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Wen Q, Guo Z, Zhang XH, Xu LP, Wang Y, Yan CH, Chen H, Chen YH, Han W, Wang FR, Sun YQ, Huang XJ, Mo XD. COVID-19 was associated with the complications after allogeneic hematopoietic stem cell transplantation. Sci Rep 2024; 14:11778. [PMID: 38782966 PMCID: PMC11116404 DOI: 10.1038/s41598-024-62731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024] Open
Abstract
We aimed to identify the severity and duration of COVID-19 infection on complications after allo-HSCT. Enrolled 179 hospitalized patients with COVID-19 were categorized into long-term infection (> 18 days, n = 90) or short-term infection group (≤ 18 days, n = 89) according to the median duration of COVID-19. The severity of COVID-19 was categorized as asymptomatic infection, mild, moderate, severe, and critical illness according to guidelines of National Institutes of Health. Particularly, severe illness and critical illness were classified as serious infection. Asymptomatic infection, mild illness and moderate illness were classified as non-serious infection. The 150-day probabilities of poor graft function (PGF), cytomegalovirus (CMV) pneumonia and non-relapse mortality (NRM) were significantly higher in long-term infection group. The 150-day probabilities of CMV pneumonia and NRM after COVID-19 were higher in serious infection group. The 150-day probabilities of overall survival (OS) was significantly lower in long-term and serious infection group. In multivariable analysis, the severity of COVID-19 was associated with NRM and OS, and the duration of COVID-19 was associated with PGF. In summary, our data reported that the severity and duration of COVID-19 were associated with several complications and contribute to poor outcomes after allo-HSCT.
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Affiliation(s)
- Qi Wen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Ze Guo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiao-Hui Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lan-Ping Xu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Chen-Hua Yan
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huan Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Hong Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Han
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Feng-Rong Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu-Qian Sun
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiao-Jun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China
| | - Xiao-Dong Mo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 2019RU029, China.
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Yang S, Wei R, Shi H, Wang Y, Lai Y, Zhao X, Lu J, Schmitz N. The impact of Bruton's tyrosine kinase inhibitor treatment on COVID-19 outcomes in Chinese patients with chronic lymphocytic leukemia. Front Oncol 2024; 14:1396913. [PMID: 38835372 PMCID: PMC11148257 DOI: 10.3389/fonc.2024.1396913] [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: 03/06/2024] [Accepted: 04/24/2024] [Indexed: 06/06/2024] Open
Abstract
Background Impact of B-cell depletion following treatment with Bruton tyrosine kinase-inhibitors (BTKi) on the outcome of SARS-CoV-2 infection in chronic lymphocytic leukemia (CLL) patients remain controversial. We investigated the impact of BTKi on susceptibility and the severity of COVID-19 in Chinese patients with CLL during the first wave of COVID-19 (Omicron variant). Methods CLL patients (n=171) visiting the Institute of Hematology, Peoples' Hospital, China (November 15, 2022- January 20, 2023) were included in the study. Seventeen patients receiving BTKi and venetoclax with or without obinutuzumab were excluded. Data from 117 patients receiving treatment with BTKi were collected using a standardized questionnaire through telephone interviews. Thirty-four patients without CLL-specific treatment served as controls. The data was analysed using IBM SPSS Software version 21 and a P value of <0.05 was considered statistically significant. Results The median age of patients was 67 years and majority were males (n=100). Treatment with BTKi was not associated with higher incidence of COVID-19 (74% [95% Confidence Interval (CI) 60%, 92%]) versus 74% (CI 48%, 100%) without any treatment (P=0.92). Hypoxemia was reported by 45% (32%, 61%) and 16% (4%, 41%) (P=0.01). BTKi was the only independent risk factor of hypoxemia (Hazard Ratio [HR], 4.22 [1.32, 13.50]; P = 0.02). Five (5.7%) patients with COVID-19 under BTKi required ICU admission; 4 of them died. No ICU admissions/deaths were observed in the control group. Conclusion In Chinese patients with CLL and treated with BTKi experienced more severe lung disease and ICU admissions due to COVID-19 than patients without CLL therapy. Frequency of infections with SARS-CoV-2, however, was not different in patients with or without BTKi treatment.
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Affiliation(s)
- Shenmiao Yang
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Rong Wei
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Hongxia Shi
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Yazhe Wang
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Yueyun Lai
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Xiaosu Zhao
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Jin Lu
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
| | - Norbert Schmitz
- Peking University Institute of Hematology, Peking University Peoples' Hospital, Beijing, China
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
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Zhang Z, Huang J, Wang L, Pan Z, Huang J, Jiang C, Zhang S, Li S, Hu X. COVID-19 in immunocompromised patients after hematopoietic stem cell transplantation: a pilot study. BLOOD SCIENCE 2024; 6:e00183. [PMID: 38283406 PMCID: PMC10817160 DOI: 10.1097/bs9.0000000000000183] [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: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients at early stage of immune reconstitution after hematopoietic stem cell transplantation (HSCT) are limited. In the present study, we retrospectively investigated the incidence and clinical features of SARS-CoV-2 infection in patients who underwent HSCT in 2022. Patients (allo-HSCT, n = 80; auto-HSCT, n = 37) were consecutively included in the study. The SARS-CoV-2 infection rate was 59.8%, and the median interval of HSCT to coronavirus disease 2019 (COVID-19) was 4.8 (range: 0.5-12) months. Most patients were categorized as mild (41.4%) or moderate (38.6%), and 20% as severe/critical. No deaths were attributable to COVID-19. Further analysis showed that lower circulating CD8+ T-cell counts and calcineurin inhibitor administration increased the risk of SARS-CoV-2 infection. Exposure to rituximab significantly increased the probability of severe or critical COVID-19 compared with that of mild/moderate illness (P < .001). In the multivariate analysis, rituximab use was associated with severe COVID-19. Additionally, COVID-19 had no significant effect on immune reconstitution. Furthermore, it was found that Epstein-Barr virus infection and rituximab administration possibly increase the risk of developing severe illness. Our study provides preliminary insights into the effect of SARS-CoV-2 on immune reconstitution and the outcomes of allo-HSCT recipients.
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Affiliation(s)
- Zilu Zhang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Jingtao Huang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Luxiang Wang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Zengkai Pan
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Jiayu Huang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Chuanhe Jiang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Sujiang Zhang
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
| | - Su Li
- GoBroad Medical Institute of Hematology (Shanghai Center), Shanghai 201418, China
| | - Xiaoxia Hu
- National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China
- Collaborative Innovation Center of Hematology, Shanghai JiaoTong University School of Medicine; Shanghai 200025, China
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Saito M, Mori A, Ishio T, Kobayashi M, Tsukamoto S, Kajikawa S, Yokoyama E, Kanaya M, Izumiyama K, Muraki H, Morioka M, Kondo T. Initial Efficacy of the COVID-19 mRNA Vaccine Booster and Subsequent Breakthrough Omicron Variant Infection in Patients with B-Cell Non-Hodgkin's Lymphoma: A Single-Center Cohort Study. Viruses 2024; 16:328. [PMID: 38543695 PMCID: PMC10974858 DOI: 10.3390/v16030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/17/2024] [Accepted: 02/18/2024] [Indexed: 05/23/2024] Open
Abstract
It has been suggested that the effect of coronavirus disease 2019 (COVID-19) booster vaccination in patients with B-cell non-Hodgkin's lymphoma (B-NHL) is inferior to that in healthy individuals. However, differences according to histological subtype or treatment status are unclear. In addition, there has been less research on patients who subsequently develop breakthrough infections. We investigated the effects of the first COVID-19 booster vaccination for patients with B-NHL and the clinical features of breakthrough infections in the Omicron variant era. In this study, B-NHL was classified into two histological subtypes: aggressive lymphoma and indolent lymphoma. Next, patients were subdivided according to treatment with anticancer drugs at the start of the first vaccination. We also examined the clinical characteristics and outcomes of patients who had breakthrough infections after a booster vaccination. The booster effect of the COVID-19 mRNA vaccine in patients with B-NHL varied considerably depending on treatment status at the initial vaccination. In the patient group at more than 1 year after the last anticancer drug treatment, regardless of the histological subtype, the booster effect was comparable to that in the healthy control group. In contrast, the booster effect was significantly poorer in the other patient groups. However, of the 213 patients who received the booster vaccine, 22 patients (10.3%) were infected with COVID-19, and 18 patients (81.8%) had mild disease; these cases included the patients who remained seronegative. Thus, we believe that booster vaccinations may help in reducing the severity of Omicron variant COVID-19 infection in patients with B-NHL.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Mirei Kobayashi
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Shihori Tsukamoto
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Sayaka Kajikawa
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
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Sun P, Yang H, Zhao B, Wang Y, Nie M, Huang K, Li Z. Outcomes of COVID-19 in patients with lymphomas participating in registered clinical trials: A real-world study from China in the Omicron outbreak era. Cancer Med 2023; 12:21148-21158. [PMID: 38011015 PMCID: PMC10726839 DOI: 10.1002/cam4.6678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This real-world study investigated the outcome of COVID-19 in lymphoma patients participating in registered clinical trials and explored potential risk factors with the outcome of COVID-19 during the first wave of the Omicron outbreak in China. METHODS One hundred and ten patients participating in registered clinical trials and diagnosed with COVID-19 in our center between December 1, 2022, and January 31, 2023, were included. RESULTS Four (3.6%) patients were identified as severe COVID-19 and 2 (1.8%) as critical COVID-19, respectively. The mortality rate observed was 2.73% for the entire cohort, 33.3% for the severe/critical COVID-19 group, and 18.8% for the hospitalized group. The 90-day OS was 98.2% for the entire cohort, 66.7% for the severe/critical COVID-19 group, and 87.5% for the hospitalized group. Advanced age (≥70 years), comorbidities, and PI3K inhibitor-containing regimen were significantly associated with the severity of COVID-19. Patients with indolent B-cell non-Hodgkin lymphomas were less likely to be hospitalized for COVID-19. CONCLUSION This study reported similar clinical features of COVID-19 in our cohort with that of non-hematological malignancy (HM) patients, while the proportion of severe/critical COVID-19 and the mortality rate were relatively higher than non-HM patients. Our findings provided valuable experience to aid clinical researchers with managing lymphoma patients participating in registered clinical trials during the ongoing pandemic of the Omicron variant.
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Affiliation(s)
- Peng Sun
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Hang Yang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Baitian Zhao
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
- Department of Clinical Trials CenterSun Yat‐Sen University Cancer CenterGuangzhouChina
| | - Yu Wang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Man Nie
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Kangming Huang
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
| | - Zhiming Li
- Department of Medical OncologySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouChina
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Li J, Liu Y, Wei X, Liu Z, Yang Z, Liu L, Zhou M, Xu G, Chen L, Ding Y, Lei H, Yang Z, Chen S, Zhang X, Tang Y, Fu H, He S, Guo B, Liang X, Zhang L, Zhang W, Wu J, Wang C, Hu C, Hu R, Luo X, Quan X, Zeng C, Liang S, Liu T, Lv J, Luo Q, Qi Q, Xu L, Xiong Y, Liu J, Huang D, Xiao C, Liu J, Yang T, Xiang Y, Li Q, Nan Y, Li J, Zhang Y, Wu Y, Liu Y. Antibody responses to SARS-CoV-2 Omicron infection in patients with hematological malignancies: A multicenter, prospective cohort study. J Med Virol 2023; 95:e29300. [PMID: 38063070 DOI: 10.1002/jmv.29300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
Little is known about antibody responses to natural Omicron infection and the risk factors for poor responders in patients with hematological malignancies (HM). We conducted a multicenter, prospective cohort study during the latest Omicron wave in Chongqing, China, aiming to compare the antibody responses, as assessed by IgG levels of anti-receptor binding domain of spike protein (anti-S-RBD), to Omicron infection in the HM cohort (HMC) with healthy control cohort (HCC), and solid cancer cohort (SCC). In addition, we intend to explore the risk factors for poor responders in the HMC. Among the 466 HM patients in this cohort, the seroconversion rate was 92.7%, no statistically difference compared with HCC (98.2%, p = 0.0513) or SCC (100%, p = 0.1363). The median anti-S-RBD IgG titer was 29.9 ng/mL, significantly lower than that of HCC (46.9 ng/mL, p < 0.0001) or SCC (46.2 ng/mL, p < 0.0001). Risk factors associated with nonseroconversion included no COVID-19 vaccination history (odds ratio [OR] = 4.58, 95% confidence interval [CI]: 1.75-12.00, p = 0.002), clinical course of COVID-19 ≤ 7 days (OR = 2.86, 95% CI: 1.31-6.25, p = 0.008) and severe B-cell reduction (0-10/μL) (OR = 3.22, 95% CI: 1.32-7.88, p = 0.010). Risk factors associated with low anti-S-RBD IgG titer were clinical course of COVID-19 ≤ 7 days (OR = 2.58, 95% CI: 1.59-4.18, p < 0.001) and severe B-cell reduction (0-10/μL) (OR = 2.87, 95% CI: 1.57-5.24, p < 0.001). This study reveals a poor antibody responses to Omicron (BA.5.2.48) infection in HM patients and identified risk factors for poor responders. Highlights that HM patients, especially those with these risk factors, may be susceptible to SARS-CoV-2 reinfection, and the postinfection vaccination strategies for these patients should be tailored. Clinical trial: ChiCTR2300071830.
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Affiliation(s)
- Jun Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yi Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xia Wei
- Department of Hematology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhanshu Liu
- Department of Hematology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zailiang Yang
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Ling Liu
- Department of Medical Laboratory, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Meiyu Zhou
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Guofa Xu
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Lanting Chen
- Department of Hematology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Ding
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Haike Lei
- Department of Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Zailin Yang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Shuang Chen
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaomei Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yifeng Tang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Huihui Fu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Sanxiu He
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Bingling Guo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiping Liang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lingqian Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wenjun Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jing Wu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyu Wang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chongling Hu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Renzhi Hu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xin Luo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xi Quan
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chensi Zeng
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Shunsi Liang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tingting Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jing Lv
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qin Luo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qin Qi
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Luxiang Xu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yan Xiong
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jueyin Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Dehong Huang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chunyan Xiao
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jun Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tao Yang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Xiang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qiying Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yingyu Nan
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jieping Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yong Zhang
- Department of Hematology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongzhong Wu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yao Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Rodríguez-Mora S, Corona M, Solera Sainero M, Mateos E, Torres M, Sánchez-Menéndez C, Casado-Fernández G, García-Pérez J, Pérez-Olmeda M, Murciano-Antón MA, López-Jiménez J, Coiras M, García-Gutiérrez V. Regular Humoral and Cellular Immune Responses in Individuals with Chronic Myeloid Leukemia Who Received a Full Vaccination Schedule against COVID-19. Cancers (Basel) 2023; 15:5066. [PMID: 37894433 PMCID: PMC10604981 DOI: 10.3390/cancers15205066] [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: 08/18/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Individuals with chronic myeloid leukemia (CML) constitute a unique group within individuals with oncohematological disease (OHD). They receive treatment with tyrosine kinase inhibitors (TKIs) that present immunomodulatory properties, and they may eventually be candidates for treatment discontinuation under certain conditions despite the chronic nature of the disease. In addition, these individuals present a lower risk of infection than other immunocompromised patients. For this study, we recruited a cohort of 29 individuals with CML in deep molecular response who were on treatment with TKIs (n = 23) or were on treatment-free remission (TFR) (n = 6), and compared both humoral and cellular immune responses with 20 healthy donors after receiving the complete vaccination schedule against SARS-CoV-2. All participants were followed up for 17 months to record the development of COVID-19 due to breakthrough infections. All CML individuals developed an increased humoral response, with similar seroconversion rates and neutralizing titers to healthy donors, despite the presence of high levels of immature B cells. On the whole, the cellular immune response was also comparable to that of healthy donors, although the antibody dependent cytotoxic activity (ADCC) was significantly reduced. Similar rates of mild breakthrough infections were observed between groups, although the proportion was higher in the CML individuals on TFR, most likely due to the immunomodulatory effect of these drugs. In conclusion, as with the healthy donors, the vaccination did not impede breakthrough infections completely in individuals with CML, although it prevented the development of severe or critical illness in this special population of individuals with OHD.
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Affiliation(s)
- Sara Rodríguez-Mora
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Magdalena Corona
- Hematology and Hemotherapy Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Faculty of Sciences, Universidad de Alcalá, 28801 Madrid, Spain
| | - Miriam Solera Sainero
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Elena Mateos
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Montserrat Torres
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Clara Sánchez-Menéndez
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Hematology and Hemotherapy Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Guiomar Casado-Fernández
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Faculty of Sciences, Universidad de Alcalá, 28801 Madrid, Spain
| | - Javier García-Pérez
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- AIDS Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Mayte Pérez-Olmeda
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Serology Service, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Javier López-Jiménez
- Hematology and Hemotherapy Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Mayte Coiras
- Immunopathology Unit, National Center of Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain
- Biomedical Research Center Network in Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Valentín García-Gutiérrez
- Hematology and Hemotherapy Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
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Guo W, Zheng Y, Feng S. Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes. Front Cell Infect Microbiol 2023; 13:1207225. [PMID: 37928188 PMCID: PMC10622671 DOI: 10.3389/fcimb.2023.1207225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
The Omicron variant of SARS-CoV-2 has rapidly become the dominant strain worldwide due to its high transmissibility, although it appears to be less pathogenic than previous strains. However, individuals with hematological malignancy (HM) and COVID-19 remain susceptible to severe infection and mortality, especially those with chronic lymphocytic leukemia (CLL) and those undergoing chimeric antigen receptor T-cell (CAR-T) treatment. Hematologists should thoroughly assess the severity of the patient's hematological disease and the potential risk of SARS-CoV-2 infection before initiating chemotherapy or immunosuppressive treatment. Vaccination and booster doses are strongly recommended and patients with a poor vaccine response may benefit from long-acting COVID-19 neutralizing monoclonal antibodies (such as Evusheld). Early use of small molecule antiviral drugs is recommended for managing mild COVID-19 in HM patients and those with severe immunodeficiency may benefit from SARS-CoV-2 neutralizing monoclonal antibody therapy and high-titer COVID-19 convalescent plasma (CCP). For moderate to severe cases, low-dose glucocorticoids in combination with early antiviral treatment can be administered, with cytokine receptor antagonists or JAK inhibitors added if the condition persists or worsens. In the treatment of hematological malignancies, delaying chemotherapy is preferable for CLL, acute leukemia (AL), and low-risk myelodysplastic syndrome (MDS), but if the disease progresses, appropriate adjustments in dosage and frequency of treatment are required, with the avoidance of anti-CD20 monoclonal antibody, CAR-T and hematopoietic stem cell transplantation (HSCT). Patients with chronic myelocytic leukemia (CML) and myeloproliferative neoplasms (MPNs) can continue current treatment. What's more, non-drug protective measures, the development of new vaccines and antiviral drugs, and monitoring of mutations in immunocompromised populations are particularly important.
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Affiliation(s)
- Wenjing Guo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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9
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Angotzi F, Petrella M, Berno T, Binotto G, Bonetto G, Branca A, Carraro M, Cavaretta CA, Cellini A, D’Amore F, Forlani L, Gianesello I, Gurrieri C, Imbergamo S, Lessi F, Maroccia A, Mazzetto F, Pavan L, Pezone S, Piazza F, Pravato S, Ruocco V, Scapinello G, Vianello F, Zambello R, Zatta I, Zoletto S, Padoan A, Trentin L, Visentin A. Tixagevimab/Cilgavimab as pre-exposure prophylaxis against SARS-CoV-2 in patients with hematological malignancies. Front Oncol 2023; 13:1212752. [PMID: 37427126 PMCID: PMC10324575 DOI: 10.3389/fonc.2023.1212752] [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: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
The approved combination of Tixagevimab/Cilgavimab has been shown to decrease the rate of symptomatic SARS-CoV-2 infection in patients at increased risk of inadequate response to vaccination. However, Tixagevimab/Cilgavimab was tested in a few studies that included patients with hematological malignancies, even if this population has shown an increased risk of unfavorable outcomes following infection (with high rates of hospitalization, intensive care unit admission, and mortality) and poor significant immunization following vaccines. We performed a real-life prospective cohort study to evaluate the rate of SARS-CoV-2 infection following pre-exposure prophylaxis with Tixagevimab/Cilgavimab in anti-spike seronegative patients compared to a cohort of seropositive patients who were observed or received a fourth vaccine dose. We recruited 103 patients with a mean age of 67 years: 35 (34%) received Tixagevimab/Cilgavimab and were followed from March 17, 2022, until November 15, 2022. After a median follow-up of 4.24 months, the 3-month cumulative incidence of infection was 20% versus 12% in the Tixagevimab/Cilgavimab and observation/vaccine groups respectively (HR 1.57; 95% CI: 0.65-3.56; p = 0.34). In this study, we report our experience with Tixagevimab/Cilgavimab and a tailored approach to SARS-CoV-2 infection prevention in patients with hematological malignancies during the SARS-CoV-2 omicron surge.
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Affiliation(s)
- Francesco Angotzi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Petrella
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Giorgia Bonetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Branca
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Marco Carraro
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Chiara Adele Cavaretta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Alessandro Cellini
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabio D’Amore
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Forlani
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ilaria Gianesello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Carmela Gurrieri
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Silvia Imbergamo
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Lessi
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Antonio Maroccia
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Federica Mazzetto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Laura Pavan
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Sara Pezone
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Stefano Pravato
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Valeria Ruocco
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Greta Scapinello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Ivan Zatta
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Simone Zoletto
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Integrated Diagnostic Medicine, Laboratory Medicine Unit, University of Padova, Padova, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
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