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Shen Y, Freeman JA, Kerridge I, Downe P, Naidu K, Holland J, Mulligan SP. Repeated COVID-19 vaccination to maximum antibody response yields very low mortality and hospitalisation rates in patients with CLL and MBL. Br J Haematol 2024; 204:487-491. [PMID: 37669920 DOI: 10.1111/bjh.19087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
We analysed COVID-19 infection outcomes of 129/241 chronic lymphocytic leukaemia (CLL) (53.9%) and 22/55 monoclonal B-lymphocytosis (MBL) (40.0%) patients following multiple vaccine doses aiming for maximum measured anti-spike antibody response. Throughout the pandemic to date, there were 8/129 CLL (6.2%) patients hospitalised, with one death (0.8%). No MBL patients were hospitalised or died. CLL patients with COVID-19 had lower anti-spike levels (3778.8 AU/mL) than those without (13 486.8 AU/mL; p = 0.0061). Anti-nucleocapsid antibody was detected in 29.8% within 2 months and 17.5% >6 months. Of COVID-19-infected CLL patients, 47.3% received anti-viral therapy. A multiple vaccine dosing strategy to achieve measured maximum antibody is highly effective in preventing severe COVID-19.
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Affiliation(s)
- Yandong Shen
- Department of Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Kolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia
| | - Jane A Freeman
- Department of Haematology and Flow Cytometry, Healius Laverty Pathology, Macquarie Park, New South Wales, Australia
- Northern Haematology and Oncology Group, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Paul Downe
- Department of Haematology and Flow Cytometry, Healius Laverty Pathology, Macquarie Park, New South Wales, Australia
| | - Kartik Naidu
- Department of Microbiology, Healius Laverty Pathology, Macquarie Park, New South Wales, Australia
| | - Juliette Holland
- Department of Microbiology, Healius Laverty Pathology, Macquarie Park, New South Wales, Australia
| | - Stephen P Mulligan
- Department of Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Kolling Institute, Royal North Shore Hospital, University of Sydney, St Leonards, New South Wales, Australia
- Department of Haematology and Flow Cytometry, Healius Laverty Pathology, Macquarie Park, New South Wales, Australia
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2
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Campbell A, Teh B, Mulligan S, Ross DM, Weinkove R, Gilroy N, Gangatharan S, Prince HM, Szer J, Trotman J, Lane S, Dickinson M, Quach H, Enjeti AK, Ku M, Gregory G, Hapgood G, Ho PJ, Cochrane T, Cheah C, Greenwood M, Latimer M, Berkahn L, Wight J, Armytage T, Diamond P, Tam CS, Hamad N. Australia and New Zealand consensus position statement: use of COVID-19 therapeutics in patients with haematological malignancies. Intern Med J 2024; 54:328-336. [PMID: 38146232 DOI: 10.1111/imj.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/19/2023] [Indexed: 12/27/2023]
Abstract
Despite widespread vaccination rates, we are living with high transmission rates of SARS-CoV-2. Although overall hospitalisation rates are falling, the risk of serious infection remains high for patients who are immunocompromised because of haematological malignancies. In light of the ongoing pandemic and the development of multiple agents for treatment, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 management in patients with haematological disorders. It is our recommendation that both patients with haematological malignancies and treating specialists be educated regarding the preventive and treatment options available and that patients continue to receive adequate vaccinations, keeping in mind the suboptimal vaccine responses that occur in haematology patients, in particular, those with B-cell malignancies and on B-cell-targeting or depleting therapy. Patients with haematological malignancies should receive treatment for COVID-19 in accordance with the severity of their symptoms, but even mild infections should prompt early treatment with antiviral agents. The issue of de-isolation following COVID-19 infection and optimal time to treatment for haematological malignancies is discussed but remains an area with evolving data. This position statement is to be used in conjunction with advice from infectious disease, respiratory and intensive care specialists, and current guidelines from the National COVID-19 Clinical Evidence Taskforce and the New Zealand Ministry of Health and Cancer Agency Te Aho o Te Kahu COVID-19 Guidelines.
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Affiliation(s)
- Ashlea Campbell
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Benjamin Teh
- National Centre for Infections in Cancer and Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Stephen Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - David M Ross
- SA Pathology and Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Haematology, Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Robert Weinkove
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shane Gangatharan
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Henry Miles Prince
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Haematology, Epworth Healthcare, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Trotman
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Steven Lane
- Cancer Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michael Dickinson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Hang Quach
- University of Melbourne, Melbourne, Victoria, Australia
- Department of Haematology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Anoop K Enjeti
- Department of Haematology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
- New South Wales Health Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Matthew Ku
- University of Melbourne, Melbourne, Victoria, Australia
- Department of Haematology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Gareth Gregory
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Gregory Hapgood
- Department of Haematology, Princess Alexandra Hospital, Melbourne, Victoria, Australia
| | - Phoebe Joy Ho
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal Prince Alfred Hospital, Melbourne, Victoria, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Chan Cheah
- University of Western Australia, Perth, Western Australia, Australia
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Haematology, Pathwest Laboratory Medicine, Perth, Western Australia, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Maya Latimer
- Department of Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Leanne Berkahn
- Department of Haematology, The Auckland City Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Joel Wight
- Townsville University Hospital, Townsville, Queensland, Australia
| | | | - Peter Diamond
- Leukaemia Foundation, Sydney, New South Wales, Australia
| | - Constantine S Tam
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
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3
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Anderson MA, Bennett R, Badoux X, Best G, Chia N, Cochrane T, Cull G, Crassini K, Harrup R, Jackson S, Kuss B, Lasica M, Lew TE, Marlton P, Opat S, Palfreyman E, Polizzotto MN, Ratnasingam S, Seymour JF, Soosapilla A, Talaulikar D, Tam CS, Weinkove R, Wight J, Mulligan SP. Chronic lymphocytic leukaemia Australasian consensus practice statement. Intern Med J 2023; 53:1678-1691. [PMID: 37743239 DOI: 10.1111/imj.16207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/30/2023] [Indexed: 09/26/2023]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B-cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment-naïve and relapsed/refractory disease, particularly for patients with high-risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance.
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Affiliation(s)
- Mary A Anderson
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rory Bennett
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Xavier Badoux
- St George Hospital, Sydney, New South Wales, Australia
| | - Giles Best
- Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Nicole Chia
- Genomic Diagnostics, Healius Pathology, Brisbane, Queensland, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Griffith University, Gold Coast, Queensland, Australia
| | - Gavin Cull
- Sir Charles Gairdner Hospital, PathWest Laboratory Medicine and University of Western Australia, Perth, Western Australia, Australia
| | - Kyle Crassini
- Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Rosemary Harrup
- Cancer and Blood Services Royal Hobart Hospital, Hobart, Tasmania, Australia
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharon Jackson
- Te Whatu Ora health New Zealand Counties Manukau, Auckland, New Zealand
| | - Bryone Kuss
- Flinders University and Medical Centre, Adelaide, South Australia, Australia
| | - Masa Lasica
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Thomas E Lew
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Division of Blood Cells and Blood Cancer, The Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Opat
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Emma Palfreyman
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mark N Polizzotto
- Department of Clinical Haematology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Clinical Hub for Interventional Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sumita Ratnasingam
- St John of God Hospital Geelong, Geelong, Victoria, Australia
- University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Geelong Clinical School, Deakin University, Geelong, Victoria, Australia
| | - John F Seymour
- Department of Clinical Haematology, The Royal Melbourne Hospital and The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Asha Soosapilla
- Flow Cytometry, Healius Pathology, Sydney, New South Wales, Australia
| | - Dipti Talaulikar
- Department of Diagnostic Genomics, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Constantine S Tam
- Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Robert Weinkove
- Te Rerenga Ora Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Joel Wight
- Department of Haematology and Bone Marrow Transplantation, Townsville University Hospital, Townsville, Queensland, Australia
- James Cook University, School of Medicine, Townsville, Queensland, Australia
| | - Stephen P Mulligan
- Royal North Shore Hospital, Sydney, New South Wales, Australia
- Healius Pathology, Sydney, New South Wales, Australia
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Okamoto S, Iida M, Hamad N, Duarte FB, Sureda A, Srivastava A, Galeano S, Chao N, Rondelli D, Flowers ME. American Society of Transplantation and Cellular Therapy International Affair Committee: Report of 3 rd Workshop on Global Perspective to Access to Transplantation at the 2022 Tandem Meeting. Transplant Cell Ther 2023:S2666-6367(23)01134-X. [PMID: 36921918 DOI: 10.1016/j.jtct.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Nada Hamad
- Department of Hematology, St Vincent's Hospital Sydney, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia; School of Medicine, Sydney, University of Notre Dame Australia
| | | | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Kilminnal, Ranipet, Tamil Nadu, India
| | | | - Nelson Chao
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Damiano Rondelli
- Division of Hematology and Oncology; Blood & Marrow Transplant Section in the Department of Medicine at the University of Illinois College of Medicine, Chicago, IL, USA
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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5
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Bouza E, Martin M, Alés JE, Aragonés N, Barragán B, de la Cámara R, Pozo JLD, García-Gutiérrez V, García-Sanz R, Gracia D, Guillem V, Jiménez-Yuste V, Martin-Delgado MC, Martínez J, López R, Rodríguez-Lescure Á, Galiana JR, Sureda AM, Tejerina-Picado F, Trilla A, Zapatero A, Palomo E, San-Miguel J. Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper. Rev Esp Quimioter 2023; 36:1-25. [PMID: 36322133 PMCID: PMC9910677 DOI: 10.37201/req/087.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes.
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Affiliation(s)
- Emilio Bouza
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), España. Patrono de la Fundación de Ciencias de la Salud. Servicio de Microbiología y Enfermedades Infecciosas Hospital General Universitario Gregorio Marañón. Catedrático de Medicina. Universidad Complutense. Madrid.,Correspondence: Emilio Bouza MD, PhD. Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46 28007 Madrid, España E-mail:
| | - Miguel Martin
- Universidad Complutense de Madrid. Jefe de Servicio de Oncología del Hospital Gregorio Marañón de Madrid
| | | | | | | | | | - José Luis Del Pozo
- Servicio de Enfermedades Infecciosas. Servicio de Microbiología. Clínica Universidad de Navarra. Pamplona España
| | | | - Ramón García-Sanz
- Laboratorio de HLA y biología molecular en hematología, Universidad de Salamanca. Sociedad Española de Hematología y Hemoterapia
| | | | - Vicente Guillem
- Servicio de Oncología Médica del Instituto Valenciano de Oncología (IVO)
| | | | - Mari Cruz Martin-Delgado
- Servicio Medicina Intensiva Hospital Universitario Torrejón. Universidad Francisco de Vitoria. Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva
| | - Joaquín Martínez
- Servicio de Hematología y Hemoterapia, Hospital 12 de Octubre, Madrid. Universidad Complutense. Madrid
| | - Rafael López
- Oncología Médica del Hospital Clínico Universitario, Santiago de Compostela
| | | | | | - Ana María Sureda
- Servicio de Hematología en Hospital Universitario Quiron Dexeus, Grupo Español de Trasplante y Terapia Celular, Electa del EBMT
| | | | - Antoni Trilla
- Servicio de Medicina Preventiva y Epidemiología del Hospital Clínic de Barcelona. Catedrático de Medicina (Salud Pública) Universidad de Barcelona
| | | | | | - Jesús San-Miguel
- Medicina Clínica y Traslacional de la Clínica Universidad de Navarra
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6
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Shen Y, Freeman JA, Holland J, Naidu K, Solterbeck A, Van Bilsen N, Downe P, Kerridge I, Wallman L, Akerman A, Aggarwal A, Milogiannakis V, Martins Costa Gomes G, Doyle CM, Sandgren KJ, Turville S, Cunningham AL, Mulligan SP. Multiple COVID-19 vaccine doses in CLL and MBL improve immune responses with progressive and high seroconversion. Blood 2022; 140:2709-21. [PMID: 36206503 DOI: 10.1182/blood.2022017814] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) or monoclonal B-lymphocytosis (MBL) have impaired response to COVID-19 vaccination. A total of 258 patients (215 with CLL and 43 with MBL) had antispike antibody levels evaluable for statistical analysis. The overall seroconversion rate in patients with CLL was 94.2% (antispike antibodies ≥50 AU/mL) and 100% in patients with MBL after multiple vaccine doses. After 3 doses (post-D3) in 167 patients with CLL, 73.7% were seropositive, 17.4% had antispike antibody levels between 50 and 999 AU/mL, and 56.3% had antispike antibody levels ≥1000 AU/mL, with a median rise from 144.6 to 1800.7 AU/mL. Of patients who were seronegative post-D2, 39.7% seroconverted post-D3. For those who then remained seronegative after their previous dose, seroconversion occurred in 40.6% post-D4, 46.2% post-D5, 16.7% post-D6, and 0% after D7 or D8. After seroconversion, most had a progressive increase in antispike antibody levels. Neutralization was associated with higher antispike antibody levels, more vaccine doses, and earlier severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants; neutralizing antibody against early clade D614G was detected in 65.3%, against Delta in 52.0%, and against Omicron in 36.5%. SARS-CoV-2-specific T-cell production of interferon γ and interleukin 2 occurred in 73.9% and 60.9%, respectively, of 23 patients tested. After multiple vaccine doses, by multivariate analysis, immunoglobulin M ≥0.53 g/L, immunoglobulin subclass G3 ≥0.22 g/L and absence of current CLL therapy were independent predictors of positive serological responses. Multiple sequential COVID-19 vaccination significantly increased seroconversion and antispike antibody levels in patients with CLL or MBL.
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7
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Lewis KL, Cheah CY. About time: why central nervous system prophylaxis timing in diffuse large B-cell lymphoma matters and does the protocol need updating? Expert Rev Hematol 2022; 15:959-962. [PMID: 36278876 DOI: 10.1080/17474086.2022.2140138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Katharine Louise Lewis
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,University of Western Australia, Nedlands, Western Australia, Australia.,Linear Clinical Research, Nedlands, Western Australia, Australia
| | - Chan Yoon Cheah
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,University of Western Australia, Nedlands, Western Australia, Australia.,Pathwest, Nedlands, Western Australia, Australia
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8
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Shen Y, Freeman JA, Holland J, Solterbeck A, Naidu K, Soosapilla A, Downe P, Tang C, Kerridge I, Wallman L, Van Bilsen N, Milogiannakis V, Akerman A, Martins Costa Gomes G, Sandgren K, Cunningham AL, Turville S, Mulligan SP. COVID‐19 Vaccine Failure in Chronic Lymphocytic Leukaemia and Monoclonal B‐Lymphocytosis; Humoral and Cellular Immunity. Br J Haematol 2021; 197:41-51. [DOI: 10.1111/bjh.18014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yandong Shen
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
| | - Jane A. Freeman
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
- Northern Haematology and Oncology Group Sydney Adventist Hospital Wahroonga NSW Australia
| | - Juliette Holland
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Ann Solterbeck
- Statistical Revelations Pty Ltd 41 The Parade, Ocean Grove VIC Australia
| | - Kartik Naidu
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Paul Downe
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Catherine Tang
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Ian Kerridge
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
| | - Lucinda Wallman
- Department of Immunology Laverty Pathology, Macquarie Park NSW Australia
| | - Nenna Van Bilsen
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | | | - Anouschka Akerman
- Kirby Institute University of New South Wales Kensington NSW Australia
| | | | - Kerrie Sandgren
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Anthony L Cunningham
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Stuart Turville
- Kirby Institute University of New South Wales Kensington NSW Australia
| | - Stephen P. Mulligan
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
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9
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Morawska M. Reasons and consequences of COVID-19 vaccine failure in patients with chronic lymphocytic leukemia. Eur J Haematol 2021; 108:91-98. [PMID: 34717004 PMCID: PMC8652891 DOI: 10.1111/ejh.13722] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
People with hematologic malignancies are at a high risk of morbidity and mortality from COVID-19. The response to vaccination is highly limited in patients with chronic lymphocytic leukemia. Less than half of the patients develop antibody response, suggesting that they remain at risk of SARS-CoV-2 infection even after the vaccination. Reasons for inadequate response to COVID-19 vaccination in chronic lymphocytic leukemia are multifactorial and attributed to disease-related immune dysregulation and patient- and therapy-related factors. The negative predictors of response to vaccination include hypogammaglobulinemia, advanced age, current active treatment, and past treatment anti-CD20 monoclonal antibodies. Despite using booster doses and heterologous immunization to improve humoral and cellular immunity, some patients with chronic lymphocytic leukemia will fail to respond. Active treatment at the time of vaccination and a recent history of anti-CD20 monoclonal antibodies use are the strongest predictors of the non-response. Current data support informing patients with chronic lymphocytic leukemia and other hematologic malignancies about the risk of infection regardless of vaccination. These individuals and members of their households should continue extreme preventive actions despite relaxed local regulations. Other emerging non-vaccine preventive strategies include passive and post-exposure prevention with monoclonal antibodies.
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Affiliation(s)
- Marta Morawska
- Experimental Hematooncology Department, Medical University of Lublin, Lublin, Poland
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D’Amelio R, Asero R, Cassatella MA, Laganà B, Lunardi C, Migliorini P, Nisini R, Parronchi P, Quinti I, Racanelli V, Senna G, Vacca A, Maggi E. Anti-COVID-19 Vaccination in Patients with Autoimmune-Autoinflammatory Disorders and Primary/Secondary Immunodeficiencies: The Position of the Task Force on Behalf of the Italian Immunological Societies. Biomedicines 2021; 9:1163. [PMID: 34572349 PMCID: PMC8465958 DOI: 10.3390/biomedicines9091163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has represented an unprecedented challenge for humankind from health, economic, and social viewpoints. In February 2020, Italy was the first western country to be deeply hit by the pandemic and suffered the highest case/fatality rate among western countries. Brand new anti-COVID-19 vaccines have been developed and made available in <1-year from the viral sequence publication. Patients with compromised immune systems, such as autoimmune-autoinflammatory disorders (AIAIDs), primary (PIDs) and secondary (SIDs) immunodeficiencies, have received careful attention for a long time regarding their capacity to safely respond to traditional vaccines. The Italian Immunological Societies, therefore, have promptly faced the issues of safety, immunogenicity, and efficacy/effectiveness of the innovative COVID-19 vaccines, as well as priority to vaccine access, in patients with AIADs, PIDs, and SIDs, by organizing an ad-hoc Task Force. Patients with AIADs, PIDs, and SIDs: (1) Do not present contraindications to COVID-19 vaccines if a mRNA vaccine is used and administered in a stabilized disease phase without active infection. (2) Should usually not discontinue immunosuppressive therapy, which may be modulated depending on the patient's clinical condition. (3) When eligible, should have a priority access to vaccination. In fact, immunizing these patients may have relevant social/health consequences, since these patients, if infected, may develop chronic infection, which prolongs viral spread and facilitates the emergence of viral variants.
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Affiliation(s)
- Raffaele D’Amelio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica S. Carlo di Paderno Dugnano, Via Ospedale 21, 20037 Milano, Italy;
| | - Marco Antonio Cassatella
- Sezione di Patologia Generale, Dipartimento di Medicina, Università di Verona, Strada Le Grazie 4, 37134 Verona, Italy;
| | - Bruno Laganà
- UOC Medicina Interna, Dipartimento di Medicina Clinica e Molecolare, AOU S. Andrea, Sapienza Università di Roma, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Claudio Lunardi
- Responsabile Unità di Malattie Autoimmunitarie, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Paola Migliorini
- Direttore Unità Operativa di Immunoallergologia Clinica, Dipartimento di Medicina Clinica e Sperimentale, Azienda Ospedaliero Universitaria Pisana, Università di Pisa, Via Roma 67, 56126 Pisa, Italy;
| | - Roberto Nisini
- Direttore Reparto Immunologia, Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Paola Parronchi
- Direttore SOD Immunologia e Terapie Cellulari, Dipartimento di Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134 Firenze, Italy;
| | - Isabella Quinti
- Responsabile UOD Centro di Riferimento Regionale per le Immunodeficienze, Dipartimento di Medicina Molecolare, AOU Policlinico Umberto I, Sapienza Università di Roma, Viale dell’Università 37, 00161 Rome, Italy;
| | - Vito Racanelli
- UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Gianenrico Senna
- Direttore USD Allergologia, Dipartimento di Medicina, AOU Policlinico G.B. Rossi, Borgo Roma, Università di Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy;
| | - Angelo Vacca
- Direttore UOC Medicina Interna “Guido Baccelli”, Dipartimento di Scienze Biomediche ed Oncologia Umana, AOU Policlinico, Università di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Enrico Maggi
- Unità di Immunità Traslazionale, Dipartimento di Immunologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Viale di S. Paolo 15, 00146 Rome, Italy
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11
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Woolley I, Steinfort D, Szer J. COVID-19: looking backward. Intern Med J 2021; 51:1203-1204. [PMID: 34423545 PMCID: PMC8652750 DOI: 10.1111/imj.15461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ian Woolley
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Daniel Steinfort
- Department Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeff Szer
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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