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Gragnani L, Visentini M, Lorini S, Santini SA, Lauletta G, Mazzaro C, Urraro T, Quartuccio L, Cacciapaglia F, Ruscitti P, Tavoni A, Marri S, Cusano G, Petraccia L, Naclerio C, Treppo E, del Frate G, Di Cola I, Raimondo V, Scorpiniti D, Monti M, Puccetti L, Elia G, Fallahi P, Basili S, Scarpato S, Iannone F, Casato M, Antonelli A, Zignego AL, Ferri C. COVID-19 and Mixed Cryoglobulinemia Syndrome: Long-Term Survey Study on the Prevalence and Outcome, Vaccine Safety, and Immunogenicity. J Clin Immunol 2023; 43:680-691. [PMID: 36795264 PMCID: PMC9933006 DOI: 10.1007/s10875-023-01444-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Mixed cryoglobulinemia syndrome (MCs) is a rare immunoproliferative systemic disorder with cutaneous and multiple organ involvement. Our multicenter survey study aimed to investigate the prevalence and outcome of COVID-19 and the safety and immunogenicity of COVID-19 vaccines in a large MCs series. METHODS The survey included 430 unselected MCs patients (130 M, 300 F; mean age 70 ± 10.96 years) consecutively collected at 11 Italian referral centers. Disease classification, clinico-serological assessment, COVID-19 tests, and vaccination immunogenicity were carried out according to current methodologies. RESULTS A significantly higher prevalence of COVID-19 was found in MCs patients compared to Italian general population (11.9% vs 8.0%, p < 0.005), and the use of immunomodulators was associated to a higher risk to get infected (p = 0.0166). Moreover, higher mortality rate was recorded in MCs with COVID-19 compared to those without (p < 0.01). Patients' older age (≥ 60 years) correlated with worse COVID-19 outcomes. The 87% of patients underwent vaccination and 50% a booster dose. Of note, vaccine-related disease flares/worsening were significantly less frequent than those associated to COVID-19 (p = 0.0012). Impaired vaccination immunogenicity was observed in MCs patients compared to controls either after the first vaccination (p = 0.0039) and also after the booster dose (p = 0.05). Finally, some immunomodulators, namely, rituximab and glucocorticoids, hampered the vaccine-induced immunogenicity (p = 0.029). CONCLUSIONS The present survey revealed an increased prevalence and morbidity of COVID-19 in MCs patients, as well an impaired immunogenicity even after booster vaccination with high rate of no response. Therefore, MCs can be included among frail populations at high risk of infection and severe COVID-19 manifestations, suggesting the need of a close monitoring and specific preventive/therapeutical measures during the ongoing pandemic.
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Affiliation(s)
- Laura Gragnani
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Serena Lorini
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Stefano Angelo Santini
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy ,Synlab Lazio, Roma, Italy
| | - Gianfranco Lauletta
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro” Medical School, Bari, Italy
| | - Cesare Mazzaro
- Clinical Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Teresa Urraro
- Rheumatology Unit, “M. Scarlato” Hospital, Scafati (SA), Italy
| | - Luca Quartuccio
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Fabio Cacciapaglia
- UO Reumatologia – Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Silvia Marri
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Giuseppina Cusano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luisa Petraccia
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | - Elena Treppo
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Giulia del Frate
- Rheumatology Clinic Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic ‘Madonna dello Scoglio’ Cotronei, Crotone, Italy
| | | | - Monica Monti
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Florenzo Iannone
- UO Reumatologia – Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | - Clodoveo Ferri
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy. .,Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy.
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