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Röltgen K, Boyd SD. Antibody and B Cell Responses to SARS-CoV-2 Infection and Vaccination: The End of the Beginning. ANNUAL REVIEW OF PATHOLOGY 2024; 19:69-97. [PMID: 37738512 DOI: 10.1146/annurev-pathmechdis-031521-042754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
As the COVID-19 pandemic has evolved during the past years, interactions between human immune systems, rapidly mutating and selected SARS-CoV-2 viral variants, and effective vaccines have complicated the landscape of individual immunological histories. Here, we review some key findings for antibody and B cell-mediated immunity, including responses to the highly mutated omicron variants; immunological imprinting and other impacts of successive viral antigenic variant exposures on antibody and B cell memory; responses in secondary lymphoid and mucosal tissues and non-neutralizing antibody-mediated immunity; responses in populations vulnerable to severe disease such as those with cancer, immunodeficiencies, and other comorbidities, as well as populations showing apparent resistance to severe disease such as many African populations; and evidence of antibody involvement in postacute sequelae of infection or long COVID. Despite the initial phase of the pandemic ending, human populations will continue to face challenges presented by this unpredictable virus.
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Affiliation(s)
- Katharina Röltgen
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA;
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
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Nelli F, Fabbri A, Virtuoso A, Giannarelli D, Marrucci E, Fiore C, Giron Berrios JR, Schirripa M, Signorelli C, Chilelli MG, Primi F, Panichi V, Caterini L, Farinelli S, Silvestri MA, Ruggeri EM. Herpes zoster after the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in actively treated cancer patients: a prospective study. Clin Exp Med 2024; 24:13. [PMID: 38244147 PMCID: PMC10799787 DOI: 10.1007/s10238-023-01263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024]
Abstract
Several concerns have been raised about a causal relationship between COVID-19 mRNA-based vaccines and the development of herpes zoster (HZ). We performed a prospective analysis of the Vax-On-Third-Profile study to investigate the incidence of HZ after the third dose of mRNA-BNT162b2 (tozinameran) and its correlation with immune responses. Patients who had received a booster dose and had been actively treated for at least 8 weeks were eligible. Serologic assessment was performed before the third dose of tozinameran (timepoint-1) and 4 weeks later (timepoint-2). We also assessed the incidence of SARS-CoV-2 breakthrough infections at predefined time points. The current analysis included 310 patients, of whom 109 (35.2%) and 111 (35.8%) were being treated with targeted therapies and cytotoxic chemotherapy, respectively. All participants received a third dose of tozinameran between September 26 and October 30, 2021. After a mean follow-up of 17.3 (IQR 15.1-18.4) months, HZ occurred in 8 recipients, for a cumulative incidence of 2.6%, and an incidence rate of 0.310 per person-year (95% CI 0.267-0.333). All HZ cases occurred within 30 days of booster dosing (range 5-29 days), with a median time to onset of 15 (IQR 9-22) days. Among the 7 patients (2.2%) who also contracted a SARS-CoV-2 infection, all cases preceded COVID-19 outbreaks. No instances of complicated HZ were reported. In multivariate analysis, impaired T helper and T cytotoxic cell counts independently correlated with HZ occurrence. These findings provide the first evidence that cancer patients on active treatment have a not negligible risk of developing HZ within 30 days after the third dose of tozinameran. The favorable clinical outcome of all observed cases confirms that protective effects of boosters in reducing the risk of severe COVID-19 outweigh the potential risk of HZ occurrence.
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Affiliation(s)
- Fabrizio Nelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy.
| | - Agnese Fabbri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Antonella Virtuoso
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Eleonora Marrucci
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Cristina Fiore
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Julio Rodrigo Giron Berrios
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Carlo Signorelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Mario Giovanni Chilelli
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Francesca Primi
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
| | - Valentina Panichi
- Citofluorimetry Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Viterbo, Italy
| | - Luciano Caterini
- Infectious Disease Unit, Department of Medicine, Central Hospital of Belcolle, Viterbo, Italy
| | - Stefania Farinelli
- Infectious Disease Unit, Department of Medicine, Central Hospital of Belcolle, Viterbo, Italy
| | - Maria Assunta Silvestri
- Microbiology and Virology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Viterbo, Italy
| | - Enzo Maria Ruggeri
- Medical Oncology Unit, Department of Oncology and Hematology, Central Hospital of Belcolle, Strada Sammartinese Snc, 01100, Viterbo, Italy
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Khawaja F, Angelidakis G, Feldman A, Ravi V, Woodman E, Bhatti M, Ariza‐Heredia E, Elhajj P, Spallone A, Jiang Y, Chemaly RF. COVID-19 in cancer patients: The impact of vaccination on outcomes early in the pandemic. Cancer Med 2023; 12:22006-22022. [PMID: 38063366 PMCID: PMC10757141 DOI: 10.1002/cam4.6781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND With the rapid evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the development of effective and safe vaccines was of utmost importance to protect vulnerable individuals, including cancer patients. Studies comparing the clinical outcomes of cancer patients with or without vaccination against coronavirus disease 2019 (COVID-19) have not demonstrated clear benefit. We aimed to determine the protective effects of COVID-19 vaccination by comparing vaccinated and unvaccinated cancer patients after the initial phase of vaccine roll-out and to identify risk factors associated with hospitalization, severe COVID-19, and 30-day COVID-19 attributable mortality. METHODS We performed a retrospective cohort study of cancer patients with COVID-19 diagnosed by polymerase chain reaction on nasal swabs between January 1, 2021 and July 30, 2021. Outcomes of interest included hospitalization, severe COVID-19, and 30-day COVID-19 attributable mortality. Univariate and multivariate analyses were performed to identify factors associated with clinical outcomes, using vaccination status as a variable of interest in all models. RESULTS Key risk factors, such as age ≥ 60 years; comorbidities including diabetes mellitus, heart failure, and lung diseases; and specific cancer types (leukemia and lymphoma) were independently associated with hospital admission for COVID-19, severe COVID-19, and 30-day COVID-19 attributable mortality in cancer patients regardless of their vaccination status. Vaccinated patients were protected against severe COVID-19 but with no impact on hospitalization or mortality due to COVID-19. CONCLUSION Our study highlights a significant benefit of COVID-19 vaccination for cancer patients-specifically its protection against severe COVID-19.
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Affiliation(s)
- Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Georgios Angelidakis
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Adina Feldman
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Vinod Ravi
- Data‐Driven Determinants for COVID‐19 Oncology Discovery Effort (D3CODE) TeamThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Sarcoma Medical Oncology, Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Eric Woodman
- Data‐Driven Determinants for COVID‐19 Oncology Discovery Effort (D3CODE) TeamThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Genomic Medicine, Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Micah Bhatti
- Department of Laboratory MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ella Ariza‐Heredia
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Peter Elhajj
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Nelli F, Fabbri A, Botticelli A, Giannarelli D, Marrucci E, Fiore C, Virtuoso A, Berrios JRG, Scagnoli S, Pisegna S, Cirillo A, Panichi V, Massari A, Silvestri MA, Ruggeri EM. Immune responses and clinical outcomes following the third dose of SARS-CoV-2 mRNA-BNT162b2 vaccine in advanced breast cancer patients receiving targeted therapies: a prospective study. Front Oncol 2023; 13:1280416. [PMID: 38023235 PMCID: PMC10662103 DOI: 10.3389/fonc.2023.1280416] [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: 08/20/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Metastatic breast cancer patients are the most prevalent oncology population with advanced disease facing COVID-19 pandemic. Immune responses after mRNA-based vaccination during treatment with CDK4/6 inhibitors or HER2-directed agents remain unclear. We conducted a prospective analysis to elucidate changes in antibody titers and lymphocyte counts following full course of mRNA-BNT162b2 (tozinameran) vaccination in recipients undergoing these targeted therapies. Methods Patients who had received a booster dosing and had been treated for at least 6 months were eligible. Antibody titers against SARS-CoV-2 spike protein were measured at four subsequent time points. Immunophenotyping of circulating lymphocytes was performed before the third dose of tozinameran and four weeks later to quantify the absolute counts of CD3+CD4+ T-helper cells, CD3+CD8+ T-cytotoxic cells, CD19+ B cells, and CD56+CD16+ NK cells. We also assessed the incidence of breakthrough infections and investigated whether immune changes affect time-to-treatment failure (TTF) after booster vaccination. Results The current analysis included 69 patients, of whom 38 (55%) and 31 (45%) were being treated with CDK4/6 inhibitors and HER2-targeted therapies, respectively. All participants received a third dose of tozinameran between September 23 and October 7, 2021. Multivariate analysis revealed that CDK4/6 inhibition predicted a significantly impaired humoral response after the booster dose. This detrimental effect was also evident for T-helper cell counts before the third immunization, but it disappeared in the subsequent evaluation. After a median follow-up of 22.3 months, we observed 19 (26%) cases of COVID-19 outbreaks, all experiencing favorable clinical outcomes. Univariate analysis showed a significant association between the onset of SARS-CoV-2 infections and the use of CDK4/6 inhibitors, as well as with an impaired antibody and T-helper cell response. Only the last two covariates remained independent predictors after multivariate testing. Dynamic variations in antibody titers and T-helper cell counts did not affect TTF in multivariate regression analysis. Conclusions Our results confirm that the immune response to tozinameran is impaired by CDK4/6 inhibitors, increasing the odds of breakthrough infections despite the third vaccine dose. Current evidence recommends maintaining efforts to provide booster immunizations to the most vulnerable cancer patients, including those with advanced breast cancer undergoing CDK4/6 inhibition.
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Affiliation(s)
- Fabrizio Nelli
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Agnese Fabbri
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Eleonora Marrucci
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Cristina Fiore
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Antonella Virtuoso
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Julio Rodrigo Giron Berrios
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Simone Scagnoli
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Simona Pisegna
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Alessio Cirillo
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Valentina Panichi
- Department of Oncology and Hematology, Cytofluorimetry Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Annalisa Massari
- Department of Oncology and Hematology, Pathology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Maria Assunta Silvestri
- Department of Oncology and Hematology, Microbiology and Virology Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Enzo Maria Ruggeri
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
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Lichtenberger LM, Vijayan KV. Severe COVID-19 outcomes and hematological cancers: the clot thickens-are platelets the culprit? Transl Cancer Res 2023; 12:2425-2428. [PMID: 37859735 PMCID: PMC10583002 DOI: 10.21037/tcr-23-672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/28/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Lenard M. Lichtenberger
- Department of Integrative Biology & Pharmacology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K. Vinod Vijayan
- Department of Medicine, Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey, Veterans Affairs Medical Center, Houston, TX, USA
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Nelli F, Fabbri A, Virtuoso A, Giannarelli D, Giron Berrios JR, Marrucci E, Fiore C, Schirripa M, Signorelli C, Chilelli MG, Primi F, Pessina G, Natoni F, Silvestri MA, Ruggeri EM. Effects of Antibody Response after Booster Vaccination on SARS-CoV-2 Breakthrough Infections and Disease Outcomes in Advanced Cancer Patients: A Prospective Analysis of the Vax-on-Third Study. Curr Oncol 2023; 30:5103-5115. [PMID: 37232844 DOI: 10.3390/curroncol30050386] [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: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
(1) Background: The clinical implications of COVID-19 outbreaks following SARS-CoV-2 vaccination in immunocompromised recipients are a worldwide concern. Cancer patients on active treatment remain at an increased risk of developing breakthrough infections because of waning immunity and the emergence of SARS-CoV-2 variants. There is a paucity of data on the effects of COVID-19 outbreaks on long-term survival outcomes in this population. (2) Methods: We enrolled 230 cancer patients who were on active treatment for advanced disease and had received booster dosing of an mRNA-BNT162b2 vaccine as part of the Vax-On-Third trial between September 2021 and October 2021. Four weeks after the third immunization, IgG antibodies against the spike receptor domain of SARS-CoV-2 were tested in all patients. We prospectively evaluated the incidence of breakthrough infections and disease outcomes. The coprimary endpoints were the effects of antibody titers on the development of breakthrough infections and the impact of COVID-19 outbreaks on cancer treatment failure. (3) Results: At a median follow-up of 16.3 months (95% CI 14.5-17.0), 85 (37%) patients developed SARS-CoV-2 infection. Hospitalization was required in 11 patients (12.9%) and only 2 (2.3%) deaths related to COVID-19 outbreaks were observed. Median antibody titers were significantly lower in breakthrough cases than in non-cases (291 BAU/mL (95% CI 210-505) vs. 2798 BAU/mL (95% CI 2323-3613), p < 0.001). A serological titer cut-off below 803 BAU/mL was predictive of breakthrough infection. In multivariate testing, antibody titers and cytotoxic chemotherapy were independently associated with an increased risk of outbreaks. Time-to-treatment failure after booster dosing was significantly shorter in patients who contracted SARS-CoV-2 infection (3.1 months (95% CI 2.3-3.6) vs. 16.2 months (95% CI 14.3-17.0), p < 0.001) and had an antibody level below the cut-off (3.6 months (95% CI 3.0-4.5) vs. 14.6 months (95% CI 11.9-16.3), p < 0.001). A multivariate Cox regression model confirmed that both covariates independently had a worsening effect on time-to-treatment failure. (4) Conclusions: These data support the role of vaccine boosters in preventing the incidence and severity of COVID-19 outbreaks. Enhanced humoral immunity after the third vaccination significantly correlates with protection against breakthrough infections. Strategies aimed at restraining SARS-CoV-2 transmission in advanced cancer patients undergoing active treatment should be prioritized to mitigate the impact on disease outcomes.
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Affiliation(s)
- Fabrizio Nelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Agnese Fabbri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Antonella Virtuoso
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Julio Rodrigo Giron Berrios
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Eleonora Marrucci
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Cristina Fiore
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Marta Schirripa
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Carlo Signorelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Mario Giovanni Chilelli
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Francesca Primi
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Gloria Pessina
- Department of Oncology and Hematology, Molecular Biology and Covid Diagnostics, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Federica Natoni
- Department of Oncology and Hematology, Molecular Biology and Covid Diagnostics, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Maria Assunta Silvestri
- Department of Oncology and Hematology, Microbiology and Virology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
| | - Enzo Maria Ruggeri
- Department of Oncology and Hematology, Medical Oncology Unit, Central Hospital of Belcolle, 01100 Viterbo, Italy
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