Synthetic G protein-coupled receptors for programmable sensing and control of cell behavior. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.15.589622. [PMID: 38659921 PMCID: PMC11042292 DOI: 10.1101/2024.04.15.589622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Synthetic receptors that mediate antigen-dependent cell responses are transforming therapeutics, drug discovery, and basic research. However, established technologies such as chimeric antigen receptors (CARs) can only detect immobilized antigens, have limited output scope, and lack built-in drug control. Here, we engineer synthetic G protein-coupled receptors (GPCRs) capable of driving a wide range of native or nonnative cellular processes in response to user-defined antigen. We achieve modular antigen gating by engineering and fusing a conditional auto-inhibitory domain onto GPCR scaffolds. Antigen binding to a fused nanobody relieves auto-inhibition and enables receptor activation by drug, thus generating Programmable Antigen-gated G protein-coupled Engineered Receptors (PAGERs). We create PAGERs responsive to more than a dozen biologically and therapeutically important soluble and cell surface antigens, in a single step, from corresponding nanobody binders. Different PAGER scaffolds permit antigen binding to drive transgene expression, real-time fluorescence, or endogenous G protein activation, enabling control of cytosolic Ca 2+ , lipid signaling, cAMP, and neuronal activity. Due to its modular design and generalizability, we expect PAGER to have broad utility in discovery and translational science.
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5
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Rossi G, Salmanton-García J, Cattaneo C, Marchesi F, Dávila-Valls J, Martín-Pérez S, Itri F, López-García A, Glenthøj A, Gomes da Silva M, Besson C, Marchetti M, Weinbergerová B, Jaksic O, Jiménez M, Bilgin YM, Van Doesum J, Farina F, Žák P, Verga L, Collins GP, Bonuomo V, Van Praet J, Nucci M, Meers S, Espigado I, Fracchiolla NS, Valković T, Poulsen CB, Čolović N, Dragonetti G, Ledoux MP, Tascini C, Buquicchio C, Blennow O, Passamonti F, Machado M, Labrador J, Duarte RF, Schönlein M, Prezioso L, Falces-Romero I, Kulasekararaj A, Garcia-Vidal C, Fernández N, Abu-Zeinah G, Ormazabal-Vélez I, Adžić-Vukičević T, Piukovics K, Stoma I, Cuccaro A, Magliano G, Szotkowski T, González-López TJ, El-Ashwah S, Bergantim R, Sili U, Maertens J, Demirkan F, De Ramón C, Petzer V, Del Principe MI, Navrátil M, Dargenio M, Seval GC, Samarkos M, Ráčil Z, Pinczés LI, Lahmer T, Busca A, Méndez GA, Vena A, Biernat MM, Merelli M, Calbacho M, Barać A, Bavastro M, Limongelli A, Ilhan O, Wolf D, Çolak GM, García-Sanz R, Emarah Z, Mišković B, Gräfe SK, Mladenović M, Aiello TF, Núñez-Martín-Buitrago L, Nordlander A, Arellano E, Zambrotta GPM, Ammatuna E, Cabirta A, Sacchi MV, Nunes Rodrigues R, Hersby DS, Hanakova M, Rahimli L, Cordoba R, Cornely OA, Pagano L. Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings. Int J Infect Dis 2023; 137:98-110. [PMID: 37863310 DOI: 10.1016/j.ijid.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/16/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. METHODS We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. RESULTS The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. CONCLUSION These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.
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Affiliation(s)
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Federico Itri
- San Luigi Gonzaga Hospital - Orbassano, Orbassano, Italy
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Caroline Besson
- Centre Hospitalier de Versailles, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, Villejuif, France
| | - Monia Marchetti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Ozren Jaksic
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
| | - Moraima Jiménez
- Department of Hematology, Vacute lymphoid leukaemia d'Hebron Hospital Universitari, Experimental Hematology, Vacute lymphoid leukaemia d'Hebron Institute of Oncology (VHIO), Vacute lymphoid leukaemia d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Yavuz M Bilgin
- Department of Internal Medicine, ADRZ, Goes, Netherlands
| | | | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy; Università Milano-Bicocca, Milan, Italy
| | - Graham P Collins
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Jens Van Praet
- Department of Nephrology and Infectious diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Marcio Nucci
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | - Toni Valković
- University Hospital Centre Rijeka, Rijeka, Croatia; Croatian Cooperative Group for Hematological Diseases (CROHEM), Faculty of Medicine and Faculty of Health Studies University of Rijeka, Rijeka, Croatia
| | | | - Natasha Čolović
- University Clinical Center Serbia, Medical Faculty University Belgrade, Belgrade, Serbia
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | | | - Carlo Tascini
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lucia Prezioso
- Hospital University of Parma - Hematology and Bone Marrow Unit, Parma, Italy
| | - Iker Falces-Romero
- La Paz University Hospital, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Austin Kulasekararaj
- King's College Hospital, London, United Kingdom; King's College London, London, United Kingdom
| | | | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ghaith Abu-Zeinah
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, United States
| | | | | | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Igor Stoma
- Gomel State Medical University, Gomel, Belarus
| | - Annarosa Cuccaro
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | | | | | | | | | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven and Department of Hematology, UZ Leuven, Leuven, Belgium
| | - Fatih Demirkan
- Dokuz Eylul University, Division of Hematology, Izmir, Turkey
| | - Cristina De Ramón
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain; IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | | | | | | | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tobias Lahmer
- Medizinische Klinik II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | - Antonio Vena
- IRCCS AOU San Martino (IRCCS Ospedale Policlinico San Martino), Genova, Italia
| | - Monika M Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | | | - Aleksandra Barać
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
| | - Martina Bavastro
- IRCCS AOU San Martino (IRCCS Ospedale Policlinico San Martino), Genova, Italia
| | | | | | - Dominik Wolf
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gökçe Melis Çolak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ramón García-Sanz
- IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain; Head of Molecular Biology an HLA Unit, Department of Hematology, University Hospital of Salamanca (HUS/IBSAL/CIBERONC), Salamanca, Spain
| | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | - Bojana Mišković
- Hospital Clinic, Barcelona, Spain; Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefanie K Gräfe
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Anna Nordlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Elena Arellano
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC), Universidad de Sevilla (Departamento de Medicina), Seville, Spain
| | | | | | - Alba Cabirta
- Department of Hematology, Vacute lymphoid leukaemia d'Hebron Hospital Universitari, Experimental Hematology, Vacute lymphoid leukaemia d'Hebron Institute of Oncology (VHIO), Vacute lymphoid leukaemia d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Vittoria Sacchi
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy; Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Bacher U, Shumilov E, Pabst T. Benefit of repeated COVID-19 vaccination for patients with B-cell malignancies. Br J Haematol 2023; 202:1081-1083. [PMID: 37519052 DOI: 10.1111/bjh.19005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Ulrike Bacher
- Department of Hematology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Evgenii Shumilov
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital Inselspital and University of Bern, Bern, Switzerland
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7
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Donhauser LV, Veloso de Oliveira J, Schick C, Manlik W, Styblova S, Lutzenberger S, Aigner M, Philipp P, Robert S, Gandorfer B, Hempel D, Hempel L, Zehn D. Responses of patients with cancer to mRNA vaccines depend on the time interval between vaccination and last treatment. J Immunother Cancer 2023; 11:e007387. [PMID: 37730271 PMCID: PMC10510941 DOI: 10.1136/jitc-2023-007387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Personalized mRNA vaccines are promising new therapeutic options for patients with cancer. Because mRNA vaccines are not yet approved for first-line therapy, the vaccines are presently applied to individuals that received prior therapies that can have immunocompromising effects. There is a need to address how prior treatments impact mRNA vaccine outcomes. METHOD Therefore, we analyzed the response to BioNTech/Pfizer's anti-SARS-CoV-2 mRNA vaccine in 237 oncology outpatients, which cover a broad spectrum of hematologic malignancies and solid tumors and a variety of treatments. Patients were stratified by the time interval between the last treatment and first vaccination and by the presence or absence of florid tumors and IgG titers and T cell responses were analyzed 14 days after the second vaccination. RESULTS Regardless of the last treatment time point, our data indicate that vaccination responses in patients with checkpoint inhibition were comparable to healthy controls. In contrast, patients after chemotherapy or cortisone therapy did not develop an immune response until 6 months after the last systemic therapy and patients after Cht-immune checkpoint inhibitor and tyrosine kinase inhibitor therapy only after 12 months. CONCLUSION Accordingly, our data support that timing of mRNA-based therapy is critical and we suggest that at least a 6-months or 12-months waiting interval should be observed before mRNA vaccination in systemically treated patients.
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Affiliation(s)
- Lara Victoria Donhauser
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
| | | | | | - Wenzel Manlik
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
| | - Sabrina Styblova
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
| | - Sarah Lutzenberger
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
| | - Michael Aigner
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
| | - Patrick Philipp
- System Technologies and Image Exploitation IOSB, Fraunhofer Institute of Optronics, Karlsruhe, Germany
| | - Sebastian Robert
- Division of Applied Health and Social Sciences, Technical University of Applied Sciences, Rosenheim, Germany
| | | | - Dirk Hempel
- Oncological Center Donauwörth, Donauwörth, Germany
| | | | - Dietmar Zehn
- Division of Animal Physiology and Immunology, Technical University of Munich, Freising, Germany
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Huang CT, Lee CP, Chen TY, Liu YC, Cho SF, Du JS, Yu ML, Huang CF, Wang SF, Hsiao HH. Serological Responses and Predictive Factors of Booster COVID-19 Vaccines in Patients with Hematologic Malignancies. J Clin Med 2023; 12:5647. [PMID: 37685720 PMCID: PMC10488979 DOI: 10.3390/jcm12175647] [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: 06/16/2023] [Revised: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Patients with hematologic malignancies are reported to have a more severe course of coronavirus disease 2019 (COVID-19) and be less responsive to vaccination. In this prospective study, we aimed to evaluate the serological responses to booster COVID-19 vaccines of Taiwanese patients with hematologic malignancies and identify potential predictive markers for effective neutralizing immunity. This study enrolled 68 patients with hematologic malignancies and 68 age- and gender-matched healthy control subjects who received three doses of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1 January 2022 to 31 October 2022. The SARS-CoV-2 immunoglobulin G (IgG) spike antibody level was measured with the Abbott assay. The effective neutralization capacity was defined as an anti-spike IgG level of ≥4160 AU/mL. Among the 68 patients with hematologic malignancies, 89.7% achieved seroconversion after booster doses. Seven patients with actively treated lymphoma remained seronegative and had the lowest humoral responses among patients with different types of hematologic malignancies. Despite comparable antibody titers between patients and healthy individuals, rates of effective neutralization (66.2% vs. 86.8%, respectively; p = 0.005) were significantly reduced in patients with hematologic malignancies. In a multivariate analysis, the independent predictors for effective neutralization were a lack of B-cell-targeted agents within six months of vaccination (odds ratio, 15.2; 95% confidence interval, 2.7-84.2; p = 0.002) and higher immunoglobulin levels (odds ratio, 4.4; 95% confidence interval, 1.3-14.7; p = 0.017). In conclusion, the majority of patients with hematologic malignancies achieved seroconversion after booster vaccination. Patients with ongoing B-cell depletion and hypogammaglobinemia were identified as having negative predictive markers for effective neutralization.
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Affiliation(s)
- Chien-Tzu Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ping Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
| | - Tzu-Yin Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yi-Chang Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shih-Feng Cho
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Shiun Du
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Lung Yu
- Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-L.Y.); (C.-F.H.)
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Chung-Feng Huang
- Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-L.Y.); (C.-F.H.)
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University and Academia Sinica, Kaohsiung 807, Taiwan
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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9
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Szabó E, Modok S, Rónaszéki B, Faragó A, Gémes N, Nagy LI, Hackler L, Farkas K, Neuperger P, Balog JÁ, Balog A, Puskás LG, Szebeni GJ. Comparison of humoral and cellular immune responses in hematologic diseases following completed vaccination protocol with BBIBP-CorV, or AZD1222, or BNT162b2 vaccines against SARS-CoV-2. Front Med (Lausanne) 2023; 10:1176168. [PMID: 37529238 PMCID: PMC10389666 DOI: 10.3389/fmed.2023.1176168] [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: 02/28/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Background Vaccination has proven the potential to control the COVID-19 pandemic worldwide. Although recent evidence suggests a poor humoral response against SARS-CoV-2 in vaccinated hematological disease (HD) patients, data on vaccination in these patients is limited with the comparison of mRNA-based, vector-based or inactivated virus-based vaccines. Methods Forty-nine HD patients and 46 healthy controls (HCs) were enrolled who received two-doses complete vaccination with BNT162b2, or AZD1222, or BBIBP-CorV, respectively. The antibodies reactive to the receptor binding domain of spike protein of SARS-CoV-2 were assayed by Siemens ADVIA Centaur assay. The reactive cellular immunity was assayed by flow cytometry. The PBMCs were reactivated with SARS-CoV-2 antigens and the production of activation-induced markers (TNF-α, IFN-γ, CD40L) was measured in CD4+ or CD8+ T-cells ex vivo. Results The anti-RBD IgG level was the highest upon BNT162b2 vaccination in HDs (1264 BAU/mL) vs. HCs (1325 BAU/mL) among the studied groups. The BBIBP-CorV vaccination in HDs (339.8 BAU/mL ***p < 0.001) and AZD1222 in HDs (669.9 BAU/mL *p < 0.05) resulted in weaker antibody response vs. BNT162b2 in HCs. The response rate of IgG production of HC vs. HD patients above the diagnostic cut-off value was 100% vs. 72% for the mRNA-based BNT162b2 vaccine; 93% vs. 56% for the vector-based AZD1222, or 69% vs. 33% for the inactivated vaccine BBIBP-CorV, respectively. Cases that underwent the anti-CD20 therapy resulted in significantly weaker (**p < 0.01) anti-RBD IgG level (302 BAU/mL) than without CD20 blocking in the HD group (928 BAU/mL). The response rates of CD4+ TNF-α+, CD4+ IFN-γ+, or CD4+ CD40L+ cases were lower in HDs vs. HCs in all vaccine groups. However, the BBIBP-CorV vaccine resulted the highest CD4+ TNF-α and CD4+ IFN-γ+ T-cell mediated immunity in the HD group. Conclusion We have demonstrated a significant weaker overall response to vaccines in the immunologically impaired HD population vs. HCs regardless of vaccine type. Although, the humoral immune activity against SARS-CoV-2 can be highly evoked by mRNA-based BNT162b2 vaccination compared to vector-based AZD1222 vaccine, or inactivated virus vaccine BBIBP-CorV, whereas the CD4+ T-cell mediated cellular activity was highest in HDs vaccinated with BBIBP-CorV.
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Affiliation(s)
- Enikő Szabó
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
| | - Szabolcs Modok
- Department of Medicine, Szent-Györgyi Albert Medical School-University of Szeged, Szeged, Hungary
| | - Benedek Rónaszéki
- Department of Medicine, Szent-Györgyi Albert Medical School-University of Szeged, Szeged, Hungary
| | - Anna Faragó
- Avidin Ltd., Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | | | | | | | - Patrícia Neuperger
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - József Á. Balog
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
| | - Attila Balog
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Avidin Ltd., Szeged, Hungary
- Avicor Ltd., Szeged, Hungary
| | - Gabor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- CS-Smartlab Devices, Kozarmisleny, Hungary
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10
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Kokogho A, Crowell TA, Aleissa M, Lupan AM, Davey S, Park Chang JB, Baden LR, Walsh SR, Sherman AC. SARS-CoV-2 Vaccine-Induced Immune Responses Among Hematopoietic Stem Cell Transplant Recipients. Open Forum Infect Dis 2023; 10:ofad349. [PMID: 37520415 PMCID: PMC10372870 DOI: 10.1093/ofid/ofad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Background Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination reduces the risk and severity of coronavirus disease 2019 (COVID-19), several variables may impact the humoral response among patients undergoing hematopoietic stem cell transplantation (HSCT). Methods A retrospective chart review was conducted among SARS-CoV-2-vaccinated HSCT recipients between 2020 and 2022 at a single center in Boston, Massachusetts. Patients age ≥18 years who received doses of Pfizer, Moderna, or J&J vaccines were included. Anti-spike (S) immunoglobulin G (IgG) titer levels were measured using the Roche assay. Responders (≥0.8 U/mL) and nonresponders (<0.8 U/mL) were categorized and analyzed. Multivariable linear and logistic regression were used to estimate the correlation coefficient and odds ratio of response magnitude and status. Results Of 152 HSCT recipients, 141 (92.8%) were responders, with a median (interquartile range [IQR]) anti-S IgG titer of 2500 (107.9-2500) U/mL at a median (IQR) of 80.5 (36-153.5) days from last dose, regardless of the number of doses received. Higher quantitative titers were associated with receipt of more vaccine doses (coeff, 205.79; 95% CI, 30.10 to 381.47; P = .022), being female (coeff, 343.5; 95% CI, -682.6 to -4.4; P = .047), being younger (<65 years; coeff, 365.2; 95% CI, -711.3 to 19.1; P = .039), and not being on anti-CD20 therapy (coeff, -1163.7; 95% CI, -1717.7 to -609.7; P = .001). Being male (odds ratio [OR], 0.11; 95% CI, 0.01 to 0.93; P = .04) and being on anti-CD20 therapy (OR, 0.16; 95% CI, 0.03 to 0.70; P = .016) were associated with nonresponse. Conclusions Overall, most HSCT recipients had high SARS-CoV-2 antibody responses. More vaccine doses improved the magnitude of immune responses. Anti-S IgG monitoring may be useful for identifying attenuated vaccine-induced responses.
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Affiliation(s)
- Afoke Kokogho
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Trevor A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Muneerah Aleissa
- Present affiliation: Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ana-Mihaela Lupan
- Department of Cell Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonya Davey
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jun Bai Park Chang
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen R Walsh
- Correspondence: Stephen R. Walsh, MDCM, Division of Infectious Diseases, Brigham & Women’s Hospital, 75 Francis Street, PBB-A-4, Boston, MA 02115 (); or Amy C. Sherman, MD, Division of Infectious Diseases, Brigham & Women’s Hospital, 75 Francis Street, PBB-A-4, Boston, MA 02115 ()
| | - Amy C Sherman
- Correspondence: Stephen R. Walsh, MDCM, Division of Infectious Diseases, Brigham & Women’s Hospital, 75 Francis Street, PBB-A-4, Boston, MA 02115 (); or Amy C. Sherman, MD, Division of Infectious Diseases, Brigham & Women’s Hospital, 75 Francis Street, PBB-A-4, Boston, MA 02115 ()
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11
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Gonzalez-Bocco IH, Beluch K, Cho A, Lahoud C, Reyes FA, Moshovitis DG, Unger-Mochrie GM, Wang W, Hammond SP, Manne-Goehler J, Koo S. Safety and tolerability study of sotrovimab (VIR-7831) prophylaxis against COVID-19 infection in immunocompromised individuals with impaired SARS-CoV-2 humoral immunity. Pilot Feasibility Stud 2023; 9:100. [PMID: 37328890 DOI: 10.1186/s40814-023-01325-y] [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: 07/04/2022] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Multiple vaccines have been approved since August 2021 to prevent infection with SARS-CoV-2; however, 20-40% of immunocompromised people fail to develop SARS-CoV-2 spike antibodies after COVID-19 vaccination and remain at high risk of infection and more severe illness than non-immunocompromised hosts. Sotrovimab (VIR-7831) is a monoclonal neutralizing antibody that binds a conserved epitope on the SARS-CoV-2 spike protein. It is neither renally excreted nor metabolized by P450 enzymes and therefore unlikely to interact with concomitant medications (e.g., immunosuppressive medications). In this open-label feasibility study protocol, we will define the optimal dose and dosing interval of sotrovimab as pre-exposure prophylaxis for immunocompromised individuals as well as its safety and tolerability in this population specifically. METHODS We will enroll 93 eligible immunocompromised adults with a negative or low-positive (< 50 U/mL) SARS-CoV-2 spike antibody. In phase 1, the first 10 patients will participate in a lead-in pharmacokinetics (PK) cohort study to determine the optimal dosing interval. Phase 2 will expand this population to 50 participants to examine rates of infusion-related reactions (IRR) with a 30-min 500 mg sotrovimab IV infusion. Phase 3 will be an expansion cohort for further assessment of the safety and tolerability of sotrovimab. In phase 4, the first 10 patients receiving 2000 mg IV of sotrovimab on the second sotrovimab infusion day will comprise a lead-in safety cohort that will inform the duration of observation following administration of the drug. The patients will be followed for safety and COVID-19 events for 36 weeks after the second dose. DISCUSSION In a previous phase III randomized, placebo-controlled pivotal trial, there were no significant differences in the prevalence of adverse events in patients receiving sotrovimab vs. placebo. Thus, we propose an open-label feasibility study protocol of sotrovimab as pre-exposure prophylaxis for immunocompromised individuals to evaluate its PK in immunocompromised individuals with impaired SARS-CoV-2 humoral immunity and define optimal dosing intervals. We also aim to determine COVID-19 infections over the study period and self-reported quality of life measures throughout the study. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05210101.
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Affiliation(s)
- Isabel H Gonzalez-Bocco
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA.
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Katherine Beluch
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Alyssa Cho
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Chloe Lahoud
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fabiola A Reyes
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dimitrios G Moshovitis
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Wei Wang
- Harvard Medical School, Boston, MA, USA
- Medicine Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah P Hammond
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Koo
- Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, MA, USA.
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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12
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Roškar Z, Dreisinger M, Tič P, Homšak E, Bevc S, Goropevšek A. New Flow Cytometric Methods for Monitoring STAT5 Signaling Reveal Responses to SARS-CoV-2 Antigen-Specific Stimulation in FOXP3+ Regulatory T Cells also in Patients with Advanced Chronic Lymphocytic Leukemia. BIOSENSORS 2023; 13:bios13050539. [PMID: 37232900 DOI: 10.3390/bios13050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Increased frequency of CD4+CD25+ regulatory T-cells (Treg) has been associated with disease progression in chronic lymphocytic leukemia (CLL). Flow cytometric methods, which allow for the simultaneous analysis of their specific transcription factor Foxp3 and activated STAT proteins, together with proliferation can help to elucidate the signaling mechanisms driving Treg expansion and suppression of FOXP3- conventional CD4+T-cells (Tcon). Herein, we first report a novel approach in which STAT5 phosphorylation (pSTAT5) and proliferation (BrdU-FITC incorporation) could be analyzed specifically in FOXP3+ and FOXP3- responding cells after CD3/CD28 stimulation. The addition of magnetically purified CD4+CD25+ T-cells from healthy donors to cocultured autologous CD4+CD25- T-cells resulted in suppression of Tcon cell cycle progression accompanied by a decrease in pSTAT5. Next, a method using imaging flow cytometry is presented for the detection of cytokine-dependent pSTAT5 nuclear translocation in FOXP3-expressing cells. Finally, we discuss our experimental data obtained by combining Treg pSTAT5 analysis and antigen-specific stimulation with SARS-CoV-2 antigens. Applying these methods on samples from patients revealed Treg responses to antigen-specific stimulation and significantly higher basal pSTAT5 in CLL patients treated with immunochemotherapy. Thus, we speculate that through the use of this pharmacodynamic tool, the efficacy of immunosuppressive drugs and their possible off-target effects can be assessed.
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Affiliation(s)
- Zlatko Roškar
- Department of Haematology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Mojca Dreisinger
- Department of Haematology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Primož Tič
- Department of Laboratory Diagnostics, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Evgenija Homšak
- Department of Laboratory Diagnostics, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Sebastjan Bevc
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Department of Nephrology, University Medical Center Maribor, 2000 Maribor, Slovenia
| | - Aleš Goropevšek
- Department of Laboratory Diagnostics, University Medical Centre Maribor, 2000 Maribor, Slovenia
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13
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Liatsou E, Ntanasis-Stathopoulos I, Lykos S, Ntanasis-Stathopoulos A, Gavriatopoulou M, Psaltopoulou T, Sergentanis TN, Terpos E. Adult Patients with Cancer Have Impaired Humoral Responses to Complete and Booster COVID-19 Vaccination, Especially Those with Hematologic Cancer on Active Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15082266. [PMID: 37190194 DOI: 10.3390/cancers15082266] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
The exclusion of patients with cancer in clinical trials evaluating COVID-19 vaccine efficacy and safety, in combination with the high rate of severe infections, highlights the need for optimizing vaccination strategies. The aim of this study was to perform a systematic review and meta-analysis of the published available data from prospective and retrospective cohort studies that included patients with either solid or hematological malignancies according to the PRISMA Guidelines. A literature search was performed in the following databases: Medline (Pubmed), Scopus, Clinicaltrials.gov, EMBASE, CENTRAL and Google Scholar. Overall, 70 studies were included for the first and second vaccine dose and 60 studies for the third dose. The Effect Size (ES) of the seroconversion rate after the first dose was 0.41 (95%CI: 0.33-0.50) for hematological malignancies and 0.56 (95%CI: 0.47-0.64) for solid tumors. The seroconversion rates after the second dose were 0.62 (95%CI: 0.57-0.67) for hematological malignancies and 0.88 (95%CI: 0.82-0.93) for solid tumors. After the third dose, the ES for seroconversion was estimated at 0.63 (95%CI: 0.54-0.72) for hematological cancer and 0.88 (95%CI: 0.75-0.97) for solid tumors. A subgroup analysis was performed to evaluate potential factors affecting immune response. Production of anti-SARS-CoV-2 antibodies was found to be more affected in patients with hematological malignancies, which was attributed to the type of malignancy and treatment with monoclonal antibodies according to the subgroup analyses. Overall, this study highlights that patients with cancer present suboptimal humoral responses after COVID-19 vaccination. Several factors including timing of vaccination in relevance with active therapy, type of therapy, and type of cancer should be considered throughout the immunization process.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Stavros Lykos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodoros N Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
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14
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Ishio T, Tsukamoto S, Yokoyama E, Izumiyama K, Saito M, Muraki H, Kobayashi M, Mori A, Morioka M, Kondo T. Anti-CD20 antibodies and bendamustine attenuate humoral immunity to COVID-19 vaccination in patients with B-cell non-Hodgkin lymphoma. Ann Hematol 2023; 102:1421-1431. [PMID: 37041299 PMCID: PMC10089694 DOI: 10.1007/s00277-023-05204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Serologic responses of COVID-19 vaccine are impaired in patients with B-cell lymphoma, especially those who had recently been treated with anti-CD20 monoclonal antibodies. However, it is still unclear whether those patients develop an immune response following vaccination. We investigated the efficacy of vaccination against SARS-CoV-2 in 171 patients with B-cell non-Hodgkin lymphoma (B-NHL) who received two doses of an mRNA-based COVID-19 vaccine and we compared the efficacy of vaccination to that in 166 healthy controls. Antibody titers were measured 3 months after administration of the second vaccine dose. Patients with B-NHL showed a significantly lower seroconversion rate and a lower median antibody titer than those in healthy controls. The antibody titers showed correlations with the period from the last anti-CD20 antibody treatment to vaccination, the period from the last bendamustine treatment to vaccination and serum IgM level. The serologic response rates and median antibody titers were significantly different between diffuse large B-cell lymphoma (DLBCL) patients in whom anti-CD20 antibody treatment was completed within 9 months before vaccination and follicular lymphoma (FL) patients in whom anti-CD20 antibody treatment was completed within 15 months before vaccination. Moreover, the serologic response rates and median antibody titers were significantly different among FL patients in whom bendamustine treatment was completed within 33 months before vaccination. We demonstrated that B-NHL patients who were recently treated with anti-CD20 antibodies and bendamustine had a diminished humoral response to COVID-19 vaccination. UMIN 000,045,267.
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Affiliation(s)
- Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan.
| | | | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan
| | | | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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15
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Thookhamme C, Navinpipat M, Sasakul A, Pattarakosol P, Lertchaisataporn K, Tawinprai K, Praditsuktavorn P. Immunogenicity of the ChAdOx1 nCoV-19 vaccine in patients with hematologic malignancies. Clin Exp Vaccine Res 2023; 12:107-115. [PMID: 37214149 PMCID: PMC10193112 DOI: 10.7774/cevr.2023.12.2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose The present study aimed to study the immunogenicity of the ChAdOx1 nCoV-19 vaccine in patients with hematologic malignancies. Materials and Methods This prospective cohort study of hematology patients aimed to evaluate their antibody levels against the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein and seroconversion rates following two doses of the ChAdOx1 nCoV-19 vaccine. Between June and July 2021, we enrolled 61 patients and included 44 patients in our analysis. Antibody levels were assessed 8 and 4 weeks after the first and second injections, respectively, and compared with those of a healthy group. Results Eight weeks after the first dose, the geometric mean antibody level was 1.02 binding antibody units (BAU)/mL in the patient group and 37.91 BAU/mL in the healthy volunteer group (p<0.01). Four weeks after the second dose, the geometric mean antibody level was 9.44 BAU/mL in patients and 641.6 BAU/mL in healthy volunteers (p<0.01). The seroconversion rates 8 weeks after the first dose were 27.27% and 98.86% in the patient and healthy volunteer groups, respectively (p<0.001). The seroconversion rate 4 weeks after the second dose was 47.73% in patients and 100% in healthy volunteers. Factors leading to lower seroconversion rates were rituximab therapy (p=0.002), steroid therapy (p<0.001), and ongoing chemotherapy (p=0.048). Factors that decreased antibody levels were hematologic cancer (p<0.001), ongoing chemotherapy (p=0.004), rituximab (p<0.001), steroid use (p<0.001), and absolute lymphocyte count <1,000/mm3 (p=0.009). Conclusion Immune responses were impaired in individuals with hematologic malignancies, particularly patients undergoing ongoing therapy and B-cell-depleting therapy. Additional vaccinations should be considered for these patients, and further investigated.
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Affiliation(s)
| | | | - Aimwipa Sasakul
- Department of Hematology, Chulabhorn Hospital, Bangkok, Thailand
| | | | | | - Kriangkrai Tawinprai
- Infectious Disease Unit, Department of Medicine, Chulabhorn Hospital, Bangkok, Thailand
| | - Pannee Praditsuktavorn
- Department of Hematology, Chulabhorn Hospital, Bangkok, Thailand
- Faculty of Medicine, Princess Srisavangvadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
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16
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Helfgott DC, Racine-Brzostek S, Short KJ, Zhao Z, Christos P, Nino I, Niu T, Contreras J, Ritchie EK, Desai P, Samuel M, Roboz GJ. Immunogenicity of COVID-19 mRNA vaccines in patients with acute myeloid leukemia and myelodysplastic syndrome. Leuk Lymphoma 2023; 64:662-670. [PMID: 36282213 DOI: 10.1080/10428194.2022.2131414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Immunocompromised patients are susceptible to complications from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The mRNA vaccines BNT162b2 and mRNA-1273 are effective in immunocompetent adults, but have diminished activity in immunocompromised patients. We measured anti-spike SARS-CoV-2 antibody (anti-S) response, avidity, and surrogate neutralizing antibody activity in COVID-19 vaccinated patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Anti-S was induced in 89% of AML and 88% of MDS patients, but median levels were significantly lower than in healthy controls. SARS-CoV-2 antibody avidity and neutralizing activity from AML patients were significantly lower than controls. Antibody avidity was significantly greater in patients after mRNA-1273 versus BNT162b2; there were trends toward higher anti-S levels and greater neutralizing antibody activity after mRNA-1273 vaccination. Patients with AML and MDS are likely to respond to COVID-19 mRNA vaccination, but differences in anti-S levels, avidity, and neutralizing antibody activity may affect clinical outcomes and require further study.
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Affiliation(s)
- David C Helfgott
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Sabrina Racine-Brzostek
- Department of Pathology and Laboratory Medicine, Translational Research Program, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Kelsey J Short
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Translational Research Program, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Paul Christos
- Department of Biostatistics, Weill Cornell Medicine, New York, NY, USA
| | - Itzel Nino
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Tina Niu
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Jorge Contreras
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Ellen K Ritchie
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Pinkal Desai
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Michael Samuel
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
| | - Gail J Roboz
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, The New York Presbyterian Hospital, New York, NY, USA
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17
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Rossi JF, Bonnet E, Castelli C, Velensek M, Wisniewski E, Heraud S, Boustany R, David C, Dinet J, Sicard R, Daures JP, Bonifacy M, Mousset L, Goffart E. Clinical and Serological Follow-Up of 216 Patients with Hematological Malignancies after Vaccination with Pfizer-BioNT162b2 mRNA COVID-19 in a Real-World Study. Vaccines (Basel) 2023; 11:vaccines11030493. [PMID: 36992077 DOI: 10.3390/vaccines11030493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Hematological malignancies (HMs) have heterogeneous serological responses after vaccination due to disease or treatment. The aim of this real-world study was to analyze it after Pfizer-BioNT162b2 mRNA vaccination in 216 patients followed up for 1 year. The first 43 patients had an initial follow-up by a telemedicine (TM) system with no major events reported. The anti-spike IgG antibodies were checked 3–4 weeks post-first vaccination and every 3–4 months, by two standard bioassays and a rapid serological test (RST). Vaccine boosts were given when the level was <7 BAU/mL. Patients who did not seroconvert after 3–4 doses received tixagevimab/cilgavimab (TC). Fifteen results were discordant between two standard bioassays. Good agreement was observed between the standard and RST in 97 samples. After two doses, 68% were seroconverted (median = 59 BAU/mL) with a median of 162 BAU/mL and 9 BAU/mL, respectively, in untreated and treated patients (p < 0.001), particularly for patients receiving rituximab. Patients with gammaglobulin levels < 5 g/L had reduced seroconversion compared to higher levels (p = 0.019). The median levels were 228 BAU/mL post-second dose if seroconverted post-first and second, or if seroconverted only post-second dose. A total of 68% of post-second dose negative patients were post-third dose positive. A total of 16% received TC, six with non-severe symptomatic COVID-19 within 15–40 days. Personalized serological follow-up should apply particularly to patients with HMs.
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Affiliation(s)
- Jean-François Rossi
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
- Faculté de Médecine Montpellier, Université de Montpellier, 34094 Montpellier, France
| | - Emmanuel Bonnet
- Recherche Clinique Clinique Beau Soleil-Nouvelles Technologies, 34070 Montpellier, France
| | - Christel Castelli
- Recherche Clinique Clinique Beau Soleil-Nouvelles Technologies, 34070 Montpellier, France
| | - Marion Velensek
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
| | - Emma Wisniewski
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
| | - Sophie Heraud
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
| | - Rania Boustany
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
| | - Céleste David
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
| | | | - Roland Sicard
- Institut du Cancer Avignon-Provence, Sainte Catherine, 84000 Avignon, France
- Thess Corporate Inc., 34070 Montpellier, France
| | - Jean-Pierre Daures
- Recherche Clinique Clinique Beau Soleil-Nouvelles Technologies, 34070 Montpellier, France
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18
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Effectiveness and Safety of COVID-19 Vaccination in Patients with Malignant Disease. Vaccines (Basel) 2023; 11:vaccines11020486. [PMID: 36851363 PMCID: PMC9962104 DOI: 10.3390/vaccines11020486] [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: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
A novel virus named SARS-CoV-2 has caused a worldwide pandemic, resulting in a disastrous impact to the public health since 2019. The disease is much more lethal among patients with malignant disease. Vaccination plays an important role in the prevention of infection and subsequent severe COVID-19. However, the efficacy and safety of vaccines for cancer patients needs further investigation. Encouragingly, there have been important findings deduced from research so far. In this review, an overview of the immunogenicity, effectiveness, and safeness of COVID-19 vaccines in patients with cancer to date is to be shown. We also highlight important questions to consider and directions that could be followed in future research.
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19
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Hernandez SPA, Hersby DS, Munk KK, Tamhane T, Trubach D, Tagliamonte M, Buonaguro L, Gang AO, Hadrup SR, Saini SK. Three doses of BNT162b2 COVID-19 mRNA vaccine establish long-lasting CD8 + T cell immunity in CLL and MDS patients. Front Immunol 2023; 13:1035344. [PMID: 36703960 PMCID: PMC9873231 DOI: 10.3389/fimmu.2022.1035344] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Patients with hematological malignancies are prioritized for COVID-19 vaccine due to their high risk for severe SARS-CoV-2 infection-related disease and mortality. To understand T cell immunity, its long-term persistence, and its correlation with antibody response, we evaluated the BNT162b2 COVID-19 mRNA vaccine-specific immune response in chronic lymphocytic leukemia (CLL) and myeloid dysplastic syndrome (MDS) patients. Longitudinal analysis of CD8+ T cells using DNA-barcoded peptide-MHC multimers covering the full SARS-CoV-2 Spike-protein (415 peptides) showed vaccine-specific T cell activation and persistence of memory T cells up to six months post-vaccination. Surprisingly, a higher frequency of vaccine-induced antigen-specific CD8+ T cells was observed in the patient group compared to a healthy donor group. Furthermore, and importantly, immunization with the second booster dose significantly increased the frequency of antigen-specific CD8+ T cells as well as the total number of T cell specificities. Altogether 59 BNT162b2 mRNA vaccine-derived immunogenic responses were identified, of which 23 established long-term CD8+ T cell memory response with a strong immunodominance for NYNYLYRLF (HLA-A24:02) and YLQPRTFLL (HLA-A02:01) epitopes. In summary, we mapped the vaccine-induced antigen-specific CD8+ T cells and showed a booster-specific activation and enrichment of memory T cells that could be important for long-term disease protection in this patient group.
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Affiliation(s)
- Susana Patricia Amaya Hernandez
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Kjærgaard Munk
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tripti Tamhane
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Darya Trubach
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Tagliamonte
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Luigi Buonaguro
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Anne Ortved Gang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sine Reker Hadrup
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sunil Kumar Saini
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark,*Correspondence: Sunil Kumar Saini,
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20
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Denkinger CM, Janssen M, Schäkel U, Gall J, Leo A, Stelmach P, Weber SF, Krisam J, Baumann L, Stermann J, Merle U, Weigand MA, Nusshag C, Bullinger L, Schrezenmeier JF, Bornhäuser M, Alakel N, Witzke O, Wolf T, Vehreschild MJGT, Schmiedel S, Addo MM, Herth F, Kreuter M, Tepasse PR, Hertenstein B, Hänel M, Morgner A, Kiehl M, Hopfer O, Wattad MA, Schimanski CC, Celik C, Pohle T, Ruhe M, Kern WV, Schmitt A, Lorenz HM, Souto-Carneiro M, Gaeddert M, Halama N, Meuer S, Kräusslich HG, Müller B, Schnitzler P, Parthé S, Bartenschlager R, Gronkowski M, Klemmer J, Schmitt M, Dreger P, Kriegsmann K, Schlenk RF, Müller-Tidow C. Anti-SARS-CoV-2 antibody-containing plasma improves outcome in patients with hematologic or solid cancer and severe COVID-19: a randomized clinical trial. NATURE CANCER 2023; 4:96-107. [PMID: 36581734 PMCID: PMC9886549 DOI: 10.1038/s43018-022-00503-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/29/2022] [Indexed: 04/26/2023]
Abstract
Patients with cancer are at high risk of severe coronavirus disease 2019 (COVID-19), with high morbidity and mortality. Furthermore, impaired humoral response renders severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines less effective and treatment options are scarce. Randomized trials using convalescent plasma are missing for high-risk patients. Here, we performed a randomized, open-label, multicenter trial ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001632-10/DE ) in hospitalized patients with severe COVID-19 (n = 134) within four risk groups ((1) cancer (n = 56); (2) immunosuppression (n = 16); (3) laboratory-based risk factors (n = 36); and (4) advanced age (n = 26)) randomized to standard of care (control arm) or standard of care plus convalescent/vaccinated anti-SARS-CoV-2 plasma (plasma arm). No serious adverse events were observed related to the plasma treatment. Clinical improvement as the primary outcome was assessed using a seven-point ordinal scale. Secondary outcomes were time to discharge and overall survival. For the four groups combined, those receiving plasma did not improve clinically compared with those in the control arm (hazard ratio (HR) = 1.29; P = 0.205). However, patients with cancer experienced a shortened median time to improvement (HR = 2.50; P = 0.003) and superior survival with plasma treatment versus the control arm (HR = 0.28; P = 0.042). Neutralizing antibody activity increased in the plasma cohort but not in the control cohort of patients with cancer (P = 0.001). Taken together, convalescent/vaccinated plasma may improve COVID-19 outcomes in patients with cancer who are unable to intrinsically generate an adequate immune response.
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Affiliation(s)
- Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.
- Partner site Heidelberg University Hospital, German Center for Infection Research, Heidelberg, Germany.
| | - Maike Janssen
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Schäkel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Gall
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Albrecht Leo
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Patrick Stelmach
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan F Weber
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Baumann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jacek Stermann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Florian Schrezenmeier
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre for Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Schmiedel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Partner site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development, Hamburg, Germany
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center, Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | | | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Anke Morgner
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Michael Kiehl
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Olaf Hopfer
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Mohammad-Amen Wattad
- Department of Hematology, Oncology, Palliative Care and Stem Cell Transplantation, Klinikum Hochsauerland, Meschede, Germany
| | - Carl C Schimanski
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Cihan Celik
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Thorsten Pohle
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Matthias Ruhe
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Winfried V Kern
- Department of Medicine II, Division of Infectious Diseases and Travel Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mary Gaeddert
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Niels Halama
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Translational Immunotherapy (D240), German Cancer Research Center, Heidelberg, Germany
- Helmholtz Institute for Translational Oncology, Mainz, Germany
| | - Stefan Meuer
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sylvia Parthé
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina Gronkowski
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Klemmer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.
- National Center for Tumor Diseases, Heidelberg, Germany.
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21
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Keppler-Hafkemeyer A, Greil C, Wratil PR, Shoumariyeh K, Stern M, Hafkemeyer A, Ashok D, Hollaus A, Lupoli G, Priller A, Bischof ML, Ihorst G, Engelhardt M, Marks R, Finke J, Bertrand H, Dächert C, Muenchhoff M, Badell I, Emmerich F, Halder H, Spaeth PM, Knolle PA, Protzer U, von Bergwelt-Baildon M, Duyster J, Hartmann TN, Moosmann A, Keppler OT. Potent high-avidity neutralizing antibodies and T cell responses after COVID-19 vaccination in individuals with B cell lymphoma and multiple myeloma. NATURE CANCER 2023; 4:81-95. [PMID: 36543907 PMCID: PMC9886553 DOI: 10.1038/s43018-022-00502-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Individuals with hematologic malignancies are at increased risk for severe coronavirus disease 2019 (COVID-19), yet profound analyses of COVID-19 vaccine-induced immunity are scarce. Here we present an observational study with expanded methodological analysis of a longitudinal, primarily BNT162b2 mRNA-vaccinated cohort of 60 infection-naive individuals with B cell lymphomas and multiple myeloma. We show that many of these individuals, despite markedly lower anti-spike IgG titers, rapidly develop potent infection neutralization capacities against several severe acute respiratory syndrome coronavirus 2 variants of concern (VoCs). The observed increased neutralization capacity per anti-spike antibody unit was paralleled by an early step increase in antibody avidity between the second and third vaccination. All individuals with hematologic malignancies, including those depleted of B cells and individuals with multiple myeloma, exhibited a robust T cell response to peptides derived from the spike protein of VoCs Delta and Omicron (BA.1). Consistently, breakthrough infections were mainly of mild to moderate severity. We conclude that COVID-19 vaccination can induce broad antiviral immunity including ultrapotent neutralizing antibodies with high avidity in different hematologic malignancies.
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Affiliation(s)
- Andrea Keppler-Hafkemeyer
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christine Greil
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul R. Wratil
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - Khalid Shoumariyeh
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Stern
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Annika Hafkemeyer
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Driti Ashok
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Hollaus
- grid.5252.00000 0004 1936 973XMedizinische Klinik und Poliklinik III, LMU Klinikum, LMU München, Munich, Germany
| | - Gaia Lupoli
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Alina Priller
- grid.6936.a0000000123222966Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich (TUM) School of Medicine, Munich, Germany
| | - Marie L. Bischof
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Gabriele Ihorst
- grid.5963.9Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard Marks
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Bertrand
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Dächert
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - Maximilian Muenchhoff
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - Irina Badell
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - Florian Emmerich
- grid.5963.9Institute for Transfusion Medicine and Gene Therapy, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hridi Halder
- grid.5252.00000 0004 1936 973XMedizinische Klinik und Poliklinik III, LMU Klinikum, LMU München, Munich, Germany
| | - Patricia M. Spaeth
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany
| | - Percy A. Knolle
- grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany ,grid.6936.a0000000123222966Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich (TUM) School of Medicine, Munich, Germany
| | - Ulrike Protzer
- grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany ,Helmholtz Munich, Munich, Germany ,grid.6936.a0000000123222966Institute of Virology, Technical University of Munich School of Medicine/Helmholtz Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5252.00000 0004 1936 973XMedizinische Klinik und Poliklinik III, LMU Klinikum, LMU München, Munich, Germany
| | - Justus Duyster
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja N. Hartmann
- grid.5963.9Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Moosmann
- grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Consortium (DKTK), partner site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5252.00000 0004 1936 973XMedizinische Klinik und Poliklinik III, LMU Klinikum, LMU München, Munich, Germany ,Helmholtz Munich, Munich, Germany
| | - Oliver T. Keppler
- grid.5252.00000 0004 1936 973XMax von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
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22
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Murray CE, O’Brien C, Alamin S, Phelan SH, Argue R, Kiersey R, Gardiner M, Naughton A, Keogh E, Holmes P, Naughton S, Scanlon A, Sloan A, McCrea P, Sui J, Dunne J, Conlon N. Cellular and humoral immunogenicity of the COVID-19 vaccine and COVID-19 disease severity in individuals with immunodeficiency. Front Immunol 2023; 14:1131604. [PMID: 37033955 PMCID: PMC10080028 DOI: 10.3389/fimmu.2023.1131604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background A well-coordinated adaptive immune response is crucial for limiting COVID-19 disease. Some individuals with immunodeficiency are at a high risk of developing severe COVID-19. Therefore, the development of standardized methods for measuring different arms of the vaccine response in the setting of immunodeficiency is of particular interest. In this study, we compared the vaccine response of individuals living with immunodeficiency with healthy controls in terms of interferon gamma (IFN-γ) production and spike protein-specific antibody level post primary COVID-19 vaccination and booster vaccines. Additionally, the disease severity of those individuals who contracted COVID-19 was assessed. Methods Whole blood was stimulated overnight from 71 participants and 99 healthy controls. Commercially available PepTivator® peptide pool and trimeric spike protein stimulation were used. ELISA was used to analyze IFN-γ levels. The total SARS-CoV-2 spike protein antibody titre was measured using a Roche Elecsys® S total antibody assay. Patient characteristics, COVID-19 infection status and IDDA 2.1 'Kaleidoscope' scores were recorded. Vaccine responses were scored from zero to three. Results 99% of healthy controls, 89% of individuals with IEI and 76% with secondary immunodeficiency (SID) had an IFN-γ level above the validated reference range after peptide mix stimulation following primary vaccination. There was an increase in IFN-γ levels in patients with inborn errors of immunity (IEI) following the booster vaccine (p = 0.0156). 100% of healthy controls, 70% of individuals living with IEI and 64% of individuals living with SID had detectable spike protein-specific antibody levels following the primary vaccination. 55% of immunodeficiency patients who had mild COVID-19 and 10% with moderate/severe COVID-19 had detectable antibody and IFN-γ levels post vaccine. The mean pre-infection IDDA 2.1 scores were higher in individuals who developed moderate/severe COVID-19 (25.2 compared to 9.41). Conclusions Covid whole-blood IGRA is a highly accurate, straightforward and robust assay and can be easily adapted to measure cellular response to COVID-19. A complete evaluation of the vaccine response may be particularly important for individuals living with immunodeficiency. A clinical immunodeficiency score and a validated vaccine response score may be valuable tools in estimating COVID-19 disease risk and identifying individuals living with immunodeficiency who may benefit from enhanced vaccination schedules.
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Affiliation(s)
- C. E. Murray
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
- *Correspondence: C. E. Murray,
| | - C. O’Brien
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - S. Alamin
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - S. H. Phelan
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - R. Argue
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
- Wellcome Trust Clinical Research Facility, St. James's Hospital, Dublin, Ireland
| | - R. Kiersey
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - M. Gardiner
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - A. Naughton
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - E. Keogh
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - P. Holmes
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - S. Naughton
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - A. Scanlon
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - A. Sloan
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - P. McCrea
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - J. Sui
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
- STTAR Bioresource, St. James’s Hospital, Dublin, Ireland
| | - J. Dunne
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - N. Conlon
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
- Wellcome Trust Clinical Research Facility, St. James's Hospital, Dublin, Ireland
- STTAR Bioresource, St. James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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23
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Mohamed S, Lucchini E, Sirianni F, Porrazzo M, Ballotta L, Ballerini M, De Sabbata GM, De Bellis E, Cappuccio I, Granzotto M, Toffoletto B, Fortunati I, Russignan A, Florea EE, Torelli L, Zaja F. Serological and cellular response to mRNA-SARS-CoV2 vaccine in patients with hematological lymphoid malignancies: Results of the study "Cervax". Front Oncol 2023; 13:1133348. [PMID: 36923438 PMCID: PMC10008958 DOI: 10.3389/fonc.2023.1133348] [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: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
messenger RNA (mRNA)-Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines such as BNT162b2 became available in late 2020, but hematological malignancy patients (HM pts) were not evaluated in initial registration trials. We hereby report the results of a prospective, unicentric, observational study Response to COVID-19 Vaccination in hEmatological malignancies (CERVAX) developed to assess the postvaccine serological and T-cell-mediated response in a cohort of SARS-CoV2-negative HM pts vaccinated with BNT162b2. Patients with lymphomas [non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL)], chronic lymphocytic leukemia (CLL), and multiple myeloma (MM); off-therapy for at least 3 months; in a watch-and-wait program; or in treatment with ibrutinib, venetoclax, and lenalidomide were included. Different time points were considered to assess the serological response to the vaccine: before the second dose (T1), at 3-6-12 months after the first dose (T2-3-4, respectively). Since March 2021, 39 pts have been enrolled: 15 (38%) NHL, 12 (31%) CLL, and 12 (31%) MM. There were 13 of the 39 pts (33%) seroconverted at T1; an increase of the serological response was registered after the second dose (T2) (22/39 pts, 56%) and maintained after 6 months (22/39 pts, 56%) and 12 months (24/39 pts, 61%) from the first dose (T3-T4, respectively). Non-serological responders at T4 were 7/39 (18%): 0/15 NHL, 1/12 MM (8%), and 6/12 CLL (50%). All of them were on therapy (one lenalidomide, three ibrutinib, and three venetoclax). SARS-CoV2-reactive T-cell analysis (interferon gamma release assays) was available since June 2022 and was evaluated at 12 months (T4) from the first dose of vaccine in 31/39 pts (79%). T-cell-mediated-responders were 17/31 (55%): most of them were NHL and MM (47%, 41% and 12% for NHL, MM, and CLL, respectively). Both serological and T-cell non-responders were represented by pts on active therapy (venetoclax/ibrutinib). During the period of observation, eight (20.5%) pts developed mild SARS-CoV2 infection; no coronavirus disease 19 (COVID-19)-related deaths or hospitalizations were registered. In conclusion, in our cohort of lymphoproliferative pts receiving BNT162b2, CLL diagnosis and venetoclax/ibrutinib seem to be related with a lower humoral or T-mediated response. Nevertheless, the efficacy of mRNA vaccine in HM pts and the importance to continue the vaccine program even in non-responders after the first dose are supported in our study by demonstrating that a humoral and T-cell-mediated seroconversion should be observed even in the subsets of heavily immunocompromised pts.
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Affiliation(s)
- Sara Mohamed
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elisa Lucchini
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Francesca Sirianni
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marika Porrazzo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Laura Ballotta
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Mario Ballerini
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Eleonora De Bellis
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Ilaria Cappuccio
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marilena Granzotto
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Barbara Toffoletto
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Ilaria Fortunati
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Anna Russignan
- Dipartimento di Medicina, sezione Ematologia, University of Verona, Verona, Italy
| | | | - Lucio Torelli
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Francesco Zaja
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
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24
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Kakkassery H, Carpenter E, Patten PEM, Irshad S. Immunogenicity of SARS-CoV-2 vaccines in patients with cancer. Trends Mol Med 2022; 28:1082-1099. [PMID: 35999131 PMCID: PMC9345889 DOI: 10.1016/j.molmed.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 01/21/2023]
Abstract
Transmission of the SARS-CoV-2 virus and its corresponding disease (COVID-19) has been shown to impose a higher burden on cancer patients than on the general population. Approved vaccines for use include new technology mRNA vaccines such as BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), and nonreplicating viral vector vaccines such as Ad26.COV2.S (Johnson & Johnson) and AZD1222 (AstraZeneca). Impaired or delayed humoral and diminished T-cell responses are evident in patients with cancer, especially in patients with haematological cancers or those under active chemotherapy. Herein we review the current data on vaccine immunogenicity in cancer patients, including recommendations for current practice and future research.
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Affiliation(s)
- Helen Kakkassery
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Esme Carpenter
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Piers E M Patten
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Sheeba Irshad
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
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25
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Wang X, Sima L. Antibody response after vaccination against SARS-CoV-2 in adults with hematological malignancies: a systematic review and meta-analysis. J Infect 2022:S0163-4453(22)00674-0. [PMID: 36417984 PMCID: PMC9675635 DOI: 10.1016/j.jinf.2022.11.013] [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: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against coronavirus disease 2019 (COVID-19), especially in fragile patients. We aimed to systematically analyze the outcomes of patients with hematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (2 doses of mRNA or one dose of vector- based vaccines). We identified 49 studies comprising 11,086 individuals. Overall risk of bias was low. The pooled response for hematological malignancies was 64% (95% confidence interval [CI]: 59-69; I²=93%) versus 96% (95% CI: 92-97; I²=44%) for solid cancer and 98% (95% CI: 96-99; I²=55%) for healthy controls (P<0.001). Outcome was different across hematological malignancies (P<0.001). The pooled response was 50% (95% CI: 43-57; I²=84%) for chronic lymphocytic leukemia, 76% (95% CI: 67-83; I²=92%) for multiple myeloma, 83% (95% CI: 69-91; I²=85%) for myeloproliferative neoplasms, 91% (95% CI: 82-96; I²=12%) for Hodgkin lymphoma, and 58% (95% CI: 44-70; I²=84%) for aggressive and 61% (95% CI: 48-72; I²=85%) for indolent non-Hodgkin lymphoma. The pooled response for allogeneic and autologous hematopoietic cell transplantation was 82% and 83%, respectively. Being in remission and prior COVID-19 showed significantly higher responses. Low pooled response was identified for active treatment (35%), anti-CD20 therapy ≤1 year (15%), Bruton kinase inhibition (23%), venetoclax (26%), ruxolitinib (42%), and chimeric antigen receptor T-cell therapy (42%). Studies on timing, value of boosters, and long-term efficacy are needed. This study is registered with PROSPERO (clinicaltrials gov. Identifier: CRD42021279051).
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Laozei Sima
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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26
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Non-Myelofibrosis Chronic Myeloproliferative Neoplasm Patients Show Better Seroconversion Rates after SARS-CoV-2 Vaccination Compared to Other Hematologic Diseases: A Multicentric Prospective Study of KroHem. Biomedicines 2022; 10:biomedicines10112892. [PMID: 36428459 PMCID: PMC9687514 DOI: 10.3390/biomedicines10112892] [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: 09/01/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Disease- and treatment-mediated immunodeficiency might render SARS-CoV-2 vaccines less effective in patients with hematologic diseases. We performed a prospective non-interventional study to evaluate humoral response after one and two doses of mRNA-1273, BNT162b2, or ChAdOx1 nCoV-19 vaccine in 118 patients with different malignant or non-malignant hematologic diseases from three Croatian treatment centers. An electrochemiluminescent assay was used to measure total anti-SARS-CoV-2 S-RBD antibody titers. After one vaccine dose, 20/66 (33%) achieved seropositivity with a median antibody titer of 6.1 U/mL. The response rate (58/90, 64.4%) and median antibody titer (>250 U/mL) were higher after two doses. Seropositivity varied with diagnosis (overall p < 0.001), with the lowest rates in lymphoma (34.6%) and chronic lymphocytic leukemia (52.5%). The overall response rate in chronic myeloproliferative neoplasms (CMPN) was 81.3% but reached 100% in chronic myeloid leukemia and other non-myelofibrosis CMPN. At univariable analysis, age > 67 years, non-Hodgkin’s lymphoma, active treatment, and anti-CD20 monoclonal antibody therapy increased the likelihood of no vaccine response, while hematopoietic stem cell recipients were more likely to respond. Age and anti-CD20 monoclonal antibody therapy remained associated with no response in a multivariable model. Patients with the hematologic disease have attenuated responses to SARS-CoV-2 vaccines, and significant variations in different disease subgroups warrant an individualized approach.
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27
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Krekeler C, Reitnauer L, Bacher U, Khandanpour C, Steger L, Boeckel GR, Klosner J, Tepasse PR, Kemper M, Hennies MT, Mesters R, Stelljes M, Schmitz N, Kerkhoff A, Schliemann C, Mikesch JH, Schmidt N, Lenz G, Bleckmann A, Shumilov E. Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario. Cancers (Basel) 2022; 14:cancers14225512. [PMID: 36428605 PMCID: PMC9688056 DOI: 10.3390/cancers14225512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Two-dose COVID-19 vaccination often results in poor humoral response rates in patients with hematologic malignancies (HMs); yet responses to COVID-19 booster vaccines and the risk of COVID-19 infection post-booster are mostly uncertain. Methods: We included 200 outpatients with HMs and predominantly lymphoid neoplasms (96%, 191/200) in our academic center and reported on the humoral responses, which were assessed by measurement of anti-spike IgG antibodies in peripheral blood as early as 14 days after mRNA-based prime-boost vaccination, as well as factors hampering booster efficacy. Previous basic (double) immunization was applied according to the local recommendations with mRNA- and/or vector-based vaccines. We also report on post-booster COVID-19 breakthrough infections that emerged in the Omicron era and the prophylaxis strategies that were applied to poor and non-responders to booster vaccines. Results: A total of 55% (110/200) of the patients achieved seroconversion (i.e., anti-spike protein IgG antibody titer > 100 AU/mL assessed in median 48 days after prime-boost vaccination) after prime-boost vaccination. Multivariable analyses revealed age, lymphocytopenia, ongoing treatment and prior anti-CD20 B-cell depletion to be independent predictors for booster failure. With each month between anti-CD20-mediated B-cell depletion and booster vaccination, the probability of seroconversion increased by approximately 4% (p < 0.001) and serum−antibody titer (S-AbT) levels increased by 90 AU/mL (p = 0.011). Notably, obinutuzumab treatment was associated with an 85% lower probability for seroconversion after prime-boost vaccination compared to rituximab (p = 0.002). Of poor or non-responders to prime-boost vaccination, 41% (47/114) underwent a second booster and 73% (83/114) underwent passive immunization. COVID-19 breakthrough infections were observed in 15% (29/200) of patients after prime-boost vaccination with predominantly mild courses (93%). Next to seroconversion, passive immunization was associated with a significantly lower risk of COVID-19 breakthrough infections after booster, even in vaccine non-responders (all p < 0.05). In a small proportion of analyzed patients with myeloid neoplasms (9/200), the seroconversion rate was higher compared to those with lymphoid ones (78% vs. 54%, accordingly), while the incidence rate of COVID-19 breakthrough infections was similar (22% vs. 14%, respectively). Following the low frequency of myeloid neoplasms in this study, the results may not be automatically applied to a larger cohort. Conclusions: Patients with HMs are at a high risk of COVID-19 booster vaccine failure; yet COVID-19 breakthrough infections after prime-boost vaccination are predominantly mild. Booster failure can likely be overcome by passive immunization, thereby providing immune protection against COVID-19 and attenuating the severity of COVID-19 courses. Further sophistication of clinical algorithms for preventing post-vaccination COVID-19 breakthrough infections is urgently needed.
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Affiliation(s)
- Carolin Krekeler
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
- Correspondence:
| | - Lea Reitnauer
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Ulrike Bacher
- Central Hematology Laboratory, Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Cyrus Khandanpour
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
- Department for Hematology and Oncology, University Hospital Schleswig-Holstein, 23564 Luebeck, Germany
| | - Leander Steger
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Göran Ramin Boeckel
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Muenster, Germany
- Department of Medicine D for Nephrology and Rheumatology, University Hospital Münster, 48149 Muenster, Germany
| | - Justine Klosner
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Muenster, Germany
| | - Marcel Kemper
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Marc Tim Hennies
- Institute of Virology, University Hospital Münster, 48149 Muenster, Germany
| | - Rolf Mesters
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Matthias Stelljes
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Norbert Schmitz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Nicole Schmidt
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), 37077 Goettingen, Germany
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Evgenii Shumilov
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
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Kos IA, Kiefer M, Brill K, Cetin O, Bittenbring JT, Ahlgrimm M, Smola S, Lohse S, Christofyllakis K, Kaddu-Mulindwa D, Neumann F, Bewarder M, Thurner L. Adaptive humoral immune response and cellular immune status in cancer patients and patients under immunosuppression vaccinated against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1683-1689. [PMID: 35994606 DOI: 10.1080/14760584.2022.2116009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with cancer and autoimmune diseases are at higher risk of severe COVID-19. They may not develop protective immune responses following vaccination. We investigated patients' cellular and humoral immune response after two COVID-19 vaccine doses. RESEARCH DESIGN AND METHODS Subjects were stratified into subgroups according to therapy and grade of immunosuppression at time of vaccination. RESULTS Antibody titers were compared to healthy controls. 32/122 (26%) did not develop detectable antibody titers. Of these, 22 (66.6%) had active therapy. Patients showed significant lower antibody titers compared to controls (median 790 vs. 3923 AU/mL, p = 0.026). Patients with active therapy had significant lower antibody titers compared to those without (median 302 vs. 3952 U/L P < 0.001). B-cell count was lower in the group without antibody titers (median 29.97 vs. 152.8; p = 0.002). 100% of patients under anti-CD20 therapy had no detectable antibody titer, followed by anti-TNF (66%), BTK inhibitors (50%), ruxolitinib (35.5%), TKI (14.2%), and lenalidomide (12.5%). Anti-CD20 therapy, ruxolitinib, BTK inhibitors, and anti-CD38 therapy presented significant lower antibody titers compared to controls. CONCLUSIONS Patients undergoing therapy for cancer or autoimmune diseases are at higher risk of insufficient humoral immune response following COVID-19 vaccination. Furthermore, alterations in the B-cell compartment correlate with lower antibody titers.
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Affiliation(s)
- Igor Age Kos
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Maximilian Kiefer
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Katharina Brill
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Onur Cetin
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Manfred Ahlgrimm
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Stefan Lohse
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Konstantinos Christofyllakis
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Frank Neumann
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Moritz Bewarder
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Lorenz Thurner
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
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29
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Schwarz M, Torre D, Lozano-Ojalvo D, Tan AT, Tabaglio T, Mzoughi S, Sanchez-Tarjuelo R, Le Bert N, Lim JME, Hatem S, Tuballes K, Camara C, Lopez-Granados E, Paz-Artal E, Correa-Rocha R, Ortiz A, Lopez-Hoyos M, Portoles J, Cervera I, Gonzalez-Perez M, Bodega-Mayor I, Conde P, Oteo-Iglesias J, Borobia AM, Carcas AJ, Frías J, Belda-Iniesta C, Ho JSY, Nunez K, Hekmaty S, Mohammed K, Marsiglia WM, Carreño JM, Dar AC, Berin C, Nicoletti G, Della Noce I, Colombo L, Lapucci C, Santoro G, Ferrari M, Nie K, Patel M, Barcessat V, Gnjatic S, Harris J, Sebra R, Merad M, Krammer F, Kim-Schulze S, Marazzi I, Bertoletti A, Ochando J, Guccione E. Rapid, scalable assessment of SARS-CoV-2 cellular immunity by whole-blood PCR. Nat Biotechnol 2022; 40:1680-1689. [PMID: 35697804 PMCID: PMC10603792 DOI: 10.1038/s41587-022-01347-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/02/2022] [Indexed: 12/30/2022]
Abstract
Fast, high-throughput methods for measuring the level and duration of protective immune responses to SARS-CoV-2 are needed to anticipate the risk of breakthrough infections. Here we report the development of two quantitative PCR assays for SARS-CoV-2-specific T cell activation. The assays are rapid, internally normalized and probe-based: qTACT requires RNA extraction and dqTACT avoids sample preparation steps. Both assays rely on the quantification of CXCL10 messenger RNA, a chemokine whose expression is strongly correlated with activation of antigen-specific T cells. On restimulation of whole-blood cells with SARS-CoV-2 viral antigens, viral-specific T cells secrete IFN-γ, which stimulates monocytes to produce CXCL10. CXCL10 mRNA can thus serve as a proxy to quantify cellular immunity. Our assays may allow large-scale monitoring of the magnitude and duration of functional T cell immunity to SARS-CoV-2, thus helping to prioritize revaccination strategies in vulnerable populations.
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Affiliation(s)
- Megan Schwarz
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Denis Torre
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Lozano-Ojalvo
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony T Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Tommaso Tabaglio
- Institute of Molecular and Cell Biology, IMCB, A*STAR, Singapore, Singapore
| | - Slim Mzoughi
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rodrigo Sanchez-Tarjuelo
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain
| | - Nina Le Bert
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Joey Ming Er Lim
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Sandra Hatem
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Tuballes
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carmen Camara
- Department of Immunology, University Hospital La Paz-IdiPAZ, Madrid, Spain
| | | | - Estela Paz-Artal
- Department of Immunology, Research Institution, Sanitaria Hospital, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, Complutense University of Madrid, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Rafael Correa-Rocha
- Laboratory of Immune-Regulation, Research Institute Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Alberto Ortiz
- Department of Nephrology, IIS-Fundación Jimenez Díaz, Madrid, Spain
| | - Marcos Lopez-Hoyos
- Department of Immunology, Hospital University of Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jose Portoles
- Department of Nephrology, Hospital of Puerta de Hierro, Madrid, Spain
| | - Isabel Cervera
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain
| | | | - Irene Bodega-Mayor
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain
| | - Patricia Conde
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain
| | - Jesús Oteo-Iglesias
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology, University Hospital La Paz-IDIPAZ, Platform of Clinical Research Units and Clinical Trials, Spain Faculty of Medicine Autonomous University of Madrid, Madrid, Spain
| | - Antonio J Carcas
- Clinical Pharmacology, University Hospital La Paz-IDIPAZ, Platform of Clinical Research Units and Clinical Trials, Spain Faculty of Medicine Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Clinical Pharmacology, University Hospital La Paz-IDIPAZ, Platform of Clinical Research Units and Clinical Trials, Spain Faculty of Medicine Autonomous University of Madrid, Madrid, Spain
| | | | - Jessica S Y Ho
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kemuel Nunez
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saboor Hekmaty
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Mohammed
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Marsiglia
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Manuel Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arvin C Dar
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | - Kai Nie
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manishkumar Patel
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vanessa Barcessat
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sacha Gnjatic
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jocelyn Harris
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Sema4, a Mount Sinai venture, Stamford, CT, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miriam Merad
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seunghee Kim-Schulze
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Human Immune Monitoring Core, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ivan Marazzi
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonio Bertoletti
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - Jordi Ochando
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- National Center for Microbiology, Carlos III Health Institute, Madrid, Spain.
| | - Ernesto Guccione
- Department of Oncological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Center for Therapeutics Discovery, Department of Oncological Sciences and Pharmacological Sciences, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Bioinformatics for Next Generation Sequencing (BiNGS) Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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30
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Song R, Liu L, Pan Q, Liu J, Tan J, Deng J, Deng Q, Lin Z, Chen M, Peng M, Ren H, Ming J. Short-term safety and immunogenicity of inactivated and peptide-based SARS-CoV-2 vaccines in patients with endocrine-related cancer. Front Immunol 2022; 13:1028246. [DOI: 10.3389/fimmu.2022.1028246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of this study was to explore the short-term safety and immunogenicity of inactivated and peptide-based SARS-CoV-2 vaccines in patients with endocrine-related cancer (ER).MethodsEighty-eight patients with ER cancer and 82 healthy controls who had completed a full course of inactivated or peptide-based SARS-CoV-2 vaccines were recruited. Adverse events (AEs) were recorded. Responses to receptor-binding domain IgG antibody (anti-RBD-IgG), neutralizing antibodies (NAbs) and RBD+ memory B cells (MBCs) were evaluated.ResultsApproximately 26.14% (23/88) of patients with ER cancer reported AEs within 7 days, which was comparable to that reported by healthy controls (24.39%, 20/82). Both the overall seroprevalence of anti-RBD-IgG and NAbs was obviously lower in the cancer group (70.45% vs. 86.59%, P < 0.05; 69.32% vs. 82.93%, P < 0.05, respectively). Anti-RBD-IgG and NAbs titers exhibited similar results, and dropped gradually over time. Patients with ongoing treatment had an attenuated immune response, especially in patients receiving active chemotherapy. The frequency of overall RBD+ MBCs was similar between the two groups, but the percentage of active MBCs was remarkably reduced in patients with ER cancer. Unlike antibody titers, MBCs responses were relatively constant over time.ConclusionInactivated and peptide-based COVID-19 vaccines were well tolerated, but with lower immunogenicity for ER cancer patients. More intensive antibody monitoring and timely booster immunization is recommended for patients with ER cancer presenting disordered subpopulations of RBD+ MBCs.
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31
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Haggenburg S, Hofsink Q, Rutten CE, Nijhof IS, Hazenberg MD, Goorhuis A. SARS-CoV-2 vaccine-induced humoral and cellular immunity in patients with hematologic malignancies. Semin Hematol 2022; 59:192-197. [PMID: 36805887 PMCID: PMC9674560 DOI: 10.1053/j.seminhematol.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Patients with hematologic conditions have a higher risk of severe COVID-19 and COVID-19-related death. This is related to immune deficiencies induced by hematologic conditions and/or the treatment thereof. Prospective vaccine immunogenicity studies have demonstrated that in the majority of patients, a 3-dose COVID-19 vaccination schedule leads to antibody concentrations comparable to levels obtained in healthy adults after a 2-dose schedule. In B cell depleted patients, humoral responses are poor, however vaccination did induce potent cellular immune responses. The effect of 3-dose vaccination schedules and COVID-19 booster vaccinations on the protection of patients with hematologic malignancies against severe COVID-19 and COVID-19 related death remains to be confirmed by population-based vaccine effectiveness studies.
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Affiliation(s)
- Sabine Haggenburg
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Quincy Hofsink
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
| | - Caroline E. Rutten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger S. Nijhof
- Department of Hematology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands,Department of Internal Medicine-Hematology, St. Antonius Hospital, Nieuwegein, The Netherlands,Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mette D. Hazenberg
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands,Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands,Department of Hematopoiesis, Sanquin Research, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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32
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Secondary antibody deficiency in chronic lymphocytic leukemia and non-Hodgkin lymphoma: Recommendations from an international expert panel. Blood Rev 2022. [DOI: 10.1016/j.blre.2022.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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33
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Nakazawa H, Sakai K, Sudo Y, Iwabuchi R, Sakai H, Nishina S, Kawakami T, Kawakami F, Matsuzawa S, Ito T, Kitahara M, Kamijo Y, Umemura T, Ushiki A, Kanai S, Tsuchiya H, Ishida F. Comparative analysis of humoral responses to BNT162b2 vaccine among patients with hematologic disorders and organ transplant recipients. Transpl Immunol 2022; 75:101713. [PMID: 36100196 PMCID: PMC9465495 DOI: 10.1016/j.trim.2022.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022]
Abstract
Vaccination against SARS-COV-2 is considered the most promising approach to curbing the pandemic. Patients with an immunocompromised state, such as those with hematological malignancies and organ transplantation recipients, are considered more susceptible to infection, but these at-risk patients were underrepresented in early clinical trials for vaccination. Although a growing body of studies suggests that the humoral response to COVID-19 vaccination in each of these at-risk groups of patients may be suboptimal in comparison to healthy controls, a clinical and strategic information for the further comparative analysis among these groups is not fully described. The humoral responses after two doses of BNT162b2 vaccination were evaluated in a total of 187 patients either with allogeneic hematopoietic transplantation, with renal transplantation, with anti-CD20 antibody therapy, or with anti-CD38 antibody therapy, and in 66 healthy controls. The early response at one to three months after vaccination was significantly inferior among patients with renal transplantation, patients with anti-CD20 antibody therapy, and patients with anti-CD38 antibody therapy in comparison to healthy control. But the patients with allogeneic hematopoietic transplantation showed early humoral response comparable to healthy control. The late response at 6 months after vaccination was still suboptimal among patients with renal transplantation and patients with anti-CD20 therapy. Among our patient group, renal transplant recipients had the lowest antibody titers after vaccination regardless of timing of vaccination. Patients who had received allogeneic hematopoietic transplantation attained a comparable serological response to the control group especially if they are vaccinated >300 days after transplantation, but the response was suboptimal if the vaccination was within 300 days after transplantation. Our results may provide policy makers with critical information for the further stratification of at-risk groups, helping contribute to a better allocation of resources, including additional booster vaccination.
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Affiliation(s)
- Hideyuki Nakazawa
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Kaoko Sakai
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuriko Sudo
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryohei Iwabuchi
- Division of Nephrology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hitoshi Sakai
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Sayaka Nishina
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toru Kawakami
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumihiro Kawakami
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shuji Matsuzawa
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshiro Ito
- Department of Hematology, National Hospital Organization Matsumoto Medical Center, Matsumoto, Japan
| | - Mari Kitahara
- Department of Hematology, Nagano Red-Cross Hospital, Nagano, Japan
| | - Yuji Kamijo
- Division of Nephrology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- The Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shinichiro Kanai
- Infection Control Room, Shinshu University Hospital, Matsumoto, Japan
| | - Hiroyuki Tsuchiya
- Department of Pharmacy, Shinshu University Hospital, Matsumoto, Japan
| | - Fumihiro Ishida
- Department of Biomedical Laboratory Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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van den Hoogen LL, Boer M, Postema A, de Rond L, de Zeeuw-Brouwer ML, Pronk I, Wijmenga-Monsuur AJ, Bijvank E, Kruiper C, Beckers L, Maurik MBV, Zutt I, van Vliet J, van Bergen R, Kuijer M, Smits G, Verschuren WMM, Picavet HSJ, van der Klis FRM, den Hartog G, van Binnendijk RS, Buisman AM. Reduced Antibody Acquisition with Increasing Age following Vaccination with BNT162b2: Results from Two Longitudinal Cohort Studies in The Netherlands. Vaccines (Basel) 2022; 10:vaccines10091480. [PMID: 36146557 PMCID: PMC9504637 DOI: 10.3390/vaccines10091480] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccine-induced protection against severe COVID-19, hospitalization, and death is of the utmost importance, especially in the elderly. However, limited data are available on humoral immune responses following COVID-19 vaccination in the general population across a broad age range. We performed an integrated analysis of the effect of age, sex, and prior SARS-CoV-2 infection on Spike S1-specific (S1) IgG concentrations up to three months post-BNT162b2 (Pfizer/BioNTech; Comirnaty) vaccination. In total, 1735 persons, eligible for COVID-19 vaccination through the national program, were recruited from the general population (12 to 92 years old). Sixty percent were female, and the median vaccination interval was 35 days (interquartile range, IQR: 35−35). All participants had seroconverted to S1 one month after two vaccine doses. S1 IgG was higher in participants with a history of SARS-CoV-2 infection (median: 4535 BAU/mL, IQR: 2341−7205) compared to infection-naive persons (1842 BAU/mL, 1019−3116), p < 0.001. In infection-naive persons, linear mixed effects regression showed a strong negative association between age and S1 IgG (p < 0.001) across the entire age range. Females had higher S1 IgG than males (p < 0.001). In persons with an infection history, age nor sex was associated with S1 IgG concentrations. The lower magnitude of S1 antibodies in older persons following COVID-19 vaccination will affect long-term protection.
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Affiliation(s)
- Lotus Leonie van den Hoogen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
- Correspondence:
| | - Mardi Boer
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Abigail Postema
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Lia de Rond
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Mary-lène de Zeeuw-Brouwer
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Inge Pronk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Alienke Jentien Wijmenga-Monsuur
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Elske Bijvank
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Caitlyn Kruiper
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Lisa Beckers
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Marjan Bogaard-van Maurik
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Ilse Zutt
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Jeffrey van Vliet
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Rianne van Bergen
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Marjan Kuijer
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - W. M. Monique Verschuren
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 TC Utrecht, The Netherlands
| | - H. Susan J. Picavet
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Fiona Regina Maria van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Gerco den Hartog
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Robert Samuel van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
| | - Anne-Marie Buisman
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands
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Borgogna C, Bruna R, Griffante G, Martuscelli L, De Andrea M, Ferrante D, Patriarca A, Mahmoud AM, Ucciero MAM, Gaidano V, Marchetti M, Rapezzi D, Lai M, Pistello M, Ladetto M, Massaia M, Gaidano G, Gariglio M. Induction of robust humoral immunity against SARS-CoV-2 after vaccine administration in previously infected haematological cancer patients. Br J Haematol 2022; 199:463-467. [PMID: 36062472 PMCID: PMC9538857 DOI: 10.1111/bjh.18429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Cinzia Borgogna
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" Hospital, Novara, Italy
| | - Gloria Griffante
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Licia Martuscelli
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Marco De Andrea
- Viral Pathogenesis Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.,CAAD Centre for Translational Research on Autoimmune and Allergic Disease, Novara, Italy
| | - Daniela Ferrante
- Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" Hospital, Novara, Italy
| | - Abdurraouf Mokhtar Mahmoud
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" Hospital, Novara, Italy
| | - Maghalie Anais Marie Ucciero
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" Hospital, Novara, Italy
| | - Valentina Gaidano
- Division of Haematology, University of Piemonte Orientale and "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Monia Marchetti
- Division of Haematology, University of Piemonte Orientale and "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Davide Rapezzi
- Division of Haematology, "Santa Croce e Carle di Cuneo" Hospital, Cuneo, Italy
| | - Michele Lai
- Department of Translational Medicine and New Technologies in Medicine and Surgery, Retrovirus Centre, University of Pisa, Pisa, Italy
| | - Mauro Pistello
- Department of Translational Medicine and New Technologies in Medicine and Surgery, Retrovirus Centre, University of Pisa, Pisa, Italy
| | - Marco Ladetto
- Division of Haematology, University of Piemonte Orientale and "SS Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Massimo Massaia
- Division of Haematology, "Santa Croce e Carle di Cuneo" Hospital, Cuneo, Italy
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and "Maggiore della Carità" Hospital, Novara, Italy
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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Noori M, Azizi S, Abbasi Varaki F, Nejadghaderi SA, Bashash D. A systematic review and meta-analysis of immune response against first and second doses of SARS-CoV-2 vaccines in adult patients with hematological malignancies. Int Immunopharmacol 2022; 110:109046. [PMID: 35843148 PMCID: PMC9273573 DOI: 10.1016/j.intimp.2022.109046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer patients particularly those with hematological malignancies are at higher risk of affecting by severe coronavirus disease 2019 (COVID-19). Due to the immunocompromised nature of the disease and the immunosuppressive treatments, they are more likely to develop less antibody protection; therefore, we aimed to evaluate the immunogenicity of COVID-19 vaccines in patients with hematological malignancies. METHODS A comprehensive systematic search was conducted in PubMed, Scopus, and Web of Science databases, as well as Google scholar search engine as of December 10, 2021. Our primary outcomes of interest comprised of estimating the antibody seropositive rate following COVID-19 vaccination in patients with hematological malignancies and to compare it with those who were affected by solid tumors or healthy subjects. The secondary outcomes were to assess the vaccine's immunogenicity based on different treatments, status of the disease, and type of vaccine. After the two-step screening, the data were extracted and the summary measures were calculated using a random-effect model. RESULTS A total of 82 articles recording 13,804 patients with a diagnosis of malignancy were included in the present review. The seropositive rates in patients with hematological malignancies after first and second vaccine doses were 30.0% (95% confidence interval (95%CI): 11.9-52.0) and 62.3% (95%CI 56.0-68.5), respectively. These patients were less likely to develop antibody response as compared to cases with solid tumors (RR 0.73, 95%CI 0.67-0.79) and healthy subjects (RR 0.62, 95%CI 0.54-0.71) following complete immunization. Chronic lymphocytic leukemia (CLL) patients had the lowest response rate among all subtypes of hematological malignancies (first dose: 22.0%, 95%CI 13.5-31.8 and second dose: 47.8%, 95%CI 41.2-54.4). Besides, anti-CD20 therapies (5.7%, 95%CI 2.0-10.6) and bruton's tyrosine kinase inhibitors (26.8%, 95%CI 16.9-37.8) represented the lowest seropositiveness post first and second doses, respectively. Notably, patients who were in active status of disease showed lower antibody detection rate compared to those on remission status (RR 0.87, 95%CI 0.76-0.99). Furthermore, lower rate of seropositivity was found in patients received BNT162.b2 compared to ones who received mRNA-1273 (RR 0.89, 95%CI 0.79-0.99). CONCLUSION Our findings highlight the substantially low rate of seroprotection in patients with hematological malignancies with a wide range of rates among disease subgroups and different treatments; further highlighting the fact that booster doses might be acquired for these patients to improve immunity against SARS-CoV-2.
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Affiliation(s)
- Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Azizi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farhan Abbasi Varaki
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tyrosine Kinase Inhibitors Do Not Promote a Decrease in SARS-CoV-2 Anti-Spike IgG after BNT162b2 Vaccination in Chronic Myeloid Leukemia: A Prospective Observational Study. Vaccines (Basel) 2022; 10:vaccines10091404. [PMID: 36146482 PMCID: PMC9501552 DOI: 10.3390/vaccines10091404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
We performed a prospective observational study of chronic myeloid leukemia (CML) patients after anti-SARS-CoV-2 BNT162b2 vaccination (VC). In total, 32 CML patients with tyrosine kinase inhibitor (TKI) therapy, 10 CML patients with treatment-free remission, and 16 healthy subjects participated in the study. From April 2021 to September 2021, all cases (median age = 58 years) were vaccinated twice. Immunoglobulin G for SARS-CoV-2 spike protein (S-IgG) was measured at three timepoints (before the first VC, 1−5 weeks after the second VC (T1), and approximately 6 months after the second VC (T2)). S-IgG was not observed before the first VC in any participant. At T1, all cases had acquired S-IgG. There were no significant differences in S-IgG levels among groups. A paired sample comparison of median S-IgG titers between T1 and T2 in all groups showed a significant reduction in T2 S-IgG titers. There were no significant differences in S-IgG levels among groups. When all patients were analyzed, those aged ≥58 years had significantly lower S-IgG levels than those aged <58 years at T1. The BNT162b2 vaccine was highly effective in CML patients with or without TKIs, and S-IgG levels were as persistent as those in healthy individuals.
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38
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Sherman AC, Crombie JL, Cheng CA, Desjardins M, Zhou G, Ometoruwa O, Rooks R, Senussi Y, McDonough M, Guerrero LI, Kupelian J, Doss-Gollin S, Smolen KK, van Haren SD, Armand P, Levy O, Walt DR, Baden LR, Issa NC. Immunogenicity of a three-dose primary series of mRNA COVID-19 vaccines in patients with lymphoid malignancies. Open Forum Infect Dis 2022; 9:ofac417. [PMID: 36043177 PMCID: PMC9384786 DOI: 10.1093/ofid/ofac417] [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: 05/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with lymphoid malignancies are at risk for poor COVID-19 related outcomes and have reduced vaccine-induced immune responses. Currently a three-dose primary regimen of mRNA vaccines is recommended in the U.S. for immunocompromised hosts.
Methods
A prospective cohort study of healthy adults (n = 27) and patients with lymphoid malignancies (n = 94) was conducted, with longitudinal follow-up through completion of a two or three-dose primary mRNA COVID vaccine series, respectively. Humoral responses were assessed in all participants, and cellular immunity in a subset of participants.
Results
The rate of seroconversion (68.1% v. 100%) and the magnitude of peak anti-S IgG titer (median anti-S IgG 32.4, IQR 0.48-75.0 v. 72.6, IQR 51.1-100.1; p = 0.0202) were both significantly lower in patients with lymphoid malignancies as compared to the healthy cohort. However, peak titers of patients with lymphoid malignancies who responded to vaccination were similar to healthy cohort titers (median anti-S IgG 64.3, IQR 23.7 - 161.5, p = 0.7424). The third dose seroconverted 7/41 (17.1%) patients who were seronegative after the first two doses. Although most patients with lymphoid malignancies produced vaccine-induced T-cell responses in the subset studied, B-cell frequencies were low with minimal memory cell formation.
Conclusions
A three-dose primary mRNA series enhanced anti-S IgG responses to titers equivalent to healthy adults in patients with lymphoid malignancies who were seropositive after the first two doses and seroconverted 17.1% who were seronegative after the first two doses. T-cell responses were present, raising the possibility that the vaccines may confer some cell-based protection even if not measurable by anti-S IgG.
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Affiliation(s)
- Amy C Sherman
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Jennifer L Crombie
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Chi An Cheng
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | - Michaël Desjardins
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Division of Infectious Diseases, Centre Hospitalier de l’Université de Montréal , Montreal, Qc , Canada
| | - Guohai Zhou
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Omolola Ometoruwa
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Rebecca Rooks
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Yasmeen Senussi
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | | | | | - John Kupelian
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Simon Doss-Gollin
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
| | - Kinga K Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Simon D van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Philippe Armand
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
- Broad Institute of MIT & Harvard , Cambridge, 02142, MA USA
| | - David R Walt
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Nicolas C Issa
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
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Mehrabi Nejad MM, Shobeiri P, Dehghanbanadaki H, Tabary M, Aryannejad A, Haji Ghadery A, Shabani M, Moosaie F, SeyedAlinaghi S, Rezaei N. Seroconversion following the first, second, and third dose of SARS-CoV-2 vaccines in immunocompromised population: a systematic review and meta-analysis. Virol J 2022; 19:132. [PMID: 35941646 PMCID: PMC9358061 DOI: 10.1186/s12985-022-01858-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Immunocompromised (IC) patients are at higher risk of more severe COVID-19 infections than the general population. Special considerations should be dedicated to such patients. We aimed to investigate the efficacy of COVID-19 vaccines based on the vaccine type and etiology as well as the necessity of booster dose in this high-risk population. MATERIALS AND METHODS We searched PubMed, Web of Science, and Scopus databases for observational studies published between June 1st, 2020, and September 1st, 2021, which investigated the seroconversion after COVID-19 vaccine administration in adult patients with IC conditions. For investigation of sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. Statistical analysis was performed using R software. RESULTS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 81 articles in the meta-analysis. The overall crude prevalence of seroconversion after the first (n: 7460), second (n: 13,181), and third (n: 909, all population were transplant patients with mRNA vaccine administration) dose administration was 26.17% (95% CI 19.01%, 33.99%, I2 = 97.1%), 57.11% (95% CI: 49.22%, 64.83%, I2 = 98.4%), and 48.65% (95% CI: 34.63%, 62.79%, I2 = 94.4%). Despite the relatively same immunogenicity of mRNA and vector-based vaccines after the first dose, the mRNA vaccines induced higher immunity after the second dose. Regarding the etiologic factor, transplant patients were less likely to develop immunity after both first and second dose rather than patients with malignancy (17.0% vs 37.0% after first dose, P = 0.02; 38.3% vs 72.1% after second dose, P < 0.001) or autoimmune disease (17.0% vs 36.4%, P = 0.04; 38.3% vs 80.2%, P < 0.001). To evaluate the efficacy of the third dose, we observed an increasing trend in transplant patients after the first (17.0%), second (38.3%), and third (48.6%) dose. CONCLUSION The rising pattern of seroconversion after boosting tends to be promising. In this case, more attention should be devoted to transplant patients who possess the lowest response rate.
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Affiliation(s)
- Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hojat Dehghanbanadaki
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolkarim Haji Ghadery
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahya Shabani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419733141, Iran.
| | - Nima Rezaei
- Department of Immunology, Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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40
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Rinaldi I, Pratama S, Wiyono L, Tandaju JR, Wardhana IL, Winston K. Efficacy and safety profile of COVID-19 mRNA vaccine in patients with hematological malignancies: Systematic review and meta-analysis. Front Oncol 2022; 12:951215. [PMID: 36003763 PMCID: PMC9393790 DOI: 10.3389/fonc.2022.951215] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 12/11/2022] Open
Abstract
Patient populations, including those with hematological malignancies, have different responses to COVID-19 vaccines. This study aimed to quantitatively analyze the efficacy and safety of COVID-19 mRNA vaccines in patients with hematological malignancies. Studies reporting on the efficacy and safety of COVID-19 mRNA vaccines in cohorts with hematological malignancies compared to healthy controls were systematically searched in four databases. Meta-analysis and subgroup analyses were performed to generate quantitative synthesis. Fifteen studies with 2,055 cohorts with hematological malignancies and 1,105 healthy subjects as control were included. After two doses of COVID-19 vaccination, only 60% of cohorts with hematological malignancies were seroconverted compared to healthy controls (RR 0.60; 95%CI 0.50–0.71). A single dose of the vaccine resulted in a significantly lower seroconversion rate (RR 0.30; 95%CI 0.16–0.54). Non-Hodgkin lymphoma cohorts had the lowest rate of seroconversion (RR 0.5; 95%CI 0.35–0.71) and those who received active treatments had lower immunological responses (RR 0.59; 95%CI 0.46–0.75). Antibody titers were lower in cohorts with hematological malignancies without any differences in adverse effects in both groups. In conclusion, cohorts with hematological malignancies showed a lower seroconversion rate and antibody titers after receiving COVID-19 mRNA vaccines. The type of malignancy and the status of treatment had a significant impact on the response to vaccination. The vaccines were shown to be safe for both patients with hematological malignancies and healthy controls. Booster doses and stricter health protocols might be beneficial for patient populations.
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Affiliation(s)
- Ikhwan Rinaldi
- Hematology and Medical Oncology Division, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- *Correspondence: Ikhwan Rinaldi,
| | - Samuel Pratama
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Lowilius Wiyono
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | | | - Kevin Winston
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
- Hospital Medicine, Bhakti Medicare Hospital, Cicurug, Sukabumi, Indonesia
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Chan WY, Zhu C, Sanchez E, Gupta R, Fielding AK, Khwaja A, Payne EM, O'Nions J. Antibody responses to SARS-CoV-2 vaccination in patients with acute myeloid leukaemia and high risk MDS on active anti-cancer therapies. Br J Haematol 2022; 198:478-481. [PMID: 35536283 PMCID: PMC9347660 DOI: 10.1111/bjh.18248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Yee Chan
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
| | - Catherine Zhu
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Emilie Sanchez
- Department of VirologyUniversity College London NHS Foundation TrustLondonUK
| | - Rajeev Gupta
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Adele K. Fielding
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Asim Khwaja
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Elspeth M. Payne
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
- UCL Cancer InstituteUniversity College LondonLondonUK
| | - Jenny O'Nions
- Department of HaematologyUniversity College London NHS Foundation TrustLondonUK
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Inchingolo AD, Malcangi G, Ceci S, Patano A, Corriero A, Vimercati L, Azzollini D, Marinelli G, Coloccia G, Piras F, Barile G, Settanni V, Mancini A, De Leonardis N, Garofoli G, Palmieri G, Isacco CG, Rapone B, Scardapane A, Curatoli L, Quaranta N, Ribezzi M, Massaro M, Jones M, Bordea IR, Tartaglia GM, Scarano A, Lorusso F, Macchia L, Larocca AMV, Aityan SK, Tafuri S, Stefanizzi P, Migliore G, Brienza N, Dipalma G, Favia G, Inchingolo F. Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast. Int J Mol Sci 2022; 23:ijms23158485. [PMID: 35955621 PMCID: PMC9369331 DOI: 10.3390/ijms23158485] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines’ immunization findings. Methods: A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention. Results: Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants. Conclusions: Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Sabino Ceci
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Alberto Corriero
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70121 Bari, Italy; (A.C.); (M.R.); (N.B.)
| | - Luigi Vimercati
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Daniela Azzollini
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Giovanni Coloccia
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Vito Settanni
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Nicole De Leonardis
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Grazia Garofoli
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Giulia Palmieri
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Ciro Gargiulo Isacco
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Arnaldo Scardapane
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Luigi Curatoli
- Department Neurosciences & Sensory Organs & Musculoskeletal System, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Nicola Quaranta
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
- Department Neurosciences & Sensory Organs & Musculoskeletal System, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Mario Ribezzi
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70121 Bari, Italy; (A.C.); (M.R.); (N.B.)
| | - Maria Massaro
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Megan Jones
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence: (F.L.); (F.I.); Tel.: +39-3282132586 (F.L.)
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Angela Maria Vittoria Larocca
- Hygiene Complex Operating Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Place Giulio Cesare 11 BARI CAP, 70124 Bari, Italy;
| | | | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, 70121 Bari, Italy;
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, University Hospital of Bari, 70100 Bari, Italy; (P.S.); (G.M.)
| | - Giovanni Migliore
- Interdisciplinary Department of Medicine, University Hospital of Bari, 70100 Bari, Italy; (P.S.); (G.M.)
| | - Nicola Brienza
- Unit of Anesthesia and Resuscitation, Department of Emergencies and Organ Transplantations, Aldo Moro University, 70121 Bari, Italy; (A.C.); (M.R.); (N.B.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, Section of Dental Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (G.M.); (S.C.); (A.P.); (L.V.); (D.A.); (G.M.); (G.C.); (F.P.); (G.B.); (V.S.); (A.M.); (N.D.L.); (G.G.); (G.P.); (C.G.I.); (B.R.); (A.S.); (N.Q.); (M.J.); (G.D.); (G.F.)
- Correspondence: (F.L.); (F.I.); Tel.: +39-3282132586 (F.L.)
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Zaleska J, Kwasnik P, Paziewska M, Purkot J, Szabelak A, Jurek M, Masny N, Dziatkiewicz I, Pronobis‐Szczylik B, Piebiak A, Szymczyk A, Jarosz‐Chudzik K, Bolkun L, Kozlowska K, Piszcz J, Subocz E, Halka J, Bator M, Kalicinska E, Wrobel T, Usnarska‐Zubkiewicz L, Rybka J, Deren‐Wagemann I, Szyca‐Smieszniak M, Dybko J, Hus I, Pula B, Cichocka E, Rymko M, Zdunczyk D, Ziarkiewicz M, Basak GW, Bullinger L, Giannopoulos K. Response to anti-SARS-CoV-2 mRNA vaccines in multiple myeloma and chronic lymphocytic leukemia patients. Int J Cancer 2022; 152:705-712. [PMID: 35830214 PMCID: PMC9349960 DOI: 10.1002/ijc.34209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
Multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) patients have increased morbidity and mortality rates of COVID-19 due to immunosuppression associated with the disease and ongoing therapy. The same immune impairment accompanying CLL and MM also affects suboptimal vaccine response. The study assessed the effectiveness of the humoral and T cell-mediated immunity following mRNA COVID-19 vaccination (using either BNT162b2 or mRNA-1273) in short-term (2-5 weeks after second dose) and long-term follow-up (12 weeks after vaccination). Between March and August 2021, blood samples were obtained from 62 CLL and 60 MM patients from eight different hematology departments in Poland. Total anti-RBD antibodies were detected in 37% MM patients before vaccination, increased to 91% and 94% in short- and long-term follow-up, respectively. In CLL, serological responses were detectable in 21% of patients before vaccination and increased to 45% in the short-term and 71% in long-term observation. We detected a tendency to higher frequencies of specific CD8+ T cells against SARS-CoV-2 after vaccination compared to samples before vaccination in MM patients and no changes in frequencies of specific T cells in CLL patients. Our study provides novel insights into mRNA vaccination efficacy in immunocompromised MM and CLL patients, and our findings highlight that specific CD8+ T cells against SARS-CoV-2 might be induced by vaccination but do not correlate positively with serological responses.
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Affiliation(s)
- Joanna Zaleska
- Department of Experimental HematooncologyMedical University of LublinLublinPoland,Department of HematologySt John's Cancer CentreLublinPoland
| | - Paulina Kwasnik
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Magdalena Paziewska
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Joanna Purkot
- Department of Experimental HematooncologyMedical University of LublinLublinPoland,Department of HematologySt John's Cancer CentreLublinPoland
| | - Aleksandra Szabelak
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Mateusz Jurek
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Natalia Masny
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Izabela Dziatkiewicz
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | | | | | - Agnieszka Szymczyk
- Department of HematologySt John's Cancer CentreLublinPoland,Department of Clinical TransplantologyMedical University of LublinLublinPoland
| | - Katarzyna Jarosz‐Chudzik
- Department of Experimental HematooncologyMedical University of LublinLublinPoland,Department of HematologySt John's Cancer CentreLublinPoland
| | - Lukasz Bolkun
- Department of HematologyMedical University of BialystokBiałystokPoland
| | | | - Jaroslaw Piszcz
- Department of HematologyMedical University of BialystokBiałystokPoland
| | - Edyta Subocz
- Department of HematologyWarmian‐Masurian Cancer Center of the Ministry of the Interior and Administration's HospitalOlsztynPoland
| | - Janusz Halka
- Department of HematologyWarmian‐Masurian Cancer Center of the Ministry of the Interior and Administration's HospitalOlsztynPoland
| | - Michal Bator
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Elzbieta Kalicinska
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Tomasz Wrobel
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Lidia Usnarska‐Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Justyna Rybka
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Izabela Deren‐Wagemann
- Department of Hematology and TransplantationLower Silesian Center of OncologyWrocławPoland
| | - Marta Szyca‐Smieszniak
- Department of Hematology and TransplantationLower Silesian Center of OncologyWrocławPoland
| | - Jaroslaw Dybko
- Department of Hematology and TransplantationLower Silesian Center of OncologyWrocławPoland
| | - Iwona Hus
- Department of Clinical TransplantologyMedical University of LublinLublinPoland,Department of HematologyInstitute of Hematology and Transfusion MedicineWarsawPoland
| | - Bartosz Pula
- Department of HematologyInstitute of Hematology and Transfusion MedicineWarsawPoland
| | - Edyta Cichocka
- Department of Hematology and Bone Marrow TransplantationNicolaus Copernicus HospitalTorunPoland
| | - Marcin Rymko
- Department of Hematology and Bone Marrow TransplantationNicolaus Copernicus HospitalTorunPoland
| | - Dorota Zdunczyk
- Department of Hematology, Transplantation and Internal MedicineMedical University of WarsawWarsawPoland
| | - Mateusz Ziarkiewicz
- Department of Hematology, Transplantation and Internal MedicineMedical University of WarsawWarsawPoland
| | - Grzegorz Wladyslaw Basak
- Department of Hematology, Transplantation and Internal MedicineMedical University of WarsawWarsawPoland
| | - Lars Bullinger
- Department of Hematology, Oncology, and Tumor ImmunologyCharité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK)BerlinGermany
| | - Krzysztof Giannopoulos
- Department of Experimental HematooncologyMedical University of LublinLublinPoland,Department of HematologySt John's Cancer CentreLublinPoland
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44
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Cuffel A, Maylin S, Le Buanec H, Delaugerre C, Minier M, Bergerat D, Merandet M, Cassius C, Peffault de Latour R, Le Goff J, Socié G, Caillat-Zucman S, Robin M, Xhaard A. Humoral and cellular responses to SARS-CoV-2 BNT162b2 vaccination in allogeneic hematopoietic stem cell transplantation recipients. Vaccine 2022; 40:4682-4685. [PMID: 35840470 PMCID: PMC9271460 DOI: 10.1016/j.vaccine.2022.07.006] [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: 02/21/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
Previous studies reporting the response to SARS-CoV-2 mRNA vaccination in alloHSCT recipients used serological and/or cellular assays, but no study has evaluated vaccine-induced neutralizing antibodies. We prospectively studied 28 alloHSCT recipients who received two BNT162b2 doses. Two patients groups were defined according to time from alloHSCT and immunosuppressive treatment, and had different baseline immunologic status. Study end-point was the evaluation of humoral and cellular responses one month after the second vaccine. All patients seroconverted. Anti-S IgG levels and neutralizing antibodies percentages were not significantly different between both groups. Using IFNγ ELISpot assay, five patients showed a strong increase, without correlation with the humoral response. Using flow cytometry lymphocyte proliferation assay, 14 patients exhibited responding T cells, without difference between both groups or correlation with anti-S IgG levels. A few low serological responders had a detectable CD4 + T cell proliferative response. This finding should be confirmed in a larger cohort.
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Affiliation(s)
- Alexis Cuffel
- Laboratoire d'immunologie-histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Sarah Maylin
- Laboratoire de virologie, Hôpital Saint-Louis, Paris, France
| | - Helene Le Buanec
- Université de Paris, Immunologie humaine, Physiopathologie, Immunothérapie, INSERM U976, Institut de Recherche Saint-Louis, Paris F-75010, France
| | - Constance Delaugerre
- Laboratoire de virologie, Hôpital Saint-Louis, Paris, France; Université de Paris, INSERM, U944, F-75010 Paris, France
| | - Marine Minier
- Laboratoire de virologie, Hôpital Saint-Louis, Paris, France
| | - David Bergerat
- Université de Paris, Immunologie humaine, Physiopathologie, Immunothérapie, INSERM U976, Institut de Recherche Saint-Louis, Paris F-75010, France
| | - Marine Merandet
- Université de Paris, Immunologie humaine, Physiopathologie, Immunothérapie, INSERM U976, Institut de Recherche Saint-Louis, Paris F-75010, France
| | | | | | - Jérôme Le Goff
- Laboratoire de virologie, Hôpital Saint-Louis, Paris, France; Université de Paris, INSERM, U976, HIPI, F-75010 Paris, France
| | - Gérard Socié
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Diderot, Paris, France; Université de Paris, INSERM, U976, HIPI, F-75010 Paris, France
| | - Sophie Caillat-Zucman
- Laboratoire d'immunologie-histocompatibilité, Hôpital Saint-Louis, Paris, France; Université de Paris, INSERM, U976, HIPI, F-75010 Paris, France
| | - Marie Robin
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Aliénor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Diderot, Paris, France.
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45
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Bergamaschi C, Pagoni M, Rosati M, Angel M, Tzannou I, Vlachou M, Darmani I, Ullah A, Bear J, Devasundaram S, Burns R, Baltadakis I, Gigantes S, Dimopoulos MA, Pavlakis GN, Terpos E, Felber BK. Reduced Antibodies and Innate Cytokine Changes in SARS-CoV-2 BNT162b2 mRNA Vaccinated Transplant Patients With Hematological Malignancies. Front Immunol 2022; 13:899972. [PMID: 35693807 PMCID: PMC9174567 DOI: 10.3389/fimmu.2022.899972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 12/29/2022] Open
Abstract
Immunocompromised individuals including patients with hematological malignancies constitute a population at high risk of developing severe disease upon SARS-CoV-2 infection. Protection afforded by vaccination is frequently low and the biology leading to altered vaccine efficacy is not fully understood. A patient cohort who had received bone marrow transplantation or CAR-T cells was studied following a 2-dose BNT162b2 mRNA vaccination and compared to healthy vaccine recipients. Anti-Spike antibody and systemic innate responses were compared in the two vaccine cohorts. The patients had significantly lower SARS-CoV-2 Spike antibodies to the Wuhan strain, with proportional lower cross-recognition of Beta, Delta, and Omicron Spike-RBD proteins. Both cohorts neutralized the wildtype WA1 and Delta but not Omicron. Vaccination elicited an innate cytokine signature featuring IFN-γ, IL-15 and IP-10/CXCL10, but most patients showed a diminished systemic cytokine response. In patients who failed to develop antibodies, the innate systemic response was dominated by IL-8 and MIP-1α with significant attenuation in the IFN-γ, IL-15 and IP-10/CXCL10 signature response. Changes in IFN-γ and IP-10/CXCL10 at priming vaccination and IFN-γ, IL-15, IL-7 and IL-10 upon booster vaccination correlated with the Spike antibody magnitude and were predictive of successful antibody development. Overall, the patients showed heterogeneous adaptive and innate responses with lower humoral and reduced innate cytokine responses to vaccination compared to naïve vaccine recipients. The pattern of responses described offer novel prognostic approaches for potentiating the effectiveness of COVID-19 vaccination in transplant patients with hematological malignancies.
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Affiliation(s)
- Cristina Bergamaschi
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Maria Pagoni
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Margherita Rosati
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Matthew Angel
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States.,Center for Cancer Research Collaborative Bioinformatics Resource, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Ifigeneia Tzannou
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | | | - Ismini Darmani
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Amirah Ullah
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Jenifer Bear
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Santhi Devasundaram
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Robert Burns
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Ioannis Baltadakis
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | - Stavros Gigantes
- Department of Hematology & Lymphomas and Bone Marrow Transplantation Unit, Evangelismos General Hospital, Athens, Greece
| | | | - George N Pavlakis
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Barbara K Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, United States
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46
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Grégoire C, Huynen P, Gofflot S, Seidel L, Maes N, Vranken L, Delcour S, Moutschen M, Hayette MP, Kolh P, Melin P, Beguin Y. Predictive factors for the presence and long-term persistence of SARS-CoV-2 antibodies in healthcare and university workers. Sci Rep 2022; 12:9790. [PMID: 35697828 PMCID: PMC9191528 DOI: 10.1038/s41598-022-13450-4] [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: 02/04/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
While patient groups at risk for severe COVID-19 infections are now well identified, the risk factors associated with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmission and immunization are still poorly understood. In a cohort of staff members of a Belgian tertiary academic hospital tested for SARS-CoV-2 antibodies during the early phase of the pandemic and followed-up after 6 weeks, 3 months and 10 months, we collected personal, occupational and medical data, as well as symptoms based on which we constructed a COVID-19 score. Seroprevalence was higher among participants in contact with patients or with COVID-19 confirmed subjects or, to a lesser extent, among those handling respiratory specimens, as well as among participants reporting an immunodeficiency or a previous or active hematological malignancy, and correlated with several symptoms. In multivariate analysis, variables associated with seropositivity were: contact with COVID-19 patients, immunodeficiency, previous or active hematological malignancy, anosmia, cough, nasal symptoms, myalgia, and fever. At 10 months, participants in contact with patients and those with higher initial COVID-19 scores were more likely to have sustained antibodies, whereas those with solid tumors or taking chronic medications were at higher risk to become seronegative.
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Affiliation(s)
- Céline Grégoire
- Division of Hematology, CHU Sart-Tilman, Avenue de l'hôpital 1, 4000, Liège, Belgium.
| | - Pascale Huynen
- Division of Medical Microbiology, Unilab, CHU of Liège, Liège, Belgium.,Center for Interdisciplinary Research On Medicines, University of Liège, Liège, Belgium
| | - Stéphanie Gofflot
- Biothèque Hospitalo-Universitaire de Liège (BHUL), CHU of Liège, Liège, Belgium
| | - Laurence Seidel
- Department of Biostatistics and Medico-Economic Information, CHU of Liège, Liège, Belgium
| | - Nathalie Maes
- Department of Biostatistics and Medico-Economic Information, CHU of Liège, Liège, Belgium
| | | | | | - Michel Moutschen
- Division of Infectious Diseases and General Internal Medicine, CHU of Liège, Liège, Belgium.,GIGA-I3 Laboratory of Immunology, University of Liège, Liège, Belgium
| | - Marie-Pierre Hayette
- Division of Medical Microbiology, Unilab, CHU of Liège, Liège, Belgium.,Center for Interdisciplinary Research On Medicines, University of Liège, Liège, Belgium
| | - Philippe Kolh
- Department of Information System Management, CHU of Liège, Liège, Belgium.,Department of Biomedical and Preclinical Sciences, University of Liège, Liège, Belgium
| | - Pierrette Melin
- Division of Medical Microbiology, Unilab, CHU of Liège, Liège, Belgium.,Center for Interdisciplinary Research On Medicines, University of Liège, Liège, Belgium
| | - Yves Beguin
- Division of Hematology, CHU Sart-Tilman, Avenue de l'hôpital 1, 4000, Liège, Belgium.,Biothèque Hospitalo-Universitaire de Liège (BHUL), CHU of Liège, Liège, Belgium.,GIGA-I3 Laboratory of Hematology, University of Liège, Liège, Belgium
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47
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SARS-CoV-2 vaccine safety and immunogenicity in patients with hematologic malignancies, transplantation, and cellular therapies. Blood Rev 2022; 56:100984. [PMID: 35752546 PMCID: PMC9188822 DOI: 10.1016/j.blre.2022.100984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
Individuals with hematological malignancies and hematopoietic stem cell transplant (HCT) recipients are immunologically heterogenous groups with varying degrees of immunosuppression at increased risk of severe disease and mortality from SARS-CoV-2 infection. SARS-CoV-2 vaccines are key interventions to preventing severe COVID-19 and its complications. While these individuals were excluded from initial vaccine trials, there is now a growing body of acceptable safety and immunogenicity data among these individuals. A consistent signal for new or worsening graft versus host disease in allogeneic HCT recipients has not been demonstrated post-vaccination. Immunogenicity in these populations is variable depending on disease and treatment factors. However, serological responses may not accurately reflect vaccine protection as correlates of protection within these populations are not yet established. Large-scale studies powered to identify rare serious events, resolve differences in vaccine responses between different vaccination strategies, and identify immune correlates of protection within these populations are needed.
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48
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Goldman JD, Gonzalez MA, Rüthrich MM, Sharon E, von Lilienfeld-Toal M. COVID-19 and Cancer: Special Considerations for Patients Receiving Immunotherapy and Immunosuppressive Cancer Therapies. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35658503 DOI: 10.1200/edbk_359656] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with cancer generally have a higher risk of adverse outcomes from COVID-19, with higher age, male sex, poor performance status, cancer type, and uncontrolled malignant disease as the main risk factors. However, the influence of specific cancer therapies varies and raises concerns during the pandemic. In patients undergoing cancer immunotherapy or other immunosuppressive cancer treatments, we summarize the evidence on outcomes from COVID-19; address the safety, immunogenicity, and efficacy of COVID-19 vaccination; and review COVID-19 antiviral therapeutics for the patient with cancer. Despite higher mortality for patients with cancer, treatment with immune checkpoint inhibitors does not seem to increase mortality risk based on observational evidence. Inhibitory therapies directed toward B-cell lineages, including monoclonal antibodies against CD20 and CAR T-cell therapies, are associated with poor outcomes in COVID-19; however, the data are sparse. Regarding vaccination in patients receiving immune checkpoint inhibitors, clinical efficacy comparable to that in the general population can be expected. In patients undergoing B-cell-depleting therapy, immunogenicity and clinical efficacy are curtailed, but vaccination is not futile, which is thought to be due to the cellular response. Vaccine reactogenicity and toxicity in all groups of patients with cancer are comparable to that of the general population. Preexposure prophylaxis with monoclonal antibodies directed against the viral spike may provide passive immunity for those not likely to mount an adequate vaccine response. If infected, prompt treatment with monoclonal antibodies or oral small molecule antivirals is beneficial, though with oral antiviral therapies, care must be taken to avoid drug interactions in patients with cancer.
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Affiliation(s)
- Jason D Goldman
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA.,Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael A Gonzalez
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Maria Madeleine Rüthrich
- Klinik für Notfallmedizin, Universitätsklinikum Jena, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany
| | - Elad Sharon
- Division of Cancer Treatment & Diagnosis, National Cancer Institute, Bethesda, MD
| | - Marie von Lilienfeld-Toal
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany.,Klinik für Innere Medizin II, Abteilung für Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
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49
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Fendler A, de Vries EGE, GeurtsvanKessel CH, Haanen JB, Wörmann B, Turajlic S, von Lilienfeld-Toal M. COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety. Nat Rev Clin Oncol 2022; 19:385-401. [PMID: 35277694 PMCID: PMC8916486 DOI: 10.1038/s41571-022-00610-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/11/2022]
Abstract
Patients with cancer have a higher risk of severe coronavirus disease (COVID-19) and associated mortality than the general population. Owing to this increased risk, patients with cancer have been prioritized for COVID-19 vaccination globally, for both primary and booster vaccinations. However, given that these patients were not included in the pivotal clinical trials, considerable uncertainty remains regarding vaccine efficacy, and the extent of humoral and cellular immune responses in these patients, as well as the risks of vaccine-related adverse events. In this Review, we summarize the current knowledge generated in studies conducted since COVID-19 vaccines first became available. We also highlight critical points that might affect vaccine efficacy in patients with cancer in the future.
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Affiliation(s)
- Annika Fendler
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - John B Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marie von Lilienfeld-Toal
- Department of Haematology and Medical Oncology, University Hospital Jena, Jena, Germany.
- Research Group Infections in Haematology/Oncology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany.
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50
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Effectiveness, immunogenicity, and safety of COVID-19 vaccines for individuals with hematological malignancies: a systematic review. Blood Cancer J 2022; 12:86. [PMID: 35641489 PMCID: PMC9152308 DOI: 10.1038/s41408-022-00684-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 12/28/2022] Open
Abstract
The efficacy of SARS-CoV-2 vaccination in patients with hematological malignancies (HM) appears limited due to disease and treatment-associated immune impairment. We conducted a systematic review of prospective studies published from 10/12/2021 onwards in medical databases to assess clinical efficacy parameters, humoral and cellular immunogenicity and adverse events (AE) following two doses of COVID-19 approved vaccines. In 57 eligible studies reporting 7393 patients, clinical outcomes were rarely reported and rates of SARS-CoV-2 infection (range 0–11.9%), symptomatic disease (0–2.7%), hospital admission (0–2.8%), or death (0–0.5%) were low. Seroconversion rates ranged from 38.1–99.1% across studies with the highest response rate in myeloproliferative diseases and the lowest in patients with chronic lymphocytic leukemia. Patients with B-cell depleting treatment had lower seroconversion rates as compared to other targeted treatments or chemotherapy. The vaccine-induced T-cell response was rarely and heterogeneously reported (26.5–85.9%). Similarly, AEs were rarely reported (0–50.9% ≥1 AE, 0–7.5% ≥1 serious AE). In conclusion, HM patients present impaired humoral and cellular immune response to COVID-19 vaccination with disease and treatment specific response patterns. In light of the ongoing pandemic with the easing of mitigation strategies, new approaches to avert severe infection are urgently needed for this vulnerable patient population that responds poorly to current COVID-19 vaccine regimens.
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