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Bankova AK, Pasin C, Huang A, Cicin‐Sain C, Epp S, Audige A, Mueller NJ, Nilsson J, Vilinovszki O, Nair G, Wolfensberger N, Hockl P, Schanz U, Trkola A, Kouyos R, Hasse B, Zinkernagel AS, Manz MG, Abela IA, Müller AMS. Antibody response to a third SARS‐CoV‐2 vaccine dose in recipients of an allogeneic haematopoietic cell transplantation. Br J Haematol 2022; 201:58-63. [PMID: 36382698 DOI: 10.1111/bjh.18562] [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: 09/11/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
Allogeneic haematopoietic cell transplantation (allo-HCT) recipients show impaired antibody (Ab) response to a standard two-dose vaccination against severe acute respiratory syndrome coronavirus-2 and currently a third dose is recommended as part of the primary vaccination regimen. By assessing Ab titres 1 month after a third mRNA vaccine dose in 74 allo-HCT recipients we show sufficient neutralisation activity in 77% of the patients. Discontinuation of immunosuppression before the third vaccine led to serological responses in 50% of low responders to two vaccinations. Identifying factors that might contribute to better vaccine responses in allo-HCT recipients is critical to optimise current vaccination strategies.
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Affiliation(s)
- Andriyana K. Bankova
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Chloé Pasin
- Institute of Medical Virology University of Zürich Zürich Switzerland
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Alice Huang
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Caroline Cicin‐Sain
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Selina Epp
- Institute of Medical Virology University of Zürich Zürich Switzerland
| | - Annette Audige
- Institute of Medical Virology University of Zürich Zürich Switzerland
| | - Nicolas J. Mueller
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Jakob Nilsson
- Department of Immunology University Hospital Zürich Zürich Switzerland
| | - Oliver Vilinovszki
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
- Department of Internal Medicine University Hospital Zürich Zürich Switzerland
| | - Gayathri Nair
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Nathan Wolfensberger
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Philipp Hockl
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology University of Zürich Zürich Switzerland
| | - Roger Kouyos
- Institute of Medical Virology University of Zürich Zürich Switzerland
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Markus G. Manz
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
| | - Irene A. Abela
- Institute of Medical Virology University of Zürich Zürich Switzerland
- Department of Infectious Diseases and Hospital Epidemiology University Hospital Zurich, University of Zürich Zürich Switzerland
| | - Antonia M. S. Müller
- Department of Medical Oncology and Hematology University Hospital Zürich Zürich Switzerland
- Department of Blood Group Serology and Transfusion Medicine Medical University of Vienna Vienna Austria
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Huang A, Cicin-Sain C, Pasin C, Epp S, Audigé A, Müller NJ, Nilsson J, Bankova A, Wolfensberger N, Vilinovszki O, Nair G, Hockl P, Schanz U, Kouyos RD, Hasse B, Zinkernagel AS, Trkola A, Manz MG, Abela IA, Müller AMS. Antibody Response to SARS-CoV-2 Vaccination in Patients Following Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:214.e1-214.e11. [PMID: 35092892 PMCID: PMC8802693 DOI: 10.1016/j.jtct.2022.01.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/06/2023]
Abstract
Vaccines against SARS-CoV-2 have been rapidly approved. Although pivotal studies were conducted in healthy volunteers, little information is available on the safety and efficacy of mRNA vaccines in immunocompromised patients, including recipients of allogeneic hematopoietic cell transplantation (allo-HCT). Here we used a novel assay to analyze patient- and transplantation-related factors and their influence on immune responses to SARS-CoV-2 vaccination over an extended period (up to 6 months) in a large and homogenous group of allo-HCT recipients at a single center in Switzerland. We examined longitudinal antibody responses to SARS-CoV-2 vaccination with BNT162b2 (BioNTech/Pfizer) and mRNA-1273 (Moderna) in 110 allo-HCT recipients and 86 healthy controls. Seroprofiling recording IgG, IgA, and IgM reactivity against SARS-CoV-2 antigens (receptor-binding domain, spike glycoprotein subunits S1 and S2, and nucleocapsid protein) was performed before vaccination, before the second dose, and at 1, 3, and 6 months after the second dose. Patients were stratified to 3 groups: 3 to 6 months post-allo-HCT, 6 to 12 months post-allo-HCT, and >12 months post-allo-HCT. Patients in the 3 to 6 months and 6 to 12 months post-allo-HCT groups developed significantly lower antibody titers after vaccination compared with patients in the >12 months post-allo-HCT group and healthy controls (P < .001). Within the cohort of allo-HCT recipients, patients age >65 years (P = .030), those receiving immunosuppression for prevention or treatment of graft-versus-host disease (GVHD) (P = .033), and patients with relapsed disease (P = .014) displayed low humoral immune responses to the vaccine. In contrast, the intensity of the conditioning regimen, underlying disease (myeloid/lymphoid/other), and presence of chronic GVHD had no impact on antibody levels. Antibody titers achieved the highest levels at 1 month after the second dose of the vaccine but waned substantially in all transplantation groups and healthy controls over time. This analysis of long-term vaccine antibody response is of critical importance to allo-HCT recipients and transplant physicians to guide treatment decisions regarding revaccination and social behavior during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Alice Huang
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Caroline Cicin-Sain
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Chloe Pasin
- Institute of Medical Virology, University of Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Selina Epp
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Annette Audigé
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Nicolas J Müller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Jakob Nilsson
- Department of Immunology, University Hospital Zurich, Switzerland
| | - Andriyana Bankova
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Nathan Wolfensberger
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Oliver Vilinovszki
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Gayathri Nair
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Philipp Hockl
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Roger D Kouyos
- Institute of Medical Virology, University of Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Irene A Abela
- Institute of Medical Virology, University of Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Antonia M S Müller
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland.
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Wolfensberger N, Georgiou G, Giabbani E, Reusser M, Njue LM, Fiedler M, Leichtle AB, Nagler M. Rapid Centrifugation in the Routine Hemostasis Laboratory. Thromb Haemost 2019; 119:2025-2033. [DOI: 10.1055/s-0039-1696712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background The use of short and uniform centrifugation schemes contributes significantly to the successful automation of laboratory procedures. It is however unclear if this is applicable to the hemostasis laboratory.
Objectives This article assesses the accuracy of measurements obtained with a rapid, high-speed centrifugation scheme in a large set of hemostasis tests, covering the full spectrum of values obtained in clinical practice, and using meaningful statistical measures.
Methods Two citrated plasma samples were obtained from consecutive patients of a tertiary hospital with suspected abnormal hemostasis tests and processed with two centrifugation schemes in parallel: 1,500 × g for 10 minutes and 3,137 × g for 7 minutes. The following tests were conducted: prothrombin time (n = 125), international normalized ratio (n = 146), activated partial thromboplastin time (n = 119), thrombin time (n = 105), fibrinogen (n = 125), factor (F)II (n = 69), FV (n = 64), FVII (n = 64), FX (n = 67), FVIII (n = 55), FIX (n = 37), FXI (n = 35), and FXIII (n = 20), D-dimer (n = 34), antithrombin (n = 31), anti-Xa activity (n = 30), von Willebrand antigen (n = 25), and von Willebrand activity (VWF:GPIbM; n = 27).
Results A wide range of results were obtained in all tests. Spearman's rank correlation coefficient was at least 0.95 for all tests except FV, FIX, and FXI. The coverage probability π at a given deviation index κ of 15% was above 0.9 for all tests except FV, FVII, FX, FVIII, FIX, FXI, and VWF:GPIbM, suggesting a lack of agreement.
Conclusion Our results suggest that high-speed centrifugation is applicable to the majority of routine hemostasis parameters. The coverage probability was more sensitive than Spearman's rank correlation to detect disagreement among centrifugation schemes.
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Affiliation(s)
- Nathan Wolfensberger
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | | | - Evelyne Giabbani
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marianne Reusser
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Linet M. Njue
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Fiedler
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander B. Leichtle
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Insel Data Science Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Nagler
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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