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Campanella A, Capasso A, Heltai S, Taccetti C, Albi E, Herishanu Y, Haggenburg S, Chatzikonstantinou T, Doubek M, Kättström M, Giannopoulos K, Simkovic M, Moreno C, Massaia M, Bumbea H, Alshemmari S, Ranghetti P, Perotta E, Martini F, Sant'Antonio E, Colia M, Combi C, Levi S, Kater AP, Hazenberg M, Nijhof IS, Hofsink Q, Demosthenous C, Kotaskova J, Zaleska J, Vrbacky F, Raya AM, Bisogno D, Tripoli IE, Popov VM, Roman V, Stavroyianni N, Karypidou M, Scarano E, Locatelli M, Frenquelli M, Scarfò L, Stamatopoulos K, Ghia P. Additional booster doses in patients with chronic lymphocytic leukemia induce humoral and cellular immune responses to SARS-CoV-2 similar to natural infection regardless ongoing treatments: A study by ERIC, the European Research Initiative on CLL. Am J Hematol 2024; 99:745-750. [PMID: 38264829 DOI: 10.1002/ajh.27218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024]
Abstract
Profound immune dysregulation and impaired response to the SARS-CoV-2 vaccine put patients with chronic lymphocytic leukemia (CLL) at risk of severe COVID-19. We compared humoral memory and T-cell responses after booster dose vaccination or breakthrough infection. (Green) Quantitative determination of anti-Spike specific antibodies. Booster doses increased seroconversion rate and antibody titers in all patient categories, ultimately generating humoral responses similar to those observed in the postinfection cohort. In detail, humoral response with overscale median antibody titers arose in >80% of patients in watch and wait, off-therapy in remission, or under treatment with venetoclax single-agent. Anti-CD20 antibodies and active treatment with BTK inhibitors (BTKi) represent limiting factors of humoral response, still memory mounted in ~40% of cases following booster doses or infection. (Blue) Evaluation of SARS-CoV-2-specific T-cell responses. Number of T-cell functional activation markers documented in each patient. The vast majority of patients, including those seronegative, developed T-cell responses, qualitatively similar between treatment groups or between vaccination alone and infection cases. These data highlight the efficacy of booster doses in eliciting T-cell immunity independently of treatment status and support the use of additional vaccination boosters to stimulate humoral immunity in patients on active CLL-directed treatments.
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Affiliation(s)
- A Campanella
- Vita Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
| | - A Capasso
- Vita Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
| | - S Heltai
- IRCCS San Raffaele Hospital, Milan, Italy
| | - C Taccetti
- Vita Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
| | - E Albi
- IRCCS San Raffaele Hospital, Milan, Italy
| | - Y Herishanu
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel-Aviv, Israel
| | | | | | - M Doubek
- University Hospital Brno, Brno, Czech Republic
| | - M Kättström
- Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - M Simkovic
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - C Moreno
- Hospital de la Santa Creu I Sant Pau, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - M Massaia
- AO S.Croce e Carle, Cuneo, Italy
- Turin University, Turin, Italy
| | - H Bumbea
- University Emergency Hospital, Bucharest, Romania
- University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania
| | - S Alshemmari
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | - E Perotta
- IRCCS San Raffaele Hospital, Milan, Italy
| | - F Martini
- IRCCS San Raffaele Hospital, Milan, Italy
| | | | - M Colia
- IRCCS San Raffaele Hospital, Milan, Italy
| | - C Combi
- IRCCS San Raffaele Hospital, Milan, Italy
| | - S Levi
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A P Kater
- Amsterdam UMC, Amsterdam, The Netherlands
| | | | - I S Nijhof
- Amsterdam UMC, Amsterdam, The Netherlands
- St Antonius Hospital, Nieuwegein, The Netherlands
| | - Q Hofsink
- Amsterdam UMC, Amsterdam, The Netherlands
| | - C Demosthenous
- Centre for Research and Technology Hellas, Thessaloniki, Greece
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - J Kotaskova
- University Hospital Brno, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - J Zaleska
- Medical University of Lublin, Lublin, Poland
| | - F Vrbacky
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Kralove, Czech Republic
| | - A Mora Raya
- Hospital de la Santa Creu I Sant Pau, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | | | - I E Tripoli
- AO S.Croce e Carle, Cuneo, Italy
- Turin University, Turin, Italy
| | - V M Popov
- Colentina Clinical Hospital, Bucharest, Romania
| | - V Roman
- Center of Immunology Department, Stefan S. Nicolau Institute of Virology, Bucharest, Romania
| | - N Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - M Karypidou
- Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - E Scarano
- IRCCS San Raffaele Hospital, Milan, Italy
| | - M Locatelli
- Laboratory Medicine Service, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - L Scarfò
- Vita Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
| | - K Stamatopoulos
- Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - P Ghia
- Vita Salute San Raffaele University, Milan, Italy
- IRCCS San Raffaele Hospital, Milan, Italy
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Kättström M, Uggla B, Tina E, Kimby E, Norén T, Athlin S. Improved plasmablast response after repeated pneumococcal revaccinations following primary immunization with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia. Vaccine 2023; 41:3128-3136. [PMID: 37061372 DOI: 10.1016/j.vaccine.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) show an immune dysfunction with increased risk of infections and poor response to vaccination. Streptococcus pneumoniae is a common cause of morbidity and mortality in CLL patients. In a previous randomized clinical trial, we found a superior immune response in CLL patients receiving conjugated pneumococcal vaccine compared to non-conjugated vaccine. The response to revaccination in CLL patients is scarcely studied. In this study, early humoral response to repeated revaccinations with pneumococcal vaccines was evaluated, by determination of B cell subsets and plasmablast dynamics in peripheral blood. METHOD CLL patients (n = 14) and immunocompetent controls (n = 31) were revaccinated with a 13-valent pneumococcal conjugate vaccine (PCV13) after previous primary immunization (3-6 years ago) with PCV13 or a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Eight weeks after the first revaccination, all CLL patients received a second revaccination with PCV13 or PPSV23. B cell subsets including plasmablasts were analyzed in peripheral blood by flow cytometry, before and after the first and the second revaccination. RESULTS None of the CLL patients, but all controls, had detectable plasmablasts at baseline (p < 0.001). After the first revaccination with PCV13, the plasmablast proportions did not increase in CLL patients (p = 0.13), while increases were seen in controls (p < 0.001). However, after a second revaccination with PCV13 or PPSV23, plasmablasts increased compared to baseline also in CLL patients (p < 0.01). If no response was evident after first revaccination, only a second revaccination with PCV13 increased plasmablasts in contrast to PPSV23 revaccination. Patients with hypogammaglobulinemia and ongoing/previous CLL specific treatment responded poorly, also to a second revaccination. CONCLUSION In CLL patients, pneumococcal revaccination induced minor early plasmablast response compared to controls, but the response improved using a strategy of repeated doses with of conjugated T cell dependent pneumococcal vaccine.
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Affiliation(s)
- Magdalena Kättström
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden.
| | - Bertil Uggla
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
| | - Elisabet Tina
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Kimby
- Unit of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Norén
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Simon Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
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Lundin J, Mulder TA, Kättström M, Wästerlid T, Uddevik A, Mellstedt H, Heimersson K, Hansson L, Palma M, Österborg A. Temporary cessation of ibrutinib results in reduced grade 3-4 infections and durable remissions-Interim analysis of an on-off-repeat Phase 1b/2 study in patients with chronic lymphocytic leukemia. EJHaem 2021; 2:525-529. [PMID: 35844699 PMCID: PMC9176042 DOI: 10.1002/jha2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
Ibrutinib is used continuously in CLL. This phase 1b/2 study interim analysis explored on-off-repeat dosing to reduce toxicity. After 12 months, 16/22 patients (73%) remained in first off-phase irrespective if initial CR/PR or TP53 aberration. Grade 3-4 infections were reduced from 55% to 5% during a similarly long off-phase (P < .01). Treg and exhausted T-cells increased (P = .01). Six patients restarted ibrutinib at early progression and remain drug-sensitive. Our interim analysis shows a durable off-phase in most patients, with reduced infections and cost-saving potential. If toxicity-driven permanent cessation of ibrutinib will be affected will be explored in the extended study.
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Affiliation(s)
- Jeanette Lundin
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Tom A. Mulder
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Magdalena Kättström
- Department of Medicine, Section of HematologyÖrebro University HospitalÖrebroSweden
| | - Tove Wästerlid
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Anders Uddevik
- Department of Medicine, Section of HematologyGävle HospitalGävleSweden
| | - Håkan Mellstedt
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Kia Heimersson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Lotta Hansson
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Marzia Palma
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
| | - Anders Österborg
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Lymphoma Unit, Department of HematologyKarolinska University Hospital SolnaStockholmSweden
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Svensson T, Kättström M, Hammarlund Y, Roth D, Andersson PO, Svensson M, Nilsson I, Rombo L, Cherif H, Kimby E. Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Vaccine 2018; 36:3701-3707. [PMID: 29748028 DOI: 10.1016/j.vaccine.2018.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
AIM To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response. BACKGROUND Streptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking. METHODS 128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA). RESULTS PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated. CONCLUSIONS In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease.
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Affiliation(s)
- Tobias Svensson
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden.
| | - Magdalena Kättström
- Department of Medicine, Section of Hematology, Örebro University Hospital, Örebro, Sweden
| | | | - Daniel Roth
- Institution of Clinical Sciences, Faculty of Medicine, Lund University Hospital, Lund, Sweden
| | - P-O Andersson
- Department of Medicine, Section of Hematology, South Älvsborg Hospital, Borås, Sweden
| | - Magnus Svensson
- Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden
| | - Ingmar Nilsson
- Department of Medicine, Karlstad Hospital, Karlstad, Sweden
| | - Lars Rombo
- Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden
| | - Honar Cherif
- Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Eva Kimby
- Department of Medicine, Unit of Hematology, Karolinska Institute and Karolinska University Hospital, Huddinge, Sweden
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