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Jang HM, Bae S, Jung J, Cho H, Yoon DH, Kim SH. Immunity Against Measles in Korean Autologous Hematopoietic Stem Cell Transplant Recipients. J Korean Med Sci 2024; 39:e224. [PMID: 39048304 PMCID: PMC11263764 DOI: 10.3346/jkms.2024.39.e224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/16/2024] [Indexed: 07/27/2024] Open
Abstract
The seropositivity of measles antibodies among 261 autologous stem cell transplant recipients (ASCTs) in Korea, assessed approximately 1-2 years after transplant (median, 11 months; interquartile range, 9-14), was significantly lower than age- and sex-matched control healthcare workers (83.1% [217/261] vs. 90.3% [539/597], P = 0.002). The findings underscore the vulnerability of adult ASCT recipients to measles. Clinicians should prioritize testing for measles IgG after ASCT and consider vaccination for ASCT recipients who remain seronegative 2 years after ASCT.
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Affiliation(s)
- Hyeon Mu Jang
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Rivero Calle I, Del Rosal Rabes T, Garrote Llanos E, Núñez Cuadros E, Navarro Gómez ML, Ramos Amador JT, Calvo C, Álvarez García F. Consensus document of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Association of Pediatrics for vaccination of immunosuppressed individuals. An Pediatr (Barc) 2023; 99:403-421. [PMID: 38057232 DOI: 10.1016/j.anpede.2023.11.009] [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: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
The number of people with immunosuppression is increasing considerably due to their greater survival and the use of new immunosuppressive treatments for various chronic diseases. This is a heterogeneous group of patients in whom vaccination as a preventive measure is one of the basic pillars of their wellbeing, given their increased risk of contracting infections. This consensus, developed jointly by the Sociedad Española de Infectología Pediátrica (Spanish Society of Pediatric Infectious Diseases) and the Advisory Committee on Vaccines of the Asociación Española de Pediatría (Spanish Association of Paediatrics), provides guidelines for the development of a personalised vaccination schedule for patients in special situations, including general recommendations and specific recommendations for vaccination of bone marrow and solid organ transplant recipients, children with inborn errors of immunity, oncologic patients, patients with chronic or systemic diseases and immunosuppressed travellers.
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Affiliation(s)
- Irene Rivero Calle
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP), Instituto de Investigación Hospital Clínico Universitario de Santiago de Compostela (IdiCHUS), CIBERes Ciber de Respiratorio, Santiago de Compostela, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP.
| | - Teresa Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), CIBERER U767, Instituto de Salud Carlos III, Madrid, Spain; Sociedad Española de Infectología Pediátrica
| | - Elisa Garrote Llanos
- Sección de Infectología, Servicio de Pediatría, Hospital Universitario, OSI Bilbao-Basurto, Bilbao, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - Esmeralda Núñez Cuadros
- Sección de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Grupo multidisciplinar pediátrico IBIMA, Málaga, Spain; Sociedad Española de Infectología Pediátrica
| | - María Luisa Navarro Gómez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISGM), CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Complutense, Madrid, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - José Tomás Ramos Amador
- Servicio Pediatría y Áreas Específicas, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Departamento de Salud Pública y Maternoinfantil, Universidad Complutense, CIBERINFEC Ciber de Enfermedades Infecciosas, Madrid, Spain; Comité Asesor de Vacunas de la AEP
| | - Cristina Calvo
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Autónoma de Madrid, Madrid, Spain; Sociedad Española de Infectología Pediátrica
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3
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Neemann KA, Sato AI. Vaccinations in children with hematologic malignancies and those receiving hematopoietic stem cell transplants or cellular therapies. Transpl Infect Dis 2023; 25 Suppl 1:e14100. [PMID: 37436808 DOI: 10.1111/tid.14100] [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: 05/19/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Children who are immune compromised are uniquely threatened by a higher risk of infections, including vaccine-preventable diseases (VPDs). Children who undergo chemotherapy or cellular therapies may not have preexisting immunity to VPDs at the time of their treatment including not yet receiving their primary vaccine series, and additionally they have higher risk of exposures (e.g., due to family structures, daycare and school setting) with decreased capacity to protect themselves using nonpharmaceutic measures (e.g., masking). In the past, efforts to revaccinate these children have often been delayed or incomplete. Treatment with chemotherapy, stem cell transplants, and/or cellular therapies impair the ability of the immune system to mount a robust vaccine response. Ideally, protection would be provided as soon as both safe and effective, which will vary by vaccine type (e.g., replicating versus nonreplicating; conjugated versus polysaccharide). While a single approach revaccination schedule following these therapies would be convenient for providers, it would not account for patient specific factors that influence the timing of immune reconstitution (IR). Evidence suggests that many of these children would mount a meaningful vaccine response as early as 3 months following completion of treatment. Here within, we provide updated guidance on how to approach vaccination both during and following completion of these therapies.
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Affiliation(s)
- Kari A Neemann
- Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Children's Hospital & Medical Center, Omaha, Nebraska, USA
| | - Alice I Sato
- Division of Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Children's Hospital & Medical Center, Omaha, Nebraska, USA
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Elgarten C, Wohlschlaeger A, Levy E, Tadley K, Wang L, Atkinson M, Roberson H, Olson T, Bunin N, Heimall J, Fisher B, Grupp S, Freedman J. Quality Improvement Initiative to Improve Time and Adherence to Revaccination after Hematopoietic Cell Transplantation: Implementation of a Revaccination Clinic within the Transplantation Program. Transplant Cell Ther 2023; 29:635.e1-635.e8. [PMID: 37517611 PMCID: PMC10592250 DOI: 10.1016/j.jtct.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Revaccination after hematopoietic cell transplantation (HCT) is critical to prevent morbidity and mortality from vaccine-preventable illnesses. The global aim of our quality improvement initiative was to enhance timely, correct, and effective revaccination after pediatric HCT. The SMART aim of our project was to decrease median unvaccinated time by 4 months by decreasing the time to vaccine eligibility, time from eligibility to vaccine initiation, and time to completion of the vaccine series. A multidisciplinary group performed a cross-sectional quantitative and qualitative evaluation of revaccination practices at our institution. We identified factors associated with delayed, incorrect, or incomplete revaccination. Several plan-do-study-act interventions were implemented to address these drivers, including revising immune readiness criteria, increasing auditing of primary care administered immunizations, and, importantly, establishing a dedicated revaccination clinic within the HCT clinic at our center. The time to vaccine eligibility decreased from 12.6 months to 10 months (a 20% decrease), and the time to complete the vaccine series decreased from 19.3 months to 15.7 months (a 19% decrease). With a quality improvement initiative, we addressed the many causes of delayed or incomplete revaccination post-HCT and through a team-based approach successfully decreased the time to vaccine start and time to vaccine completion at our center.
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Affiliation(s)
- Caitlin Elgarten
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Anne Wohlschlaeger
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
| | - Ellen Levy
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
| | - Katharine Tadley
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
| | - Lei Wang
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Megan Atkinson
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
| | - Houston Roberson
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
| | - Timothy Olson
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy Bunin
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Heimall
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian Fisher
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephan Grupp
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Freedman
- Cellular Therapy and Transplantation Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Wilson Dib R, Ariza-Heredia E, Spallone A, Chemaly RF. Respiratory Viral Infections in Recipients of Cellular Therapies: A Review of Incidence, Outcomes, Treatment, and Prevention. Open Forum Infect Dis 2023; 10:ofad166. [PMID: 37065990 PMCID: PMC10096899 DOI: 10.1093/ofid/ofad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Respiratory viral infections (RVIs) are of major clinical importance in immunocompromised patients and represent a substantial cause of morbidity and mortality in patients with hematologic malignancies and those who have undergone hematopoietic cell transplantation. Similarly, patients receiving immunotherapy with CD19-targeted chimeric antigen receptor-modified T cells, natural killer cells, and genetically modified T-cell receptors are susceptible to RVIs and progression to lower respiratory tract infections. In adoptive cellular therapy recipients, this enhanced susceptibility to RVIs results from previous chemotherapy regimens such as lymphocyte-depleting chemotherapy conditioning regimens, underlying B-cell malignancies, immune-related toxicities, and secondary prolonged, profound hypogammaglobulinemia. The aggregated risk factors for RVIs have both immediate and long-term consequences. This review summarizes the current literature on the pathogenesis, epidemiology, and clinical aspects of RVIs that are unique to recipients of adoptive cellular therapy, the preventive and therapeutic options for common RVIs, and appropriate infection control and preventive strategies.
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Affiliation(s)
- Rita Wilson Dib
- Department of Internal Medicine, Division of Infectious Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ella Ariza-Heredia
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Antibody Response against Vaccine Antigens in Children after TCRαβ-Depleted Haploidentical Stem Cell Transplantation: Is It Similar to That in Recipients with Fully Matched Donors? Transplant Cell Ther 2023; 29:128.e1-128.e9. [PMID: 36323399 DOI: 10.1016/j.jtct.2022.10.019] [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: 07/24/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Recipients of hematopoietic stem cell transplantation (HSCT) with HLA-mismatched donors are more immune suppressed than those with fully matched donors. The immunologic response to vaccines also may differ in HLA-mismatched haploidentical HSCT recipients. In this study, we aimed to evaluate the antibody response to vaccines in pediatric TCRαβ-depleted haploidentical HSCT recipients. This longitudinal study included a study group of 21 children who underwent haploidentical HSCT without CD19 depletion and with TCRαβ depletion and a control group of 38 children who underwent fully matched donor HSCT. Antibody levels were quantified by serologic tests before vaccination and after each dose against tetanus, diphtheria, pneumococcus, hepatitis B, hepatitis A, measles, rubella, mumps, and varicella. The median recipient age was significantly lower (P = .037) and the median donor age was significantly higher (P = .000) in the haploidentical group compared with the fully matched group. At the months 1, 3, 6, 9 and 12 post-transplantation, the median CD4, CD8, and CD19 cell counts and lymphocyte counts were similar in the haploidentical and fully matched groups. The median natural killer cell count was higher in the haploidentical group at the months 1, 3, and 6 post-transplantation (P = .001, .006, and .004, respectively). The median time to first vaccination was similar in the 2 groups (12.5 [range, 11 to 14] months for the haploidentical group and 11 [range, 9 to 13] months for the fully matched group; P = .441). Seroprotection rates were 100% in both groups after the second and third doses of diphtheria vaccine, the third dose of tetanus vaccine, the third dose of hepatitis B vaccine, the second and third doses of pneumococcal conjugate vaccines (PCV13), and pneumococcal polysaccharide vaccine (PSPV23), although lower after the initial doses and before vaccination. Seroprotection for hepatitis A, rubella, and varicella was >90% in the fully matched group and 100% for the haploidentical group after the second doses. Measles and mumps seroprotection rates were >80% in the haploidentical group and approximately 70% for the fully matched group after the second dose. Antibody response and seroprotection rates against vaccine antigens were similar in the haploidentical group and the fully matched when revaccination was started at 12 months post-transplantation. These findings support the idea that TCRαβ-depleted haploidentical HSCT recipients can be revaccinated according to the same vaccination schedule as fully matched HSCT recipients. Revaccination earlier after transplantation and vaccine responses for recipients of different types of HSCT should be evaluated in future studies.
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Khawaja F, Papanicolaou G, Dadwal S, Pergam SA, Wingard JR, Boghdadly ZE, Abidi MZ, Waghmare A, Shahid Z, Michaels L, Hill JA, Kamboj M, Boeckh M, Auletta JJ, Chemaly RF. Frequently Asked Questions on Coronavirus Disease 2019 Vaccination for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Recipients From the American Society for Transplantation and Cellular Therapy and the American Society of Hematology. Transplant Cell Ther 2023; 29:10-18. [PMID: 36273782 PMCID: PMC9584756 DOI: 10.1016/j.jtct.2022.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), disproportionately affects immunocompromised and elderly patients. Not only are hematopoietic cell transplantation (HCT) and chimeric antigen receptor (CAR) T-cell recipients at greater risk for severe COVID-19 and COVID-19-related complications, but they also may experience suboptimal immune responses to currently available COVID-19 vaccines. Optimizing the use, timing, and number of doses of the COVID-19 vaccines in these patients may provide better protection against SARS-CoV-2 infection and better outcomes after infection. To this end, current guidelines for COVID-19 vaccination in HCT and CAR T-cell recipients from the American Society of Transplantation and Cellular Therapy Transplant Infectious Disease Special Interest Group and the American Society of Hematology are provided in a frequently asked questions format.
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Affiliation(s)
- Fareed Khawaja
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Genovefa Papanicolaou
- Division of Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanjeet Dadwal
- Division of Infectious Diseases, City of Hope, Duarte, California
| | - Steven A Pergam
- Vaccine and Infectious Diseases, Fred Hutchinson Cancer Center, Seattle, Washington
| | - John R Wingard
- Division of Hematology/Oncology, University of Florida, Gainesville, Florida
| | - Zeinab El Boghdadly
- Division of Infectious Diseases, The Ohio State University College of Medicine, Columbus, Ohio
| | - Maheen Z Abidi
- Division of Infectious Diseases, University of Colorado, Boulder, Colorado
| | - Alpana Waghmare
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington
| | - Zainab Shahid
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura Michaels
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joshua A Hill
- Vaccine and Infectious Diseases, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Mini Kamboj
- Division of Infectious Diseases, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Boeckh
- Vaccine and Infectious Diseases, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jeffery J Auletta
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Divisions of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
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8
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Chen J, Li Z, Zhao Q, Chen L. Roles of apelin/APJ system in cancer: Biomarker, predictor, and emerging therapeutic target. J Cell Physiol 2022; 237:3734-3751. [DOI: 10.1002/jcp.30845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jiawei Chen
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology University of South China Hengyang Hunan China
| | - Zhiyue Li
- Health Management Center, The Third Xiangya Hospital Central South University Changsha Hunan Province China
| | - Qun Zhao
- Department of Orthopedics Third Xiangya Hospital of Central South University Changsha Hunan China
| | - Linxi Chen
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology University of South China Hengyang Hunan China
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9
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Safety and Tolerability of SARS-CoV2 Emergency-Use Authorized Vaccines for Allogeneic Hematopoietic Stem Cell Transplant Recipients. Transplant Cell Ther 2021; 27:938.e1-938.e6. [PMID: 34274492 PMCID: PMC8280601 DOI: 10.1016/j.jtct.2021.07.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 12/25/2022]
Abstract
The safety and efficacy of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) emergency-use authorized (EUA) vaccines have been confirmed in the general population. However, there are no data on its safety and tolerability or efficacy in recipients of allogeneic hematopoietic stem cell transplant (HCT). We performed this study to identify the incidence of adverse events following SARS-CoV2 EUA vaccines, the incidence of new-onset graft-versus-host disease (GVHD) or worsening of existing GVHD after EUA vaccine administration, and the incidence SARS-CoV2 positivity in vaccinated HCT patients. We retrospectively reviewed 113 HCT patients who received at least one dose of EUA vaccine to describe the safety and tolerability, any impact on GVHD, and the incidence of SARS-CoV2 PCR positivity after vaccination. Patients received either Pfizer (BNT162b2) or Moderna (mRNA-1273) vaccines. Patients were included if they were 18 years or older and had received at least one dose of vaccine in the post-HCT setting. Most patients presented with myalgias/arthralgias (first dose, 7.7%; second dose, 14.6%), fatigue (first dose, 15.4%; second dose, 29.2%), and injection site pain (first dose, 40.4%; second dose, 43.8%). Other side-effects experienced by patients included nausea, vomiting, diarrhea, headache, and injection-site rash and swelling. Liver function abnormalities occurred in 18.6% of patients. Neutropenia, thrombocytopenia, and lymphopenia occurred in 13.3%, 11.5%, and 8.8% of patients, respectively. Forty percent of patients had active chronic GVHD at the time of vaccination, and worsening chronic GVHD occurred in 3.5% of the patients. New chronic GVHD developed in 9.7% of patients after vaccination. The SARS-CoV2 EUA vaccines were well tolerated in allogeneic HCT recipients.
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10
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Chung DJ, Shah GL, Devlin SM, Ramanathan LV, Doddi S, Pessin MS, Hoover E, Marcello LT, Young JC, Boutemine SR, Serrano E, Sharan S, Momotaj S, Margetich L, Bravo CD, Papanicolaou GA, Kamboj M, Mato AR, Roeker LE, Hultcrantz M, Mailankody S, Lesokhin AM, Vardhana SA, Knorr DA. Disease- and Therapy-Specific Impact on Humoral Immune Responses to COVID-19 Vaccination in Hematologic Malignancies. Blood Cancer Discov 2021; 2:568-576. [PMID: 34778797 PMCID: PMC8580617 DOI: 10.1158/2643-3230.bcd-21-0139] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) vaccine response data for patients with hematologic malignancy, who carry high risk for severe COVID-19 illness, are incomplete. In a study of 551 hematologic malignancy patients with leukemia, lymphoma, and multiple myeloma, anti-SARS-CoV-2 spike IgG titers and neutralizing activity were measured at 1 and 3 months from initial vaccination. Compared with healthy controls, patients with hematologic malignancy had attenuated antibody titers at 1 and 3 months. Furthermore, patients with hematologic malignancy had markedly diminished neutralizing capacity of 26.3% at 1 month and 43.6% at 3 months, despite positive seroconversion rates of 51.5% and 68.9% at the respective time points. Healthy controls had 93.2% and 100% neutralizing capacity at 1 and 3 months, respectively. Patients with leukemia, lymphoma, and multiple myeloma on observation had uniformly blunted responses. Treatment with Bruton tyrosine kinase inhibitors, venetoclax, phosphoinositide 3-kinase inhibitors, anti-CD19/CD20-directed therapies, and anti-CD38/B-cell maturation antigen-directed therapies substantially hindered responses, but single-agent immunomodulatory agents did not. Significance Patients with hematologic malignancy have compromised COVID-19 vaccine responses at baseline that are further suppressed by active therapy, with many patients having insufficient neutralizing capacity despite positive antibody titers. Refining vaccine response parameters is critical to guiding clinical care, including the indication for booster vaccines, for this vulnerable population.See related article by Tamari et al., p. 577. This article is highlighted in the In This Issue feature, p. 549.
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Affiliation(s)
- David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York.
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, MSKCC, New York, New York
| | | | - Sital Doddi
- Department of Laboratory Medicine, MSKCC, New York, New York
| | | | - Elizabeth Hoover
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - LeeAnn T Marcello
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - Jennifer C Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | | | - Edith Serrano
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Saumya Sharan
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Saddia Momotaj
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lauren Margetich
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | | | | | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, MSKCC, New York, New York
| | - Anthony R Mato
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lindsey E Roeker
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Malin Hultcrantz
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Sham Mailankody
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Alexander M Lesokhin
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Santosha A Vardhana
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Lymphoma Service, Department of Medicine, MSKCC, New York, New York
- Human Oncology and Pathogenesis Program, MSKCC, New York, New York
| | - David A Knorr
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
- The Rockefeller University, New York, New York
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11
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Thirumalairaj R, Parikh PM, Agarwal A, Singh R, Krishnamurthy A, Desai SS, Maheshwari A, Mehta P, Ghafur A, Somashekhar SP, Iqbal A, Savant DN, Hussain SMA, Bhatt A, Wangdi T, Bajpai J, Ranade AA, Babu KG, Bapna A, Biswas G, Malhotra H, Krishna MV, Baral RP, Vashishtha R, Safi AJ, Agarwal S, Agarwal JP, Rathnam KK, Mohapatra PN, Kumar RV, Rajappa S, Limaye SA, Vora A, Reddy VAP, Parekh BB, Rath GK. South Asian Declaration-Consensus Guidelines for COVID-19 Vaccination in Cancer Patients. South Asian J Cancer 2021; 10:3-8. [PMID: 34430512 PMCID: PMC8378920 DOI: 10.1055/s-0041-1731909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.
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Affiliation(s)
- Raja Thirumalairaj
- Department of Medical Oncology, Apollo Cancer Center, Teynampet, Chennai, India
| | - Purvish M Parikh
- Department of Oncology, Integrated Academic Society of Clinical Oncology, Mumbai Oncocare Centers, Mumbai, Maharashtra, India
| | - Amit Agarwal
- Department of Medical Oncology, BLK Superspecilaity Hospital, Delhi, India
| | - Randeep Singh
- Department of Molecular Oncology Society, Narayana Health, Delhi, India
| | | | - Sharad S Desai
- Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
| | - Amita Maheshwari
- Divison of Gynecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Mehta
- Department of Medical Oncology/Hematoncology/BMT, Asian Institute of Medical Sciences, Faridabad, India
| | - Abdul Ghafur
- Department of Infectious Diseases, Apollo Cancer Institute, Chennai, India
| | - S P Somashekhar
- Department of Surgical Oncology, MHEPL, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Ahamed Iqbal
- Oncology and Radiotherapy Department, Teaching Hospital, Batticaloa, Sri Lanka
| | | | - Syed Md Akram Hussain
- Department of Radiotherapy, Square Oncology and Radiotherapy Centre, Dhaka, Bangladesh
| | - Amit Bhatt
- Department of Medical Oncology, Avinash Cancer Clinic, Pune, India
| | - Tashi Wangdi
- Oncology Department, JDWNR Hospital and KGUMS, Thimphu, Bhutan
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - K Govind Babu
- Department of Medical and Pediatric Oncology, St. Johns Medical College and Hospital, HCG Hospitals, Bangalore, India
| | - Ajay Bapna
- Department of Medical Oncology, BMCHRC, Jaipur, Rajasthan, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospital and Sum Hospital, Bhubaneswar, Odisha, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | - M Vamshi Krishna
- Department of Medical Oncology and Hematology, Institute of Oncology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Rajendra Prasad Baral
- Department of Medical Oncology, Norvic International Hospital and Om Hospital and Research Center, Kathmandu, Nepal
| | - Rajesh Vashishtha
- Department of Radiation Oncology, Max Super Speciality Hospital, Bathinda, Punjab, India
| | - Ahmad Javid Safi
- Afghanistan Cancer Foundation and Covid-19 Control Command Centre, Kabil, Afghanistan
| | - Sharmila Agarwal
- Department of Radiotherapy, Jaslok Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Krishna Kumar Rathnam
- Department of Medical Oncology, Meenakshi Mission Hospital and Research Centre, Madurai, India
| | - P N Mohapatra
- Department of Medical Oncology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Rajeev Vijay Kumar
- Department of Oncology, BGS Gleneagles Global Hospital, Bangalore, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Center, Hyderabad, India
| | - Sewanti Atul Limaye
- Department of Oncology and Oncology Research, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Amish Vora
- Department of Oncology, H.O.P.E. Oncology Cancer Clinic, PSRI Hospital, New Delhi, India
| | - Vijay A P Reddy
- Department of Radiation Oncology, Apollo Cancer Institute, Hyderabad, India
| | - Bhavesh B Parekh
- Department of Oncology, Shalby Cancer and Research Institute, Ahmedabad, Gujrat, India
| | - G K Rath
- National Cancer Center, Delhi, India
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12
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Kamboj M. Blunted humoral response after mRNA vaccine in patients with haematological malignancies. Lancet Haematol 2021; 8:e540-e542. [PMID: 34224666 PMCID: PMC8253544 DOI: 10.1016/s2352-3026(21)00197-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Mini Kamboj
- Infectious Disease Service, Department of Medicine and Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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13
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Negahdaripour M, Shafiekhani M, Moezzi SMI, Amiri S, Rasekh S, Bagheri A, Mosaddeghi P, Vazin A. Administration of COVID-19 vaccines in immunocompromised patients. Int Immunopharmacol 2021; 99:108021. [PMID: 34352567 PMCID: PMC8316069 DOI: 10.1016/j.intimp.2021.108021] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
Since the beginning of vaccination programs against COVID-19 in different countries, several populations such as patients with specific immunological conditions have been considered as the priorities for immunization. In this regard, patients with autoimmune diseases or those receiving immunosuppressive agents and anti-cancer therapies, need special attention. However, no confirmed data is presently available regarding COVID-19 vaccines in these populations due to exclusion from the conducted clinical trials. Given the probable suppression or over-activation of the immune system in such patients, reaching a consensus for their vaccination is critical, besides gathering data and conducting trials, which could probably clarify this matter in the future. In this review, besides a brief on the available COVID-19 vaccines, considerations and available knowledge about administering similar vaccines in patients with cancer, hematopoietic stem cell transplantation, solid organ transplantation, multiple sclerosis (MS), inflammatory bowel disease (IBD), and rheumatologic and dermatologic autoimmune disorders are summarized to help in decision making. As discussed, live-attenuated viruses, which should be avoided in these groups, are not employed in the present COVID-19 vaccines. Thus, the main concern regarding efficacy could be met using a potent COVID-19 vaccine. Moreover, the vaccination timing for maximum efficacy could be decided according to the patient’s condition, indicated medications, and the guides provided here. Post-vaccination monitoring is also advised to ensure an adequate immune response. Further studies in this area are urgently warranted.
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Affiliation(s)
- Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Iman Moezzi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sogand Amiri
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Rasekh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Bagheri
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Mosaddeghi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsaneh Vazin
- Clinical Pharmacy Department, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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14
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Ram R, Hagin D, Kikozashvilli N, Freund T, Amit O, Bar-On Y, Beyar-Katz O, Shefer G, Moshiashvili MM, Karni C, Gold R, Kay S, Glait-Santar C, Eshel R, Perry C, Avivi I, Apel A, Benyamini N, Shasha D, Ben-Ami R. Safety and Immunogenicity of the BNT162b2 mRNA COVID-19 Vaccine in Patients after Allogeneic HCT or CD19-based CART therapy-A Single-Center Prospective Cohort Study. Transplant Cell Ther 2021; 27:788-794. [PMID: 34214738 PMCID: PMC8242200 DOI: 10.1016/j.jtct.2021.06.024] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
Data are scarce regarding both the safety and immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in patients undergoing immune cell therapy; thus, we prospectively evaluated these two domains in patients receiving this vaccine after allogeneic hematopoietic cell transplantation (HCT; n = 66) or after CD19-based chimeric antigen receptor T cell (CART) therapy (n = 14). Overall, the vaccine was well tolerated, with mild non-hematologic vaccine-reported adverse events in a minority of the patients. Twelve percent of the patients after the first dose and 10% of the patients after the second dose developed cytopenia, and there were three cases of graft-versus-host disease exacerbation after each dose. A single case of impending graft rejection was summarized as possibly related. Evaluation of immunogenicity showed that 57% of patients after CART infusion and 75% patients after allogeneic HCT had evidence of humoral and/or cellular response to the vaccine. The Cox regression model indicated that longer time from infusion of cells, female sex, and higher CD19+ cells were associated with a positive humoral response, whereas a higher CD4+/CD8+ ratio was correlated with a positive cellular response, as confirmed by the ELISpot test. We conclude that the BNT162b2 mRNA COVID-19 vaccine has impressive immunogenicity in patients after allogeneic HCT or CART. Adverse events were mostly mild and transient, but some significant hematologic events were observed; hence, patients should be closely monitored.
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Affiliation(s)
- Ron Ram
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nino Kikozashvilli
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Freund
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Odelia Amit
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Bar-On
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofrat Beyar-Katz
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Shefer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Endocrinology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Miguel Morales Moshiashvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Endocrinology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Chen Karni
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Gold
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Sigi Kay
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Glait-Santar
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Eshel
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chava Perry
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Avivi
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Apel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Hematology Ward, Shamir Medical Center (Assaf Haraofeh), Zerifin, Israel
| | - Noam Benyamini
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Shasha
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronen Ben-Ami
- Bone Marrow Transplantation Unit, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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15
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Woodfield MC, Pergam SA, Shah PD. Cocooning against COVID-19: The argument for vaccinating caregivers of patients with cancer. Cancer 2021; 127:2861-2863. [PMID: 33891713 PMCID: PMC8251451 DOI: 10.1002/cncr.33598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022]
Abstract
Current national COVID‐19 vaccination guidelines and recommendations focus vaccine guidance on patients with cancer. In this COVID‐19 vaccination race, “cocoon vaccination” strategies, which include informal caregivers and household contacts as priority groups for SARS‐CoV‐2 vaccination, could be an additional strategy used to protect patients with cancer who may have limited immune responses to current vaccinations. Medical systems specializing in cancer care should support education and vaccination campaigns which target informal caregivers and household contacts in addition to cancer patients.
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Affiliation(s)
| | - Steven A Pergam
- University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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16
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Carr E. COVID-19 Vaccines: Preparing for Vaccination in the Context of Clinical Oncology Care. Clin J Oncol Nurs 2021; 25:76-84. [PMID: 33480870 DOI: 10.1188/21.cjon.76-84] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
BACKGROUND In the environment of an infectious pandemic, vaccines are a primary public health strategy to prevent the spread of disease. With the COVID-19 pandemic, there is heightened interest in safe and effective vaccines and their use in the context of clinical oncology practice. OBJECTIVES This article provides foundational information about vaccines in general and vaccines developed to protect against the SARS-CoV-2 virus in the United States, as well as clinical nurse strategies to apply vaccines in clinical oncology practice. METHODS The article is based on a review of public health literature and reputable websites about vaccines and their development in clinical care. FINDINGS This foundational information about vaccines reviews their history and development, as well as the development of COVID-19 vaccines specifically, and discusses COVID-19 vaccines as part of clinical oncology care. Supporting best practices in clinical oncology care, nurses can provide factual, evidence-based information about vaccine safety, effectiveness, and safe administration.
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Affiliation(s)
- Ellen Carr
- University of California San Diego Moores Cancer Center
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17
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McMasters M, Blair BM, Lazarus HM, Alonso CD. Casting a wider protective net: Anti-infective vaccine strategies for patients with hematologic malignancy and blood and marrow transplantation. Blood Rev 2020; 47:100779. [PMID: 33223246 DOI: 10.1016/j.blre.2020.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Patients who have hematologic malignancies are at high risk for infections but vaccinations may be effective prophylaxis. The increased infection risk derives from immune defects secondary to malignancy, the classic example being CLL, and chemotherapies and immunotherapy used to treat the malignancies. Therapy of hematologic malignancies is being revolutionized by introduction of novel targeted agents and immunomodulatory medications, improving the survival of patients. At the same time those agents uniquely change the infection risk and response to immunizations. This review will summarize current vaccine recommendations for patients with hematologic malignancies including patients who undergo hematopoietic cell transplant.
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Affiliation(s)
- Malgorzata McMasters
- Division of Hematologic Malignancy and Bone Marrow Transplant, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Barbra M Blair
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn D Alonso
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
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18
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Etzioni-Friedman T, Etzioni A. Adherence to Immunization: Rebuttal of Vaccine Hesitancy. Acta Haematol 2020; 144:413-417. [PMID: 33202404 PMCID: PMC7705945 DOI: 10.1159/000511760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
Immunizations have been saving the lives of millions of people since they were first used by Edward Jenner in 1796, and new vaccines are being developed all the time. Hopefully, a new vaccine for coronavirus disease 2019 (COVID-19) will be developed in the near future, and perhaps even one for human immunodeficiency virus. Although the effectiveness of vaccinations has been proven over the years and adverse effects to currently available vaccinations are extremely rare, many people continue to defer immunizations for themselves and their families. According to the World Health Organization (WHO), this phenomenon, known as "vaccine hesitancy," is a major public health problem globally. This review summarizes the unproven adverse effects of various vaccines and stresses the importance of enforcing vaccination policies to minimize vaccine hesitancy. Every effort should be made to improve existing vaccines and to produce new ones, according to carefully designed scientific preclinical and clinical trials. This is particularly important in today's era, in light of the global transparency regarding vaccination development, and the potential for future pandemics such as COVID-19.
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Affiliation(s)
- Tamar Etzioni-Friedman
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Amos Etzioni
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel,
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19
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Whitaker JA. Immunization Strategies to Span the Spectrum of Immunocompromised Adults. Mayo Clin Proc 2020; 95:1530-1548. [PMID: 32067801 DOI: 10.1016/j.mayocp.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 01/01/2023]
Abstract
The Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention provides annual recommendations for routine adult immunizations. Many recommendations consider patient factors such as age, medical conditions, and medications that increase an individual's risk for infection with a vaccine-preventable disease. These factors, particularly those that lead to immunocompromise, may also alter the risk-benefit ratio for live vaccines, and/or lead to decreased vaccine immunogenicity and effectiveness. The provider may need to consider alternative vaccination strategies, including higher antigen dose vaccines, adjuvanted vaccines, avoidance of live vaccines, and careful timing of vaccination to optimize safety and effectiveness in immunocompromised populations. This thematic review discusses general principles regarding immunization of adults across the spectrum of immunocompromise, examines current guidelines and studies that support them, and outlines future research needs.
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Affiliation(s)
- Jennifer A Whitaker
- Department of Molecular Virology and Department of Microbiology and Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX.
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20
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Laws HJ, Baumann U, Bogdan C, Burchard G, Christopeit M, Hecht J, Heininger U, Hilgendorf I, Kern W, Kling K, Kobbe G, Külper W, Lehrnbecher T, Meisel R, Simon A, Ullmann A, de Wit M, Zepp F. Impfen bei Immundefizienz. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:588-644. [PMID: 32350583 PMCID: PMC7223132 DOI: 10.1007/s00103-020-03123-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hans-Jürgen Laws
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ulrich Baumann
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität FAU Erlangen-Nürnberg, Erlangen, Deutschland
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
| | - Gerd Burchard
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Deutschland
| | - Maximilian Christopeit
- Interdisziplinäre Klinik für Stammzelltransplantation, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Jane Hecht
- Abteilung für Infektionsepidemiologie, Fachgebiet Nosokomiale Infektionen, Surveillance von Antibiotikaresistenz und -verbrauch, Robert Koch-Institut, Berlin, Deutschland
| | - Ulrich Heininger
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Universitäts-Kinderspital beider Basel, Basel, Schweiz
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Kern
- Klinik für Innere Medizin II, Abteilung Infektiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Kerstin Kling
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland.
| | - Guido Kobbe
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wiebe Külper
- Abteilung für Infektionsepidemiologie, Fachgebiet Impfprävention, Robert Koch-Institut, Berlin, Deutschland
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Roland Meisel
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Maike de Wit
- Klinik für Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Onkologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - Fred Zepp
- Ständige Impfkommission (STIKO), Robert Koch-Institut, Berlin, Deutschland
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Deutschland
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