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Hill JA, Martens MJ, Young JAH, Bhavsar K, Kou J, Chen M, Lee LW, Baluch A, Dhodapkar MV, Nakamura R, Peyton K, Howard DS, Ibrahim U, Shahid Z, Armistead P, Westervelt P, McCarty J, McGuirk J, Hamadani M, DeWolf S, Hosszu K, Sharon E, Spahn A, Toor AA, Waldvogel S, Greenberger LM, Auletta JJ, Horowitz MM, Riches ML, Perales MA. SARS-CoV-2 Vaccination in the First Year After Hematopoietic Cell Transplant or Chimeric Antigen Receptor T-Cell Therapy: A Prospective, Multicenter, Observational Study. Clin Infect Dis 2024; 79:542-554. [PMID: 38801746 PMCID: PMC11327798 DOI: 10.1093/cid/ciae291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The optimal timing of vaccination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines after cellular therapy is incompletely understood. The objectives of this study are to determine whether humoral and cellular responses after SARS-CoV-2 vaccination differ if initiated <4 months versus 4-12 months after cellular therapy. METHODS We conducted a multicenter, prospective, observational study at 30 cancer centers in the United States. SARS-CoV-2 vaccination was administered as part of routine care. We obtained blood prior to and after vaccinations at up to 5 time points and tested for SARS-CoV-2 spike (anti-S) IgG in all participants and neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains, as well as SARS-CoV-2-specific T-cell receptors, in a subgroup. RESULTS We enrolled 466 allogeneic hematopoietic cell transplantation (HCT) (n = 231), autologous HCT (n = 170), and chimeric antigen receptor T-cell (CAR-T-cell) therapy (n = 65) recipients between April 2021 and June 2022. Humoral and cellular responses did not significantly differ among participants initiating vaccinations <4 months versus 4-12 months after cellular therapy. Anti-S IgG ≥2500 U/mL was correlated with high neutralizing antibody titers and attained by the last time point in 70%, 69%, and 34% of allogeneic HCT, autologous HCT, and CAR-T-cell recipients, respectively. SARS-CoV-2-specific T-cell responses were attained in 57%, 83%, and 58%, respectively. Pre-cellular therapy SARS-CoV-2 infection or vaccination and baseline B-cell count were key predictors of post-cellular therapy immunity. CONCLUSIONS These data support mRNA SARS-CoV-2 vaccination prior to, and reinitiation 3 to 4 months after, cellular therapies with allogeneic HCT, autologous HCT, and CAR-T-cell therapy.
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Grants
- Kyowa Kirin
- OptumHealth
- Takeda Oncology Co
- Xenikos BV
- Talaris Therapeutics
- Karyopharm Therapeutics
- Sanofi Genzyme
- MorphoSys
- U10HL069294 National Cancer Institute [NCI]
- Karius
- Vertex
- OncoImmune, Inc
- Orca Biosystems, Inc
- Medexus, Merck & Co.
- Kyowa Kirin International plc
- Seagen, Inc
- P30 CA015704 NCI NIH HHS
- Bristol Myers Squibb Co
- HistoGenetics
- Millennium
- U24 CA076518 NCI NIH HHS
- Oncopeptides, Inc
- Janssen Research & Development, LLC
- Miltenyi Biotec, Inc
- AlloVir, Inc
- Janssen/Johnson & Johnson
- HRSA HHS
- Terumo Blood and Cell Technologies
- N00014-20-1-2705 Department of Health and Human Services [DHHS]
- Adienne SA
- Novartis
- Kiadis Pharma
- Actinium Pharmaceuticals, Inc
- Bluebird Bio, Inc
- Novartis Pharmaceuticals Corporation
- Medical College of Wisconsin
- HHSH234200637015C National Institute of Allergy and Infectious Diseases
- TG Therapeutics
- Pfizer, Inc
- Kite Pharma, Inc
- P30 CA008748 NCI NIH HHS
- Incyte Corporation
- Pharmacyclics, LLC
- Tscan
- National Heart, Lung, and Blood Institute [NHLBI]
- CytoSen Therapeutics, Inc
- Gilead
- Astellas Pharma US
- Takeda Pharmaceuticals
- Accenture
- AbbVie
- Gilead Company
- Be the Match Foundation
- Leukemia and Lymphoma Society
- Adaptive Biotechnologies
- National Marrow Donor Program/Be the Match
- Multiple Myeloma Research Foundation
- Stemcyte
- DBA Eurofins Transplant Diagnostics
- CareDx
- Eurofins Viracor
- NIH HHS
- CSL Behring
- Medac GmbH
- GlaxoSmithKline
- Fate Therapeutics
- American Society for Transplantation and Cellular Therapy
- Gamida-Cell, Ltd
- NCI
- Legend Biotech
- Kadmon
- Ossium Health, Inc
- Vor Biopharma
- Jasper Therapeutics
- Jazz Pharmaceuticals, Inc
- Iovance
- U24CA076518
- LabCorp
- Omeros Corporation
- Amgen, Inc
- Magenta Therapeutics
- Daiichi Sankyo Co, Ltd
- Priothera
- Office of Naval Research
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Affiliation(s)
- Joshua A Hill
- Vaccine and Infectious Disease, Fred Hutchinson Cancer Center, and Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael J Martens
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jo-Anne H Young
- Division of Infectious Diseases, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kavita Bhavsar
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jianqun Kou
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Min Chen
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lik Wee Lee
- Adaptive Biotechnologies Corporation, Seattle, Washington, USA
| | - Aliyah Baluch
- Division of Infectious Diseases, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Madhav V Dhodapkar
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | | | - Dianna S Howard
- Division of Hematology and Oncology, Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Uroosa Ibrahim
- Division of Hematology and Medical Oncology, Mount Sinai Hospital, New York, New York, USA
| | - Zainab Shahid
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paul Armistead
- Division of Hematology, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Peter Westervelt
- Division of Oncology, Barnes-Jewish Hospital, Washington University, St. Louis, Missouri, USA
| | - John McCarty
- Division of Hematology, Oncology & Palliative Care, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas, Lawrence, Kansas, USA
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan DeWolf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kinga Hosszu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, Maryland, USA
| | - Ashley Spahn
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Amir A Toor
- Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Stephanie Waldvogel
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
| | - Lee M Greenberger
- The Leukemia and Lymphoma Society, Rye Brook, New York, New York, USA
| | - Jeffery J Auletta
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota, USA
- Division of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marcie L Riches
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Miguel-Angel Perales
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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2
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Konuma T, Hamatani-Asakura M, Nagai E, Adachi E, Kato S, Isobe M, Monna-Oiwa M, Takahashi S, Yotsuyanagi H, Nannya Y. Cellular and humoral immunogenicity against SARS-CoV-2 vaccination or infection is associated with the memory phenotype of T- and B-lymphocytes in adult allogeneic hematopoietic cell transplant recipients. Int J Hematol 2024; 120:229-240. [PMID: 38842630 DOI: 10.1007/s12185-024-03802-3] [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: 10/06/2023] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
We conducted a cross-sectional study to evaluate cellular and humoral immunogenicity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination or infection and examine how lymphocyte subpopulations in peripheral blood correlate with cellular and humoral immunogenicity in adult allogeneic hematopoietic cell transplantation (HCT) recipients. The median period from SARS-CoV-2 vaccination or infection to sample collection was 110.5 days (range, 6-345 days). The median SARS-CoV-2 spike-specific antibody level was 1761 binding antibody units (BAU)/ml (range, 0 to > 11,360 BAU/ml). Enzyme-linked immunosorbent spot (ELISpot) assay of T cells stimulated with SARS-CoV-2 spike antigens showed that interferon-gamma (IFN-γ)-, interleukin-2 (IL-2)-, and IFN-γ + IL-2-producing T cells were present in 68.9%, 62.0%, and 56.8% of patients, respectively. The antibody level was significantly correlated with frequency of IL-2-producing T cells (P = 0.001) and IFN-γ + IL-2-producing T cells (P = 0.006) but not IFN-γ-producing T cells (P = 0.970). Absolute counts of CD8+ and CD4+ central memory T cells were higher in both IL-2- and IFN-γ + IL-2-producing cellular responders compared with non-responders. These data suggest that cellular and humoral immunogenicity against SARS-CoV-2 vaccination or infection is associated with the memory phenotype of T cells and B cells in adult allogeneic HCT recipients.
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Affiliation(s)
- Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan.
| | - Megumi Hamatani-Asakura
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Etsuko Nagai
- Department of Laboratory Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiko Kato
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Masamichi Isobe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Maki Monna-Oiwa
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
| | - Satoshi Takahashi
- Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuhito Nannya
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, Japan
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3
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Chong EA, Kumashie KG, Chong ER, Fabrizio J, Gupta A, Svoboda J, Barta SK, Walsh KM, Napier EB, Lundberg RK, Nasta SD, Gerson JN, Landsburg DJ, Gonzalez J, Gaano A, Weirick ME, McAllister CM, Awofolaju M, John GN, Kammerman SC, Novacek J, Pajarillo R, Lundgreen KA, Tanenbaum N, Gouma S, Drapeau EM, Adamski S, D’Andrea K, Pattekar A, Hicks A, Korte S, Sharma H, Herring S, Williams JC, Hamilton JT, Bates P, Hensley SE, Prak ETL, Greenplate AR, Wherry EJ, Schuster SJ, Ruella M, Vella LA. Immunologic Predictors of Vaccine Responsiveness in Patients With Lymphoma and Chronic Lymphocytic Leukemia. J Infect Dis 2024; 230:15-27. [PMID: 39052709 PMCID: PMC11272091 DOI: 10.1093/infdis/jiae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/13/2024] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
Patients with B-cell lymphomas have altered cellular components of vaccine responses due to malignancy and therapy, and the optimal timing of vaccination relative to therapy remains unknown. Severe acute respiratory syndrome coronavirus 2 vaccines created an opportunity for new insights in vaccine timing because patients were challenged with a novel antigen across multiple phases of treatment. We studied serologic messenger RNA vaccine response in retrospective and prospective cohorts with lymphoma and chronic lymphocytic leukemia, paired with clinical and research immune parameters. Reduced serologic response was observed more frequently during active treatment, but nonresponse was also common within observation and posttreatment groups. Total immunoglobulin A and immunoglobulin M correlated with successful vaccine response. In individuals treated with anti-CD19-directed chimeric antigen receptor-modified T cells, nonresponse was associated with reduced B and T follicular helper cells. Predictors of vaccine response varied by disease and therapeutic group, and therefore further studies of immune health during and after cancer therapies are needed to individualize vaccine timing.
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Affiliation(s)
- Elise A Chong
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | | | - Emeline R Chong
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | - Joseph Fabrizio
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | - Aditi Gupta
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - Jakub Svoboda
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - Stefan K Barta
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - Kristy M Walsh
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | - Ellen B Napier
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | - Rachel K Lundberg
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
| | - Sunita D Nasta
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - James N Gerson
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - Daniel J Landsburg
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | | | | | | | | | | | - Gavin N John
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Shane C Kammerman
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia
| | - Josef Novacek
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia
| | | | | | | | | | | | - Sharon Adamski
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | - Kurt D’Andrea
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | - Ajinkya Pattekar
- Center for Cellular Immunotherapies
- Department of Pathology and Laboratory Medicine
| | - Amanda Hicks
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | - Scott Korte
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | - Harsh Sharma
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | - Sarah Herring
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | | | - Jacob T Hamilton
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
| | | | | | | | | | - E John Wherry
- Institute for Immunology
- Department of Pathology and Laboratory Medicine
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stephen J Schuster
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
| | - Marco Ruella
- The Richard Berman Family Innovations Center in CLL and Lymphomas, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania
- Center for Cellular Immunotherapies
- Institute for Immunology
| | - Laura A Vella
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia
- Department of Pathology and Laboratory Medicine
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4
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An J, Zhao J, Zou P, Zhang Y, Wei J, Tian W, Wei J. Infections associated with CAR-T cell therapy in patients with relapsed refractory multiple myeloma: Risks and prevention strategies. Cancer Med 2024; 13:e7372. [PMID: 38923216 PMCID: PMC11196838 DOI: 10.1002/cam4.7372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Chimeric antigen receptor T (CAR-T) cell therapy has emerged as a potent treatment for relapsed or refractory multiple myeloma, demonstrating significant clinical efficacy. Despite these advances, treatment-related toxicities, particularly infections, pose a significant challenge to patient safety. METHODS This review synthesizes current knowledge on the mechanisms underlying post-CAR-T therapy infections, focusing on the interplay between immune dysfunction, host factors, and treatment-induced toxicity. It provides a comprehensive analysis of the temporal and individual variability in infection characteristics and the confounding clinical presentation of cytokine release syndrome. RESULTS The review identifies that patients receiving CAR-T cells are at increased risk of concurrent infections due to the heterogeneity in infection characteristics across different time periods, individuals, and patient groups. It highlights the diagnostic and therapeutic complexities introduced by the overlapping symptoms of infection and cytokine release syndrome. CONCLUSION To enhance the infection control post-CAR-T therapy, this review proposes preventive strategies tailored to the early and long-term management of patients. It underscores the need for a nuanced understanding of infection mechanisms and the importance of personalized prevention plans to improve clinical outcomes in multiple myeloma treatment.
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Affiliation(s)
- Jing An
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesThird Hospital of Shanxi Medical University, Tongji Shanxi HospitalTaiyuanShanxiChina
- School of Public HealthShanxi Medical UniversityTaiyuanShanxiChina
| | - Jie Zhao
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesThird Hospital of Shanxi Medical University, Tongji Shanxi HospitalTaiyuanShanxiChina
- Sino‐German Joint Oncological Research LaboratoryShanxi Bethune Hospital, Shanxi Academy of Medical SciencesTaiyuanShanxiChina
| | - Ping Zou
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
| | - Junni Wei
- School of Public HealthShanxi Medical UniversityTaiyuanShanxiChina
| | - Weiwei Tian
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesThird Hospital of Shanxi Medical University, Tongji Shanxi HospitalTaiyuanShanxiChina
- School of Public HealthShanxi Medical UniversityTaiyuanShanxiChina
- Sino‐German Joint Oncological Research LaboratoryShanxi Bethune Hospital, Shanxi Academy of Medical SciencesTaiyuanShanxiChina
| | - Jia Wei
- Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical SciencesThird Hospital of Shanxi Medical University, Tongji Shanxi HospitalTaiyuanShanxiChina
- Sino‐German Joint Oncological Research LaboratoryShanxi Bethune Hospital, Shanxi Academy of Medical SciencesTaiyuanShanxiChina
- Department of Hematology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Immunotherapy Research Center for Hematologic Diseases of Hubei ProvinceWuhanHubeiChina
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5
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Kamboj M, Bohlke K, Baptiste DM, Dunleavy K, Fueger A, Jones L, Kelkar AH, Law LY, LeFebvre KB, Ljungman P, Miller ED, Meyer LA, Moore HN, Soares HP, Taplitz RA, Woldetsadik ES, Kohn EC. Vaccination of Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1699-1721. [PMID: 38498792 PMCID: PMC11095883 DOI: 10.1200/jco.24.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To guide the vaccination of adults with solid tumors or hematologic malignancies. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. RECOMMENDATIONS The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Mini Kamboj
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Kieron Dunleavy
- MedStar Georgetown University Hospital, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Abbey Fueger
- The Leukemia and Lymphoma Society, Rye Brook, NY
| | - Lee Jones
- Fight Colorectal Cancer, Arlington, VA
| | - Amar H Kelkar
- Harvard Medical School, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Per Ljungman
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eric D Miller
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Heloisa P Soares
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | | | - Elise C Kohn
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD
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6
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Sharifi Aliabadi L, Azari M, Taherian MR, Barkhordar M, Abbas SAM, Azari M, Ahmadvand M, Salehi Z, Rouzbahani S, Vaezi M. Immunologic responses to the third and fourth doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in cell therapy recipients: a systematic review and meta-analysis. Virol J 2024; 21:103. [PMID: 38702752 PMCID: PMC11067217 DOI: 10.1186/s12985-024-02375-1] [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: 01/18/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Multiple studies have provided evidence of suboptimal or poor immune responses to SARS-CoV-2 vaccines in recipients of hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor-T (CAR-T) cell therapy compared to healthy individuals. Given the dynamic nature of SARS-CoV2, characterized by the emergence of many viral variations throughout the general population, there is ongoing discussion regarding the optimal quantity and frequency of additional doses required to sustain protection against SARS-CoV2 especially in this susceptible population. This systematic review and meta-analysis investigated the immune responses of HSCT and CAR-T cell therapy recipients to additional doses of the SARS-CoV-2 vaccines. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study involved a comprehensive search across PubMed, Scopus, Web of Science Core Collection, Embase, and Cochrane Biorxiv and medRxiv, focusing on the serological responses to the third and fourth vaccine doses in HSCT and CAR-T cell patients. RESULTS This study included 32 papers, with 31 qualifying for the meta-analysis. Results showed that after the third dose, the seroconversion rate in HSCT and CAR-T cell therapy recipients who didn't respond to the second dose was 46.10 and 17.26%, respectively. Following the fourth dose, HSCT patients had a seroconversion rate of 27.23%. Moreover, post-third-dose seropositivity rates were 87.14% for HSCT and 32.96% for CAR-T cell therapy recipients. Additionally, the seropositive response to the fourth dose in the HSCT group was 90.04%. CONCLUSION While a significant portion of HSCT recipients developed antibodies after additional vaccinations, only a minority of CAR-T cell therapy patients showed a similar response. This suggests that alternative vaccination strategies are needed to protect these vulnerable groups effectively. Moreover, few studies have reported cellular responses to additional SARS-CoV-2 vaccinations in these patients. Further studies evaluating cellular responses are required to determine a more precise assessment of immunogenicity strength against SARS-CoV-2 after additional doses.
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Affiliation(s)
- Leyla Sharifi Aliabadi
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Azari
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Taherian
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barkhordar
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Morteza Azari
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ahmadvand
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Salehi
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Rouzbahani
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mohammad Vaezi
- Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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7
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Asimakopoulos JV, Lalou E, Seferlis G, Malliarou M, Konstantinou E, Drandakis I, Vasilopoulos I, Georgopoulou AN, Kopsaftopoulou A, Machairas A, Piperidou A, Karapaschalidis A, Lefaki ME, Galopoulos D, Arapaki MP, Petsa P, Benekou E, Siakantaris MP, Papavassiliou AG, Tsaftaridis P, Panayiotidis P, Vassilakopoulos TP, Papapanagiotou A, Angelopoulou MK. Monitoring Humoral Response Following BNT162b2 mRNA Vaccination against SARS-CoV-2 in Hematopoietic Stem-Cell Transplantation Patients: A Single-Center Prospective Study along with a Brief Review of Current Literature. Hematol Rep 2024; 16:220-233. [PMID: 38651451 PMCID: PMC11036264 DOI: 10.3390/hematolrep16020022] [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: 01/10/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Data on antibody response (AR) after vaccination against SARS-CoV2 in hematopoietic stem-cell transplantation setting (HSCT) were initially scarce, mainly due to the exclusion of such patients from approval studies. Shortly after the worldwide application of vaccination against SARS-CoV-2 in vulnerable populations such as patients with hematologic malignancies, limited single-center trials, including HSCT patients, were published. However, there was a great heterogeneity between them regarding the type of underlying malignancy, co-current treatment, type of vaccine, method of AR measurement, and time point of AR measurement. Herein, we present the results of a prospective study on AR after vaccination for SARS-CoV-2 using the BNT162b2 vaccine in a cohort of 54 HSCT recipients-mostly autologous from a single Unit-along with a broad review of the current literature. In our cohort, the AR positivity rate at 1 month was 80.8% and remained positive in 85.7% of patients at 3 months after vaccination. There were only nine non-responders, who were more heavily pretreated and more frequently hypogammaglobulinemic compared to responders. High antibody titers (AT), [AT ≥ 1000 U/mL], were detected in 38.5% and 30.6% of the patients at m1 and m3, respectively. A significant decline in AT between m1 and m3 was demonstrated-p < 0.0001; median AT1 and AT3 were 480.5 and 293 U/mL, respectively. A novel finding of our study was the negative impact of IgA hypogammaglobulinemia on response to vaccination. Other negative significant factors were treatment with anti-CD20 antibody at vaccination and vaccination within 18 months from HSCT. Our data indicate that HSCT recipients elicit a positive response to the BNT162b2 vaccine against SARS-CoV-2 when vaccinated at 6 months post-transplant, and vaccination should be offered to this patient population even within the post-pandemic COVID-19 era.
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Affiliation(s)
- John V. Asimakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Eleni Lalou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - George Seferlis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Maria Malliarou
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Biochemistry Laboratory, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (M.M.); (A.G.P.); (A.P.)
| | - Eliana Konstantinou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Ioannis Drandakis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Ioannis Vasilopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Angeliki N. Georgopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Anastasia Kopsaftopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Alexandros Machairas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Alexia Piperidou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Anestis Karapaschalidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Maria-Ekaterini Lefaki
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Dimitrios Galopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Maria-Panagiota Arapaki
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Panagiota Petsa
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Ekaterini Benekou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Marina P. Siakantaris
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Athanasios G. Papavassiliou
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Biochemistry Laboratory, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (M.M.); (A.G.P.); (A.P.)
| | - Panagiotis Tsaftaridis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Biochemistry Laboratory, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (M.M.); (A.G.P.); (A.P.)
| | - Maria K. Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Aghiou Thoma 17 str, 11527 Athens, Attica, Greece; (E.L.); (G.S.); (E.K.); (I.D.); (I.V.); (A.N.G.); (A.K.); (A.M.); (A.P.); (A.K.); (M.-E.L.); (M.-P.A.); (P.P.); (E.B.); (M.P.S.); (P.T.); (P.P.); (T.P.V.)
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8
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Bansal R, Vergidis P, Tosh PK, Wilson J, Hathcock M, Khurana A, Bennani NN, Paludo J, Villasboas JC, Wang Y, Ansell SM, Johnston PB, Freeman C, Lin Y. Serial Evaluation of Preimmunization Antibody Titers in Lymphoma Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:455.e1-455.e7. [PMID: 38346643 DOI: 10.1016/j.jtct.2024.02.003] [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: 12/23/2022] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Antibody titers and the potential need for immunization have not been formally studied in recipients of chimeric antigen receptor T cell therapy (CAR-T). Prior studies have shown that CD19-targeted CAR-T can induce persistent B cell aplasia but preserve plasma cells for humoral response. Aiming to assess the immune repertoire and antibody titer status of CAR-T recipients, we conducted a retrospective study of immune cell recovery and antibody titers to vaccines in anti-CD19 CAR-T recipients at Mayo Clinic, Rochester. In our cohort of 95 CAR-T recipients, almost one-half had low CD4 T and B cell counts prior to CAR-T that remained persistently low post-CAR-T. Prior to CAR-T, the seronegative rate was lowest for tetanus and highest for pneumococcus irrespective of prior transplantation status (within 2 years of CAR-T). At 3 months post-CAR-T, overall seronegativity rates were similar to pre-CAR-T rates for the prior transplantation and no prior transplantation groups. For patients who received IVIG, loss of seropositivity was seen for hepatitis A (1 of 7; 14%). No seroconversion was noted for pneumococcus. For patients who did not receive IVIG, loss of seropositivity was seen for pneumococcus (2 of 5; 40%) and hepatitis A (1 of 4; 25%). CAR-T recipients commonly experience T cell and B cell lymphopenia and might not have adequate antibody titers against vaccine-preventable diseases despite IVIG supplementation. Loss of antibody titers post-CAR-T is possible, highlighting the need for revaccination. Additional studies with long-term follow-up are needed to inform the optimal timing of immunization post-CAR-T.
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Affiliation(s)
- Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Pritish K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Catherine Freeman
- Division of Asthma, Allergy and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.
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9
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Abid MB, Rubin M, Szabo A, Longo W, Fenske TS, McCoy C, Lorge A, Abedin S, D'Souza A, Dhakal B, Shah NN, Hamadani M. Efficacy of Multiple SARS-CoV-2 Vaccine Doses in Patients with B Cell Hematologic Malignancies Receiving Chimeric Antigen Receptor T Cell Therapy: A Contemporary Cohort Analysis. Transplant Cell Ther 2024; 30:285-297. [PMID: 38142942 DOI: 10.1016/j.jtct.2023.12.011] [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: 08/29/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
The mortality due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) approaches 40% in recipients of chimeric antigen receptor (CAR) T cell therapy (CAR-T). The efficacy of repeated vaccine doses, including bivalent boosters, remains unknown. We examined the efficacy of repeated vaccine doses among CAR-T recipients who received at least 2 or more vaccine doses after T cell infusion. This single-center retrospective study included adults age >18 years receiving CAR-T for relapsed/refractory (R/R) B cell hematologic malignancies targeting CD19, BCMA, or CD19 and CD20 between September 2018 through March 2022 and were alive beyond 2021 to receive incremental SARS-CoV-2 vaccine doses with available seroconversion data. Multivariable analyses were performed using the design-adjusted Cox regression and logistic regression approaches with stratification. In multivariable analysis, seroconversion rates were significantly greater with a total of 4 or more vaccine doses (odds ratio [OR], 8.22; P = .008). CAR-T recipients with other B cell hematologic malignancies had significantly lower seroconversion rates and diminished Ab titers compared to those with R/R multiple myeloma (OR, .07; P = .003). One patient died due to COVID-19 in this vaccinated study cohort, accounting for a COVID-19-attributable mortality rate of 1.7%. The results provide baseline vaccine response data in a contemporary cohort including patients with diverse group of SARS-COV2 variants and support the latest Centers for Disease Control and Prevention guidelines for repeated vaccinations directed against the prevalent variant of concern.
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Affiliation(s)
- Muhammad Bilal Abid
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Micah Rubin
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Walter Longo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cole McCoy
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Lorge
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sameem Abedin
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Binod Dhakal
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
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10
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Ben Khlil AA, Zamali I, Belloumi D, Gdoura M, Kharroubi G, Marzouki S, Dachraoui R, Ben Yaiche I, Bchiri S, Hamdi W, Gharbi M, Ben Hmid A, Samoud S, Galai Y, Torjmane L, Ladeb S, Bettaieb J, Triki H, Ben Abdeljelil N, Ben Othman T, Ben Ahmed M. Immunogenicity and Tolerance of BNT162b2 mRNA Vaccine in Allogeneic Hematopoietic Stem Cell Transplant Patients. Vaccines (Basel) 2024; 12:174. [PMID: 38400157 PMCID: PMC10892348 DOI: 10.3390/vaccines12020174] [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: 12/28/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (ASCT) induces acquired immunodeficiency, potentially altering vaccine response. Herein, we aimed to explore the clinical tolerance and the humoral and cellular immune responses following anti-SARS-CoV-2 vaccination in ASCT recipients. METHODS A prospective, non-randomized, controlled study that involved 43 ASCT subjects and 31 healthy controls. Humoral response was investigated using the Elecsys® test anti-SARS-CoV-2. Cellular response was assessed using the QFN® SARS-CoV-2 test. The lymphocyte cytokine profile was tested using the LEGENDplex™ HU Th Cytokine Panel Kit (12-plex). RESULTS Adverse effects (AE) were observed in 69% of patients, encompassing pain at the injection site, fever, asthenia, or headaches. Controls presented more side effects like pain in the injection site and asthenia with no difference in the overall AE frequency. Both groups exhibited robust humoral and cellular responses. Only the vaccine transplant delay impacted the humoral response alongside a previous SARS-CoV-2 infection. Noteworthily, controls displayed a Th1 cytokine profile, while patients showed a mixed Th1/Th2 profile. CONCLUSIONS Pfizer-BioNTech® anti-SARS-CoV-2 vaccination is well tolerated in ASCT patients, inducing robust humoral and cellular responses. Further exploration is warranted to understand the impact of a mixed cytokine profile in ASCT patients.
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Affiliation(s)
- Ahmed Amine Ben Khlil
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
| | - Imen Zamali
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
| | - Dorra Belloumi
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Mariem Gdoura
- Laboratory of Virology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (M.G.); (M.G.)
- Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Ghassen Kharroubi
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Soumaya Marzouki
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
| | - Rym Dachraoui
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Insaf Ben Yaiche
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Soumaya Bchiri
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
| | - Walid Hamdi
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
| | - Manel Gharbi
- Laboratory of Virology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (M.G.); (M.G.)
| | - Ahlem Ben Hmid
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
| | - Samar Samoud
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
| | - Yousr Galai
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Lamia Torjmane
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Saloua Ladeb
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Jihene Bettaieb
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Henda Triki
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Virology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (M.G.); (M.G.)
| | - Nour Ben Abdeljelil
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Tarek Ben Othman
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Department of Hematology and Transplant, Centre National de Greffe de Moelle Osseuse, Tunis 1006, Tunisia
| | - Melika Ben Ahmed
- Department of Clinical Immunology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.A.B.K.); (I.Z.); (W.H.); (A.B.H.); (S.S.); (Y.G.)
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis 1068, Tunisia; (D.B.); (G.K.); (R.D.); (I.B.Y.); (L.T.); (S.L.); (J.B.); (H.T.); (N.B.A.); (T.B.O.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.M.); (S.B.)
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11
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Hill JA, Martens MJ, Young JAH, Bhavsar K, Kou J, Chen M, Lee LW, Baluch A, Dhodapkar MV, Nakamura R, Peyton K, Howard DS, Ibrahim U, Shahid Z, Armistead P, Westervelt P, McCarty J, McGuirk J, Hamadani M, DeWolf S, Hosszu K, Sharon E, Spahn A, Toor AA, Waldvogel S, Greenberger LM, Auletta JJ, Horowitz MM, Riches ML, Perales MA. SARS-CoV-2 vaccination in the first year after hematopoietic cell transplant or chimeric antigen receptor T cell therapy: A prospective, multicenter, observational study (BMT CTN 2101). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.24.24301058. [PMID: 38343800 PMCID: PMC10854344 DOI: 10.1101/2024.01.24.24301058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background The optimal timing of vaccination with SARS-CoV-2 vaccines after cellular therapy is incompletely understood. Objective To describe humoral and cellular responses after SARS-CoV-2 vaccination initiated <4 months versus 4-12 months after cellular therapy. Design Multicenter prospective observational study. Setting 34 centers in the United States. Participants 466 allogeneic hematopoietic cell transplant (HCT; n=231), autologous HCT (n=170), or chimeric antigen receptor T cell (CAR-T cell) therapy (n=65) recipients enrolled between April 2021 and June 2022. Interventions SARS-CoV-2 vaccination as part of routine care. Measurements We obtained blood prior to and after vaccinations at up to five time points and tested for SARS-CoV-2 spike (anti-S) IgG in all participants and neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains, as well as SARS-CoV-2-specific T cell receptors (TCRs), in a subgroup. Results Anti-S IgG and neutralizing antibody responses increased with vaccination in HCT recipients irrespective of vaccine initiation timing but were unchanged in CAR-T cell recipients initiating vaccines within 4 months. Anti-S IgG ≥2,500 U/mL was correlated with high neutralizing antibody titers and attained by the last time point in 70%, 69%, and 34% of allogeneic HCT, autologous HCT, and CAR-T cell recipients, respectively. SARS-CoV-2-specific T cell responses were attained in 57%, 83%, and 58%, respectively. Humoral and cellular responses did not significantly differ among participants initiating vaccinations <4 months vs 4-12 months after cellular therapy. Pre-cellular therapy SARS-CoV-2 infection or vaccination were key predictors of post-cellular therapy anti-S IgG levels. Limitations The majority of participants were adults and received mRNA vaccines. Conclusions These data support starting mRNA SARS-CoV-2 vaccination three to four months after allogeneic HCT, autologous HCT, and CAR-T cell therapy. Funding National Marrow Donor Program, Leukemia and Lymphoma Society, Multiple Myeloma Research Foundation, Novartis, LabCorp, American Society for Transplantation and Cellular Therapy, Adaptive Biotechnologies, and the National Institutes of Health.
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Affiliation(s)
- Joshua A Hill
- Vaccine and Infectious Disease, Fred Hutchinson Cancer Center, and Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Martens
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Kavita Bhavsar
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jianqun Kou
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Min Chen
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lik Wee Lee
- Adaptive Biotechnologies Corp, Seattle, WA, USA
| | - Aliyah Baluch
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | | | | | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Armistead
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Peter Westervelt
- Barnes-Jewish Hospital, Washington University, St. Louis, MO, USA
| | - John McCarty
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Susan DeWolf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kinga Hosszu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, MD, USA
| | - Ashley Spahn
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - Amir A Toor
- Lehigh Valley Health Network, Allentown, PA, USA
| | - Stephanie Waldvogel
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | | | - Jeffery J Auletta
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcie L Riches
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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12
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Tsutsumi Y, Ito S, Horikita F, Moriki A, Teshima T. COVID‑19 antibody production by vaccination in chemotherapy with CD20 antibody for B‑cell lymphoma. Mol Clin Oncol 2023; 19:96. [PMID: 37920416 PMCID: PMC10619194 DOI: 10.3892/mco.2023.2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
Most hematologic diseases are immunosuppressed, either by the disease itself or by treatment. As such, the implementation of vaccination is largely at the discretion of the attending physician. In this context, an objective measure is needed, therefore the index of vaccination against coronavirus disease 2019 (COVID-19) in B-cell lymphomas treated with antibody therapy against CD20 (including after the completion of therapy) was examined. A total of 40 patients with B-cell lymphoma during or after antibody therapy against CD20 were vaccinated twice with the BNT162b2 messenger RNA (mRNA) COVID-19 vaccine (Pfizer, Inc. and BioNTech SE.) at 3-week intervals and then again six months later with the same vaccine or mRNA-1273 (Moderna, Inc.). Antibody testing was conducted ~1 month after the third vaccination. Analysis was performed using the antibody titers to the anti-spike immunoglobulin assay, with a titer of 0.8 U/ml or higher (considered positive) and a titer of 264 U/ml or higher (considered the value at which the efficacy of the vaccine can be fully expected). Significant factors of antibody acquisition were identified when i) antibody titers were 0.8 U/ml or higher (CD4 ≥400/µl), ii) no anti-CD20 antibody maintenance therapy was undertaken (CD19 ≥100/µl), iii) patients were not on treatment (CD4 ≥400/µl), or 4) at least six months had passed since treatment ended (CD19 ≥100/µl). When antibody titers were 264 U/ml or higher, the treatment method, the stage of the primary disease and other factors related to the condition treatment method of the patient were relevant. When these were analyzed by multivariate analysis, the significant factor when antibody titers were set to 0.8 U/ml was CD19 ≥100/µl. In contrast, when setting them to 264 U/ml or higher, CD4 ≥400/µl was not significant, but there was a tendency for it to be related. The findings of the present study on vaccine-induced antibody acquisition in patients with B-cell lymphoma indicated that it is desirable to have a CD19 titer of at least 100/µl and a CD4 titer of at least 400/µl (both conditions should be met), and that no maintenance therapy with anti-CD20 antibody should be administered for at least six months after the last treatment or completion of the treatment. Interestingly, when the criteria for antibody titers were compared between 0.8 U/ml, where antibody titer is detected, and 264 U/ml, where vaccine efficacy is expected, several key factors were different. It is possible that these key factors may change depending on the antibody titer used as a criterion.
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Affiliation(s)
- Yutaka Tsutsumi
- Department of Hematology, Hakodate Municipal Hospital, Minato-cho, Hakodate, Hokkaido 041-8680, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Minato-cho, Hakodate, Hokkaido 041-8680, Japan
| | - Fuka Horikita
- Department of Hematology, Hakodate Municipal Hospital, Minato-cho, Hakodate, Hokkaido 041-8680, Japan
| | - Asako Moriki
- Department of Hematology, Hakodate Municipal Hospital, Minato-cho, Hakodate, Hokkaido 041-8680, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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13
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Kampouri E, Hill JA, Dioverti V. COVID-19 after hematopoietic cell transplantation and chimeric antigen receptor (CAR)-T-cell therapy. Transpl Infect Dis 2023; 25 Suppl 1:e14144. [PMID: 37767643 DOI: 10.1111/tid.14144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
More than 3 years have passed since Coronavirus disease 2019 (COVID-19) was declared a global pandemic, yet COVID-19 still severely impacts immunocompromised individuals including those treated with hematopoietic cell transplantation (HCT) and chimeric antigen receptor-T-cell therapies who remain at high risk for severe COVID-19 and mortality. Despite vaccination efforts, these patients have inadequate responses due to immunosuppression, which underscores the need for additional preventive approaches. The optimal timing, schedule of vaccination, and immunological correlates for protective immunity remain unknown. Antiviral therapies used early during disease can reduce mortality and severity due to COVID-19. The combination or sequential use of antivirals could be beneficial to control replication and prevent the development of treatment-related mutations in protracted COVID-19. Despite conflicting data, COVID-19 convalescent plasma remains an option in immunocompromised patients with mild-to-moderate disease to prevent progression. Protracted COVID-19 has been increasingly recognized among these patients and has been implicated in intra-host emergence of SARS-CoV-2 variants. Finally, novel SARS-CoV2-specific T-cells and natural killer cell-boosting (or -containing) products may be active against multiple variants and are promising therapies in immunocompromised patients.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Veronica Dioverti
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Ge T, Liu H, Wang ZH, Cao Y, Zhang YC, Huang L, Qian WB, Zhou XX. [Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:825-831. [PMID: 38049334 PMCID: PMC10694084 DOI: 10.3760/cma.j.issn.0253-2727.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Indexed: 12/06/2023]
Abstract
Objective: To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy, and study the influencing factors of severe COVID-19 infection in these patients. Methods: The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology and Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University between December 2017 and February 2023, and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied. Patients were divided into light, medium, severe, and critical groups, and the differences between the groups were analyzed using the chi-square test. A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection. The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery (BCR) groups. Results: Of the 59 pre- and post-infusion infections, 39 (66.1%) led to mild COVID-19, 9 (15.3%) resulted in moderate COVID-19, 10 (16.9%) resulted in severe COVID-19, and 1 (1.7%) led to critical COVID-19. Moroever, age greater than 55 years, having received autologous hematopoietic stem cell transplantation, progressive disease status, and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection. Patients with B-cell aplasia had a more severe infection with COVID-19 (P<0.001), a longer duration (P=0.015), a longer antiviral therapy course (P<0.001), and a higher hospitalization rate (P<0.001) than the BCR group. Conclusion: Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.
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Affiliation(s)
- T Ge
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - H Liu
- Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Z H Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Y C Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - L Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - W B Qian
- Department of Hematology, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - X X Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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15
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Meejun T, Srisurapanont K, Manothummetha K, Thongkam A, Mejun N, Chuleerarux N, Sanguankeo A, Phongkhun K, Leksuwankun S, Thanakitcharu J, Lerttiendamrong B, Langsiri N, Torvorapanit P, Worasilchai N, Plongla R, Hirankarn N, Nematollahi S, Permpalung N, Moonla C, Kates OS. Attenuated immunogenicity of SARS-CoV-2 vaccines and risk factors in stem cell transplant recipients: a meta-analysis. Blood Adv 2023; 7:5624-5636. [PMID: 37389818 PMCID: PMC10514108 DOI: 10.1182/bloodadvances.2023010349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is diminished in hematopoietic stem cell transplant (HSCT) recipients. To summarize current evidence and identify risk factors for attenuated responses, 5 electronic databases were searched since database inceptions through 12 January 2023 for studies reporting humoral and/or cellular immunogenicity of SARS-CoV-2 vaccination in the HSCT population. Using descriptive statistics and random-effects models, extracted numbers of responders and pooled odds ratios (pORs) with 95% confidence intervals (CIs) for risk factors of negative immune responses were analyzed (PROSPERO: CRD42021277109). From 61 studies with 5906 HSCT recipients, after 1, 2, and 3 doses of messenger RNA (mRNA) SARS-CoV-2 vaccines, the mean antispike antibody seropositivity rates (95% CI) were 38% (19-62), 81% (77-84), and 80% (75-84); neutralizing antibody seropositivity rates were 52% (40-64), 71% (54-83), and 78% (61-89); and cellular immune response rates were 52% (39-64), 66% (51-79), and 72% (52-86). After 2 vaccine doses, risk factors (pOR; 95% CI) associated with antispike seronegativity were male recipients (0.63; 0.49-0.83), recent rituximab exposure (0.09; 0.03-0.21), haploidentical allografts (0.46; 0.22-0.95), <24 months from HSCT (0.25; 0.07-0.89), lymphopenia (0.18; 0.13-0.24), hypogammaglobulinemia (0.23; 0.10-0.55), concomitant chemotherapy (0.48; 0.29-0.78) and immunosuppression (0.18; 0.13-0.25). Complete remission of underlying hematologic malignancy (2.55; 1.05-6.17) and myeloablative conditioning (1.72; 1.30-2.28) compared with reduced-intensity conditioning were associated with antispike seropositivity. Ongoing immunosuppression (0.31; 0.10-0.99) was associated with poor cellular immunogenicity. In conclusion, attenuated humoral and cellular immune responses to mRNA SARS-CoV-2 vaccination are associated with several risk factors among HSCT recipients. Optimizing individualized vaccination and developing alternative COVID-19 prevention strategies are warranted.
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Affiliation(s)
- Tanaporn Meejun
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Kasama Manothummetha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Achitpol Thongkam
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nuthchaya Mejun
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nipat Chuleerarux
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Anawin Sanguankeo
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kasidis Phongkhun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Surachai Leksuwankun
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Nattapong Langsiri
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pattama Torvorapanit
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Rongpong Plongla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattiya Hirankarn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saman Nematollahi
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Nitipong Permpalung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Olivia S. Kates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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16
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Liang EC, Onstad LE, Carpenter P, Pergam SA, Flowers ME, Lee SJ, Liu C. Association of Self-Reported COVID-19 Vaccination Status with COVID-19 Infection among Adult Long-Term Hematopoietic Cell Transplantation Survivors. Transplant Cell Ther 2023; 29:584.e1-584.e9. [PMID: 37394113 PMCID: PMC10528463 DOI: 10.1016/j.jtct.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
Hematopoietic cell transplantation (HCT) recipients experience significant morbidity and mortality from coronavirus disease 19 (COVID-19) infection. Data are limited regarding long-term HCT survivors' uptake of and experiences with COVID-19 vaccination and infection. This study aimed to characterize COVID-19 vaccination uptake, use of other prevention measures, and COVID-19 infection outcomes in adult HCT recipients at our institution. Between July 1, 2021, and June 30, 2022, long-term adult HCT survivors were surveyed regarding overall health, chronic graft-versus-host (cGVHD) status, and experiences with COVID-19 vaccinations, prevention measures, and infections. Patients reported COVID-19 vaccination status, vaccine-related adverse effects, use of nonpharmaceutical prevention measures, and infections. Comparisons by response and vaccination status were performed using the chi-square test and Fisher exact test for categorical variables and the Kruskal-Wallis test for continuous variables. Of 4758 adult HCT survivors who underwent HCT between 1971 and 2021 and consented to participate in annual surveys, 1719 (36%) completed the COVID-19 module, and 1598 of 1705 (94%) reported receiving ≥1 dose of COVID-19 vaccine. Severe vaccine-related adverse effects were infrequent (5%). Among respondents receiving an mRNA vaccine, completion of doses according to the Centers for Disease Control and Prevention's vaccine recommendations at the time of survey return was 2 doses in 675 of 759 (89%), 3 doses in 610 of 778 (78%), and 4 doses in 26 of 55 (47%). Two hundred fifty respondents (15%) reported COVID-19 infection; 25 (10%) required hospitalization. Vaccinated respondents reported significantly higher uptake of household vaccination (1284 of 1404 [91%] versus 18 of 88 [20%]; P < .001) and the use of nonpharmaceutical interventions (P < .001). Vaccinated respondents were significantly less likely to have contracted COVID-19 (85 of 1480 [6%] versus 130 of 190 [68%]; P < .001), as were their household members (149 of 1451 [10%] versus 85 of 185 [46%]; P < .001). Receipt of additional COVID-19 vaccine doses beyond the first dose was associated with a reduced risk of COVID-19 infection (odds ratio, .63; 95% confidence interval, .47 to .85; P = .002). Vaccination was well tolerated and associated with a lower risk of COVID-19 infection among HCT survivors and their household contacts. Vaccination and booster doses should be encouraged as part of a multifaceted approach in this high-risk population.
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Affiliation(s)
- Emily C Liang
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Paul Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Steven A Pergam
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Catherine Liu
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington.
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17
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Cesaro S, Mikulska M, Hirsch HH, Styczynski J, Meylan S, Cordonnier C, Navarro D, von Lilienfeld-Toal M, Mehra V, Marchesi F, Besson C, Masculano RC, Beutel G, Einsele H, Maertens J, de la Camara R, Ljungman P, Pagano L. Update of recommendations for the management of COVID-19 in patients with haematological malignancies, haematopoietic cell transplantation and CAR T therapy, from the 2022 European Conference on Infections in Leukaemia (ECIL 9). Leukemia 2023; 37:1933-1938. [PMID: 37460673 PMCID: PMC10457191 DOI: 10.1038/s41375-023-01938-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Simone Cesaro
- Paediatric Haematology-Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Hans H Hirsch
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Jan Styczynski
- Department of Paediatric Haematology and Oncology, Jurasz University Hospital, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Sylvain Meylan
- Infectious Diseases Service, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital, APHP, and University Paris Est-Créteil, Paris, France
| | - Davide Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Marie von Lilienfeld-Toal
- Klinik fur Innere Medizin II (Haematologie/Oncologie), Universitatsklinikum Jena, Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Varun Mehra
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Francesco Marchesi
- Haematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Caroline Besson
- Service d'Hematologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, Villejuif, France
| | - Raul Cordoba Masculano
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Gernot Beutel
- Department for Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Herman Einsele
- Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
| | - Johan Maertens
- Haematology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Per Ljungman
- Division of Haematology, Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Livio Pagano
- Institute of Haematology, Faculty of Medicine and Surgery, "Sacro Cuore" Catholic University, Rome, Italy
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18
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Lin CY, Chien HJ. Acute exacerbation of ocular graft-versus-host disease and anterior uveitis after COVID-19 vaccination. BMC Ophthalmol 2023; 23:360. [PMID: 37596535 PMCID: PMC10439537 DOI: 10.1186/s12886-023-03103-z] [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: 03/10/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND To report a case of simultaneous occurrence of acute exacerbation of ocular graft-versus-host disease (GVHD) and anterior uveitis following coronavirus disease 2019 (COVID-19) vaccination. CASE PRESENTATION A 60-year-old man with primary myelofibrosis and GVHD after receiving allogeneic hematopoietic stem cell transplantation (HSCT), developed acute exacerbation of ocular GVHD and anterior uveitis after receiving first dose of COVID-19 vaccine. The patient developed erythema of the eyelids, conjunctival hyperemia, superficial punctate keratopathy, and prominent anterior chamber inflammation in both eyes. The ocular GVHD and anterior uveitis were managed with mainly topical corticosteroids, antibiotics, lubricants, and systemic corticosteroids, but were difficult to control. Intravitreal injection of dexamethasone was administered, and the inflammation gradually subsided 6 months after the onset of initial symptoms. CONCLUSIONS Clinicians should be aware of rare refractory anterior uveitis and acute exacerbation of ocular GVHD after COVID-19 vaccination in patients undergoing HSCT. Early diagnosis and aggressive treatment should be considered to reduce the likelihood of severe complications.
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Affiliation(s)
- Chen-Yu Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan
| | - Hung-Jen Chien
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan.
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19
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Zhang T, Tian W, Wei S, Lu X, An J, He S, Zhao J, Gao Z, Li L, Lian K, Zhou Q, Zhang H, Wang L, Su L, Kang H, Niu T, Zhao A, Pan J, Cai Q, Xu Z, Chen W, Jing H, Li P, Zhao W, Cao Y, Mi J, Chen T, Chen Y, Zou P, Lukacs-Kornek V, Kurts C, Li J, Liu X, Mei Q, Zhang Y, Wei J. Multidisciplinary recommendations for the management of CAR-T recipients in the post-COVID-19 pandemic era. Exp Hematol Oncol 2023; 12:66. [PMID: 37501090 PMCID: PMC10375673 DOI: 10.1186/s40164-023-00426-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented challenge on public health systems. Despite the measures put in place to contain it, COVID-19 is likely to continue experiencing sporadic outbreaks for some time, and individuals will remain susceptible to recurrent infections. Chimeric antigen receptor (CAR)-T recipients are characterized by durable B-cell aplasia, hypogammaglobulinemia and loss of T-cell diversity, which lead to an increased proportion of severe/critical cases and a high mortality rate after COVID-19 infection. Thus, treatment decisions have become much more complex and require greater caution when considering CAR T-cell immunotherapy. Hence, we reviewed the current understanding of COVID-19 and reported clinical experience in the management of COVID-19 and CAR-T therapy. After a panel discussion, we proposed a rational procedure pertaining to CAR-T recipients with the aim of maximizing the benefit of CAR-T therapy in the post COVID-19 pandemic era.
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Affiliation(s)
- Tingting Zhang
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Weiwei Tian
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Shuang Wei
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Department of Respiratory and Critical Care Medicine, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Xinyi Lu
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Jing An
- School of Public Health, Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Shaolong He
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Jie Zhao
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Zhilin Gao
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Li Li
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Ke Lian
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China
| | - Qiang Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Department of Cardiovascular Medicine, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Liang Wang
- Department of Hematology, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Liping Su
- Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Huicong Kang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Department of Neurology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ailin Zhao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Pan
- State Key Laboratory of Experimental Hematology, Boren Biotherapy Translational Laboratory, Boren Clinical Translational Center, Beijing GoBroad Boren Hospital, Beijing, 100070, China
| | - Qingqing Cai
- Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Zhenshu Xu
- Hematology Department, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, 350001, Fujian, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Hongmei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, 100191, China
| | - Peng Li
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510535, Guangdong, China
| | - Wanhong Zhao
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shanxi, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, 430030, Hubei, China
| | - Jianqing Mi
- Shanghai Institute of Hematology, Ruijin Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tao Chen
- Department and Institute of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yuan Chen
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Department of Geriatrics, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China
| | - Ping Zou
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Veronika Lukacs-Kornek
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, 53111, Bonn, Germany
| | - Christian Kurts
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, 53111, Bonn, Germany
| | - Jian Li
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, 53111, Bonn, Germany
| | - Xiansheng Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Department of Respiratory and Critical Care Medicine, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China.
| | - Qi Mei
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China.
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, 430030, Hubei, China.
| | - Jia Wei
- Department of Hematology, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China.
- Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, 030032, Shanxi, China.
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, 430030, Hubei, China.
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20
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Fattizzo B, Rampi N, Barcellini W. Vaccinations in hematological patients in the era of target therapies: Lesson learnt from SARS-CoV-2. Blood Rev 2023; 60:101077. [PMID: 37029066 PMCID: PMC10043962 DOI: 10.1016/j.blre.2023.101077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
Novel targeting agents for hematologic diseases often exert on- or off-target immunomodulatory effects, possibly impacting on response to anti-SARS-CoV-2 vaccinations and other vaccines. Agents that primarily affect B cells, particularly anti-CD20 monoclonal antibodies (MoAbs), Bruton tyrosine kinase inhibitors, and anti-CD19 chimeric antigen T-cells, have the strongest impact on seroconversion. JAK2, BCL-2 inhibitors and hypomethylating agents may hamper immunity but show a less prominent effect on humoral response to vaccines. Conversely, vaccine efficacy seems not impaired by anti-myeloma agents such as proteasome inhibitors and immunomodulatory agents, although lower seroconversion rates are observed with anti-CD38 and anti-BCMA MoAbs. Complement inhibitors for complement-mediated hematologic diseases and immunosuppressants used in aplastic anemia do not generally affect seroconversion rate, but the extent of the immune response is reduced under steroids or anti-thymocyte globulin. Vaccination is recommended prior to treatment or as far as possible from anti-CD20 MoAb (at least 6 months). No clearcut indications for interrupting continuous treatment emerged, and booster doses significantly improved seroconversion. Cellular immune response appeared preserved in several settings.
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Affiliation(s)
- Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Nicolò Rampi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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21
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Chu C, Jiang SK, Shao YC, Yeh SP. Case report: Sudden onset optic neuritis shortly after SARS-CoV-2 vaccination in an allogeneic hematopoietic stem cell transplant recipient with chronic graft-vs.-host disease. Front Med (Lausanne) 2023; 10:1177610. [PMID: 37409268 PMCID: PMC10318169 DOI: 10.3389/fmed.2023.1177610] [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: 03/01/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) recipients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a high mortality rate. The American Society of Transplantation and Cellular Therapy (ASTCT) and the European Society for Blood and Marrow Transplantation (EBMT) recommend vaccination for these vulnerable populations. However, emerging data suggested that vaccination might elicit immunological adverse events, including an exacerbation of graft-vs.-host disease (GVHD). Herein, we report a case of severe optic neuritis developed shortly after AstraZeneca COVID-19 vaccination in an allogeneic HSCT recipient with underlying chronic GVHD. The patient had a headache 5 days after vaccination, and the disease progressed rapidly to complete blindness 17 days after the vaccination. The diagnosis of optic neuritis was well-confirmed by the presence of an anti-myelin oligodendrocyte glycoprotein antibody and the typical features of MRI image and Ophthalmoscopy. Other differential diagnoses, such as infection or leukemia relapse in the central nervous system (CNS), were carefully excluded. A timely high-dose corticosteroid was administered, and her visual acuity improved rapidly. She returned to her baseline status 1 month later. With more than 1 year of follow-up, no optic neuritis or leukemia relapse was observed. In summary, allogeneic transplant recipients can develop severe optic neuritis after vaccination. Optic neuritis can be an exacerbation of GVHD or rarely a sporadic adverse event of vaccination. Furthermore, our experience indicates that a prompt diagnosis and early steroid treatment are vital for a good recovery.
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Affiliation(s)
- Chiang Chu
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shin-Kuang Jiang
- Division of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Ching Shao
- Eye Center, China Medical University Hospital, Taichung, Taiwan
| | - Su-Peng Yeh
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
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22
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Aleissa MM, Little JS, Davey S, Saucier A, Zhou G, Gonzalez-Bocco IH, Crombie JL, Looka A, Baden LR, Issa NC, Hammond SP, Jacobson CA, Sherman AC. Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Immunogenicity among Chimeric Antigen Receptor T Cell Therapy Recipients. Transplant Cell Ther 2023; 29:398.e1-398.e5. [PMID: 36906276 PMCID: PMC9995387 DOI: 10.1016/j.jtct.2023.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
Patients receiving chimeric antigen receptor T cell (CAR-T) therapy may have impaired humoral responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations owing to their underlying hematologic malignancy, prior lines of therapy, and CAR-T-associated hypogammaglobulinemia. Comprehensive data on vaccine immunogenicity in this patient population are limited. A single-center retrospective study of adults receiving CD19 or BCMA-directed CAR-T therapy for B cell non-Hodgkin lymphoma or multiple myeloma was conducted. Patients received at least 2 doses of SARS-CoV-2 vaccination with BNT162b2 or mRNA-1273 or 1 dose of Ad26.COV2.S and had SARS-CoV-2 anti-spike antibody (anti-S IgG) levels measured at least 1 month after the last vaccine dose. Patients were excluded if they received SARS-CoV-2 monoclonal antibody therapy or immunoglobulin within 3 months of the index anti-S titer. The seropositivity rate (assessed by an anti-S assay cutoff of ≥.8 U/mL in the Roche assay) and median anti-S IgG titers were analyzed. Fifty patients were included in the study. The median age was 65 years (interquartile range [IQR], 58 to 70 years), and the majority were male (68%). Thirty-two participants (64%) had a positive antibody response, with a median titer of 138.5 U/mL (IQR, 11.61 to 2541 U/mL). Receipt of ≥3 vaccines was associated with a significantly higher anti-S IgG level. Our study supports current guidelines for SARS-CoV-2 vaccination among recipients of CAR-T therapy and demonstrates that a 3-dose primary series followed by a fourth booster increases antibody levels. However, the relatively low magnitude of titers and low percentage of nonresponders demonstrates that further studies are needed to optimize vaccination timing and determine predictors of vaccine response in this population.
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Affiliation(s)
- Muneerah M Aleissa
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Jessica S Little
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sonya Davey
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Saucier
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isabel H Gonzalez-Bocco
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jennifer L Crombie
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Andrew Looka
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nicolas C Issa
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sarah P Hammond
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caron A Jacobson
- Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Amy C Sherman
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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23
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Macková J, Hainz P, Kryštofová J, Roubalová K, Šťastná-Marková M, Vaníková Š, Musil J, Vydra J, Němečková Š. Specific immune response to mRNA vaccines against COVID-19 in patients receiving allogeneic stem cell transplantation for myeloid malignancy was altered by immunosuppressive therapy. Leuk Res 2023; 130:107314. [PMID: 37216792 DOI: 10.1016/j.leukres.2023.107314] [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: 03/08/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are at high risk of complications associated with COVID-19 infection due to dysfunction of their immune system. Vaccination can protect from the adverse consequences of COVID-19. However, studies on the efficacy of COVID-19 vaccines in HSCT recipients with insufficient post-HSCT immune reconstitution are still scarce. In our study, we determined how immunosuppressive medication and the reconstitution of the cellular immune system influenced T cell responses specific for the surface glycoprotein of SARS-CoV-2 virus (S antigen) after two doses of mRNA vaccine against COVID-19 in patients with myeloid malignancies treated with HSCT. METHODS Vaccination outcomes were followed in 18 (allo-HSCT) recipients and 8 healthy volunteers. The IgG antibodies against SARS-CoV-2 spike (S) and nucleocapsid (NCP) protein were determined in ELISA and S-specific T cells were detected using a sensitive ELISPOT-IFNγ based on in vitro expansion and restimulation of T cells in pre- and post-vaccination blood samples. Multiparametric flow cytometry analysis of peripheral blood leukocyte differentiation markers was employed for determination of reconstitution of the main subpopulations of T cells and NK cells at month 6 after HSCT. RESULTS S- specific IgG antibody response detected in 72% of the patients was lower than in healthy vaccinees (100%). Vaccine-induced T-cell responses to S1 or S2 antigen were significantly reduced in HSCT recipients, which were treated with corticosteroids in dose 5 mg of prednisone- equivalents or higher during the vaccination period or in preceeding 100 days in comparison with recipients un-affected with corticosteroids. A significant positive correlation was found between the level of anti-SARS-Cov-2 spike protein IgG antibodies and the number of functional S antigen-specific T cells. Further analysis also showed that the specific response to vaccination was significantly influenced by the interval between administration of vaccine and transplantation. Vaccination outcomes were not related to age, sex, type of mRNA vaccine used, basic diagnosis, HLA match between HSC donor and recipient, and blood counts of lymphocytes, neutrophils, and monocytes at the time of vaccination. Multiparametric flow cytometry analysis of peripheral blood leukocyte differentiation markers showed that good humoral and cellular S-specific immune responses induced by vaccination were associated with well-reconstituted CD4+ T cells, mainly CD4+ effector memory subpopulation at six months after HSCT. CONCLUSIONS The results showed that both humoral and cellular adaptive immune responses of HSCT recipients to the SARS-CoV-2 vaccine were significantly suppressed by corticosteroid therapy. Specific response to the vaccine was significantly affected by the length of the interval between HSCT and vaccination. Vaccination as early as 5 months after HSCT can lead to a good response. Immune response to the vaccine is not related to age, gender, HLA match between HSC donor and recipient, or type of myeloid malignancy. Vaccine efficacy was dependent on well-reconstituted CD4+ T cells, at six months after HSCT.
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Affiliation(s)
- Jana Macková
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Petr Hainz
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jitka Kryštofová
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Kateřina Roubalová
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Markéta Šťastná-Marková
- Transplant Unit and Hematological Intensive Care Unit, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Šárka Vaníková
- Department of Immunomonitoring and Flow Cytometry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jan Musil
- Department of Immunomonitoring and Flow Cytometry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jan Vydra
- Transplant Unit and Hematological Intensive Care Unit, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Šárka Němečková
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
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24
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Hill JA, Martens MJ, Young JAH, Bhavsar K, Kou J, Chen M, Lee LW, Baluch A, Dhodapkar MV, Nakamura R, Peyton K, Shahid Z, Armistead P, Westervelt P, McCarty J, McGuirk J, Hamadani M, DeWolf S, Hosszu K, Sharon E, Spahn A, Toor AA, Waldvogel S, Greenberger LM, Auletta JJ, Horowitz MM, Riches ML, Perales MA. SARS-CoV-2 vaccination in the first year after allogeneic hematopoietic cell transplant: a prospective, multicentre, observational study. EClinicalMedicine 2023; 59:101983. [PMID: 37128256 PMCID: PMC10133891 DOI: 10.1016/j.eclinm.2023.101983] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
Background The optimal timing for SARS-CoV-2 vaccines within the first year after allogeneic hematopoietic cell transplant (HCT) is poorly understood. Methods We conducted a prospective, multicentre, observational study of allogeneic HCT recipients who initiated SARS-CoV-2 vaccinations within 12 months of HCT. Participants were enrolled at 22 academic cancer centers across the United States. Participants of any age who were planning to receive a first post-HCT SARS-CoV-2 vaccine within 12 months of HCT were eligible. We obtained blood prior to and after each vaccine dose for up to four vaccine doses, with an end-of-study sample seven to nine months after enrollment. We tested for SARS-CoV-2 spike protein (anti-S) IgG; nucleocapsid protein (anti-N) IgG; neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains; and SARS-CoV-2-specific T-cell receptors (TCRs). The primary outcome was a comparison of anti-S IgG titers at the post-V2 time point in participants initiating vaccinations <4 months versus 4-12 months after HCT using a propensity-adjusted analysis. We also evaluated factors associated with high-level anti-S IgG titers (≥2403 U/mL) in logistic regression models. Findings Between April 22, 2021 and November 17, 2021, 175 allogeneic HCT recipients were enrolled in the study, of whom all but one received mRNA SARS-CoV-2 vaccines. SARS-CoV-2 anti-S IgG titers, neutralizing antibody titers, and TCR breadth and depth did not significantly differ at all tested time points following the second vaccination among those initiating vaccinations <4 months versus 4-12 months after HCT. Anti-S IgG ≥2403 U/mL correlated with neutralizing antibody levels similar to those observed in a prior study of non-immunocompromised individuals, and 57% of participants achieved anti-S IgG ≥2403 U/mL at the end-of-study time point. In models adjusted for SARS-CoV-2 infection pre-enrollment, SARS-CoV-2 vaccination pre-HCT, CD19+ B-cell count, CD4+ T-cell count, and age (as applicable to the model), vaccine initiation timing was not associated with high-level anti-S IgG titers at the post-V2, post-V3, or end-of-study time points. Notably, prior graft-versus-host-disease (GVHD) or use of immunosuppressive medications were not associated with high-level anti-S IgG titers. Grade ≥3 vaccine-associated adverse events were infrequent. Interpretation These data support starting mRNA SARS-CoV-2 vaccination three months after HCT, irrespective of concurrent GVHD or use of immunosuppressive medications. This is one of the largest prospective analyses of vaccination for any pathogen within the first year after allogeneic HCT and supports current guidelines for SARS-CoV-2 vaccination starting three months post-HCT. Additionally, there are few studies of mRNA vaccine formulations for other pathogens in HCT recipients, and these data provide encouraging proof-of-concept for the utility of early vaccination targeting additional pathogens with mRNA vaccine platforms. Funding National Marrow Donor Program, Leukemia and Lymphoma Society, Multiple Myeloma Research Foundation, Novartis, LabCorp, American Society for Transplantation and Cellular Therapy, Adaptive Biotechnologies, and the National Institutes of Health.
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Affiliation(s)
- Joshua A Hill
- Vaccine and Infectious Disease, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Martens
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Kavita Bhavsar
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jianqun Kou
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Min Chen
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lik Wee Lee
- Adaptive Biotechnologies Corp, Seattle, WA, USA
| | - Aliyah Baluch
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Armistead
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Peter Westervelt
- Barnes-Jewish Hospital, Washington University, St. Louis, MO, USA
| | - John McCarty
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Susan DeWolf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kinga Hosszu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, MD, USA
| | - Ashley Spahn
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - Amir A Toor
- Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Waldvogel
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | | | - Jeffery J Auletta
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcie L Riches
- Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weil Cornell Medical College, New York, NY, USA
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25
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Spyridonidis A. Is a third SARS-CoV-2 vaccine dose efficient in allogeneic haematopoietic cell transplant recipients? Br J Haematol 2023; 201:9-10. [PMID: 36477621 PMCID: PMC9878174 DOI: 10.1111/bjh.18591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
When and how often should allogeneic haematopoietic cell transplantation recipients be vaccinated against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is unclear. The report by Bankova et al. suggests that a third SARS-CoV-2 vaccine dose is important but still insufficient in some patients to establish an adequate humoral response. Commentary on: Bankova et al. Antibody response to a third SARS-CoV-2 vaccine dose in recipients of an allogeneic hematopoietic cell transplantation. Br J Haematol. 2023;201:58-63.
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Affiliation(s)
- Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular TherapyUniversity of PatrasPatrasGreece
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26
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Henig I, Isenberg J, Yehudai-Ofir D, Leiba R, Ringelstein-Harlev S, Ram R, Avni B, Amit O, Grisariu S, Azoulay T, Slouzkey I, Zuckerman T. Third BNT162b2 mRNA SARS-CoV-2 Vaccine Dose Significantly Enhances Immunogenicity in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation. Vaccines (Basel) 2023; 11:vaccines11040775. [PMID: 37112688 PMCID: PMC10145595 DOI: 10.3390/vaccines11040775] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
COVID-19-related mortality among hematopoietic stem cell transplantation (HSCT) recipients in the pre-vaccine era ranged between 22 and 33%. The Pfizer/BioNTech BNT162b2 vaccine demonstrated significant immunogenicity and efficacy in the healthy population; however, its long-term effects on allogeneic HSCT recipients remained unclear. Our study longitudinally evaluated humoral and cellular responses to the BNT162b2 vaccine in adult allogeneic HSCT patients. A positive response was defined as antibody titers ≥ 150 AU/mL post-second vaccination. Among 77 included patients, 51 (66.2%) responded to vaccination. Response-associated factors were female gender, recent anti-CD20 therapy, and a longer interval between transplant and vaccination. Response rates reached 83.7% in patients vaccinated >12 months post-transplant. At 6 months post-second vaccination, antibody titers dropped, but were significantly increased with the booster dose. Moreover, 43% (6/14) of non-responders to the second vaccination acquired sufficient antibody titers after booster administration, resulting in an overall response rate of 79.5% for the entire cohort. The BNT162b2 vaccine was effective in allogeneic transplant recipients. Although antibody titers decreased with time, the third vaccination led to their significant elevation, with 93% of third-dose responders maintaining titers above 150 AU/mL at 3 months post-administration.
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27
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La Rosa C, Chiuppesi F, Park Y, Zhou Q, Yang D, Gendzekhadze K, Ly M, Li J, Kaltcheva T, Ortega Francisco S, Gutierrez MA, Ali H, Otoukesh S, Amanam I, Salhotra A, Pullarkat VA, Aldoss I, Rosenzweig M, Aribi AM, Stein AS, Marcucci G, Dadwal SS, Nakamura R, Forman SJ, Al Malki MM, Diamond DJ. Functional SARS-CoV-2-specific T cells of donor origin in allogeneic stem cell transplant recipients of a T-cell-replete infusion: A prospective observational study. Front Immunol 2023; 14:1114131. [PMID: 36936918 PMCID: PMC10020189 DOI: 10.3389/fimmu.2023.1114131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
In the current post-pandemic era, recipients of an allogeneic hematopoietic stem cell transplant (HCT) deserve special attention. In these vulnerable patients, vaccine effectiveness is reduced by post-transplant immune-suppressive therapy; consequently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is often associated with elevated morbidity and mortality. Characterizing SARS-CoV-2 adaptive immunity transfer from immune donors to HCT recipients in the context of immunosuppression will help identify optimal timing and vaccination strategies that can provide adequate protection to HCT recipients against infection with evolving SARS-CoV-2 variants. We performed a prospective observational study (NCT04666025 at ClinicalTrials.gov) to longitudinally monitor the transfer of SARS-CoV-2-specific antiviral immunity from HCT donors, who were either vaccinated or had a history of COVID-19, to their recipients via T-cell replete graft. Levels, function, and quality of SARS-CoV-2-specific immune responses were longitudinally analyzed up to 6 months post-HCT in 14 matched unrelated donor/recipients and four haploidentical donor/recipient pairs. A markedly skewed donor-derived SARS-CoV-2 CD4 T-cell response was measurable in 15 (83%) recipients. It showed a polarized Th1 functional profile, with the prevalence of central memory phenotype subsets. SARS-CoV-2-specific IFN-γ was detectable throughout the observation period, including early post-transplant (day +30). Functionally experienced SARS-CoV-2 Th1-type T cells promptly expanded in two recipients at the time of post-HCT vaccination and in two others who were infected and survived post-transplant COVID-19 infection. Our data suggest that donor-derived SARS-CoV-2 T-cell responses are functional in immunosuppressed recipients and may play a critical role in post-HCT vaccine response and protection from the fatal disease. Clinical trial registration clinicaltrials.gov, identifier NCT04666025.
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Affiliation(s)
- Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Flavia Chiuppesi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Yoonsuh Park
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Dongyun Yang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ketevan Gendzekhadze
- Histocompatibility Laboratory, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Minh Ly
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Jing Li
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Teodora Kaltcheva
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Sandra Ortega Francisco
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Miguel-Angel Gutierrez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Haris Ali
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Salman Otoukesh
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Idoroenyi Amanam
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Vinod A. Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Ahmed M. Aribi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | | | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Stephen J. Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Monzr M. Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
| | - Don J. Diamond
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, United States
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28
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Giesen N, Busch E, Schalk E, Beutel G, Rüthrich MM, Hentrich M, Hertenstein B, Hirsch HH, Karthaus M, Khodamoradi Y, Koehler P, Krüger W, Koldehoff M, Krause R, Mellinghoff SC, Penack O, Sandherr M, Seggewiss-Bernhardt R, Spiekermann K, Sprute R, Stemler J, Weissinger F, Wörmann B, Wolf HH, Cornely OA, Rieger CT, von Lilienfeld-Toal M. AGIHO guideline on evidence-based management of COVID-19 in cancer patients: 2022 update on vaccination, pharmacological prophylaxis and therapy in light of the omicron variants. Eur J Cancer 2023; 181:102-118. [PMID: 36652889 PMCID: PMC9737523 DOI: 10.1016/j.ejca.2022.11.030] [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: 11/16/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
The novel coronavirus SARS-CoV-2 and the associated infectious disease COVID-19 pose a significant challenge to healthcare systems worldwide. Patients with cancer have been identified as a high-risk population for severe infections, rendering prophylaxis and treatment strategies for these patients particularly important. Rapidly evolving clinical research, resulting in the recent advent of various vaccines and therapeutic agents against COVID-19, offers new options to improve care and protection of cancer patients. However, ongoing epidemiological changes and rise of new virus variants require repeated revisions and adaptations of prophylaxis and treatment strategies to meet these new challenges. Therefore, this guideline provides an update on evidence-based recommendations with regard to vaccination, pharmacological prophylaxis and treatment of COVID-19 in cancer patients in light of the currently dominant omicron variants. It was developed by an expert panel of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) based on a critical review of the most recent available data.
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Affiliation(s)
- Nicola Giesen
- Department of Hematology, Oncology and Palliative Care, Robert Bosch Hospital, Stuttgart, Germany.
| | - Elena Busch
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Gernot Beutel
- Department for Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; Working Party Intensive Care in Haematologic and Oncologic Patients (iCHOP) of the German Society of Haematology and Medical Oncology (DGHO), Germany
| | - Maria M Rüthrich
- Department of Interdisciplinary Intensive Care Medicine, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | | | - Hans H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland; Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland; Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Neuperlach/Klinikum Harlaching, Munich, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - William Krüger
- Department of Hematology and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Greifswald, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Hygiene and Environmental Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Olaf Penack
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Michael Sandherr
- MVZ Penzberg, Department of Hematology and Oncology, Weilheim, Germany
| | - Ruth Seggewiss-Bernhardt
- Medizinische Klinik V, Sozialstiftung Bamberg, Bamberg, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Weissinger
- Department of Internal Medicine, Hematology, Oncology, Stem Cell Transplantation and Palliative Care, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Bernhard Wörmann
- Division of Haematology, Oncology and Tumor Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology, Oncology and Hemostaseology, Südharzklinikum Nordhausen, Nordhausen, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Christina T Rieger
- Hemato-Oncology Germering & Interdisciplinary Tumorcenter, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marie von Lilienfeld-Toal
- Department of Haematology and Medical Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
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29
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Nishikubo M, Shimomura Y, Maruoka H, Nasu S, Nishioka T, Sakizono K, Mitsuyuki S, Kubo T, Okada N, Nakagawa D, Kamijo K, Imoto H, Yamamoto R, Nagai Y, Hiramoto N, Yoshioka S, Yonetani N, Matsushita A, Miyakoshi C, Doi A, Ishikawa T. Humoral response and safety of the BNT162b2 and mRNA-1273 COVID-19 vaccines in allogeneic hematopoietic stem cell transplant recipients: An observational study. J Infect Chemother 2023; 29:274-280. [PMID: 36442827 PMCID: PMC9699714 DOI: 10.1016/j.jiac.2022.11.010] [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: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of mRNA COVID-19 vaccines and the optimal timing of vaccine administration in allogeneic hematopoietic stem cell transplantation (Allo-HSCT) recipients remains inadequately investigated. We examine the effectiveness and safety of mRNA COVID-19 vaccines in allo-HSCT recipients. METHOD This prospective observational study included 44 allo-HSCT recipients and 38 healthy volunteers. The proportion of subjects acquiring anti-S1 IgG antibodies were considered as the primary endpoint. The occurrence of adverse events after vaccination and objective deterioration of chronic graft-versus-host disease (GVHD) were defined as secondary endpoints. In addition, we compared the geometric mean titers (GMT) of anti-S1 antibody titers in subgroups based on time interval between transplantation and vaccination. RESULTS A humoral response to the vaccine was evident in 40 (91%) patients and all 38 healthy controls. The GMT of anti-S1 titers in patients and healthy controls were 277 (95% confidence interval [CI]: 120-643) BAU/mL and 532 (95% CI 400-708) BAU/mL, respectively. (p = 0.603). A short time interval between transplantation and vaccination (≤6 months) was associated with low anti-S1 IgG antibody titers. No serious adverse events and deterioration of chronic GVHD were observed. Only one case of new development of mild chronic GVHD was recorded. CONCLUSION Messenger RNA COVID-19 vaccines induce humoral responses in allo-HSCT recipients and can be administered safely.
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Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan,Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan,Corresponding author. Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomomi Nishioka
- LSI Medience Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kenji Sakizono
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Mitsuyuki
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomoyo Kubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Daishi Nakagawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kimimori Kamijo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hiroharu Imoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yuya Nagai
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Akiko Matsushita
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
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Wiedmeier-Nutor JE, Iqbal M, Rosenthal AC, Bezerra ED, Garcia-Robledo JE, Bansal R, Johnston PB, Hathcock M, Larsen JT, Bergsagel PL, Wang Y, Reeder CB, Leis JF, Fonseca R, Palmer JM, Gysbers BJ, Mwangi R, Warsame RM, Kourelis T, Hayman SR, Dingli D, Kapoor P, Kumar SK, Durani U, Villasboas JC, Paludo J, Bennani NN, Nowakowski G, Ansell SM, Castro JE, Kharfan-Dabaja MA, Lin Y, Vergidis P, Murthy HS, Munoz J. Response to COVID-19 vaccination post CAR T therapy in patients with non-Hodgkin lymphoma and multiple myeloma. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:456-462. [PMID: 37003846 PMCID: PMC9990888 DOI: 10.1016/j.clml.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
COVID-19 adversely affects individuals with cancer. Several studies have found that seroconversion rates among patients with hematologic malignancies are suboptimal when compared to patients without cancer. Patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are immunocompromised due to impaired humoral and cellular immunity in addition to prescribed immunosuppressive therapy. Chimeric antigen receptor T-cell (CAR T) therapy is now widely used for NHL and MM, but little is known about seroconversion rates after COVID-19 vaccination among these populations. We evaluated SARS-CoV-2 spike-binding IgG antibody levels following COVID-19 vaccination among NHL and MM CAR T therapy recipients. Out of 104 CAR T infusions, 19 patients developed known COVID-19 infection post-CAR T. We tested 17 patients that received CAR T for antibody spike titers post COVID-19 vaccination, only 29 % (n = 5) were able to mount a clinically relevant antibody response (>250 IU/mL).
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Affiliation(s)
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | | | - Jeremy T Larsen
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - P Leif Bergsagel
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Jeanne M Palmer
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Brianna J Gysbers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Urshila Durani
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Januario E Castro
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Javier Munoz
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
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31
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Effectiveness and Safety of COVID-19 Vaccination in Patients with Malignant Disease. Vaccines (Basel) 2023; 11:vaccines11020486. [PMID: 36851363 PMCID: PMC9962104 DOI: 10.3390/vaccines11020486] [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: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
A novel virus named SARS-CoV-2 has caused a worldwide pandemic, resulting in a disastrous impact to the public health since 2019. The disease is much more lethal among patients with malignant disease. Vaccination plays an important role in the prevention of infection and subsequent severe COVID-19. However, the efficacy and safety of vaccines for cancer patients needs further investigation. Encouragingly, there have been important findings deduced from research so far. In this review, an overview of the immunogenicity, effectiveness, and safeness of COVID-19 vaccines in patients with cancer to date is to be shown. We also highlight important questions to consider and directions that could be followed in future research.
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32
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Pizzano U, Facchin G, Marcon C, Fabris M, Battista ML, Cerno M, Geromin A, Pucillo M, Petruzzellis G, Vianello G, Battaglia G, Peressutti R, Grillone L, Tascini C, Curcio F, Fanin R, Patriarca F. Antibody, cell-mediated response and infection susceptibility in allogeneic hematopoietic stem cell recipients after COVID-19 mRNA vaccination. Transpl Infect Dis 2023; 25:e14003. [PMID: 36748718 DOI: 10.1111/tid.14003] [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: 09/14/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients undergoing allogeneic stem-cell transplantation (allo-SCT) have reduced responses to vaccines due to immunosuppressive status linked to GvHD prophylaxis and treatment. In our study, we compared humoral responses to anti-SARS-CoV-2 mRNA vaccine, and infection onset, according to patients and transplant features; we also evaluated cellular response in patients without seroconversion. METHODS We tested antibodies titer after second and third vaccine doses. Antibodies were detected through an immune-enzymatic assay. In a patients' subgroup without seroconversion, we tested cell-mediated responses evaluating interferon-gamma release by T-lymphocytes exposed to virus spike protein. RESULTS Seroconversion rate increased from 66% at 30 days to 81% at 90 days after the second dose; it was 97% at 150 days after the third dose. We found a significant association between seroconversion after the second dose and two variables: shorter interval between allo-SCT and vaccination; ongoing immunosuppression. Twelve of 19 patients (63%) without antibodies after the second dose did not show cellular responses. Nineteen percent of patients developed SARS-CoV-2 infection after the third dose, with favorable outcome in all cases. Patients within 12 months after allo-SCT showed a significantly higher infection risk. CONCLUSIONS Our study suggests that an interval shorter than 12 months between allo-SCT and first vaccine dose and/or ongoing immunosuppression were associated with humoral and cellular response deficiency after two doses. Third dose induced an increased and sustained humoral response in the majority of patients. However, patients within 1 year after allo-SCT remained at higher infection risk and may be candidate for prophylaxis with anti-SARS-CoV-2 monoclonal antibodies.
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Affiliation(s)
- Umberto Pizzano
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gabriele Facchin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Chiara Marcon
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Martina Fabris
- Division of Laboratory Medicine, University Hospital ASUFC, Udine, Italy
| | - Marta Lisa Battista
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Michela Cerno
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Antonella Geromin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Martina Pucillo
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Giuseppe Petruzzellis
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Giampaolo Vianello
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Giulia Battaglia
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | | - Lucrezia Grillone
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Carlo Tascini
- Department of Medical Area (DAME), University of Udine, Udine, Italy.,Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Francesco Curcio
- Department of Medical Area (DAME), University of Udine, Udine, Italy.,Division of Laboratory Medicine, University Hospital ASUFC, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Francesca Patriarca
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
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33
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Reeg DB, Hofmann M, Neumann-Haefelin C, Thimme R, Luxenburger H. SARS-CoV-2-Specific T Cell Responses in Immunocompromised Individuals with Cancer, HIV or Solid Organ Transplants. Pathogens 2023; 12:pathogens12020244. [PMID: 36839516 PMCID: PMC9966413 DOI: 10.3390/pathogens12020244] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Adaptive immune responses play an important role in the clinical course of SARS-CoV-2 infection. While evaluations of the virus-specific defense often focus on the humoral response, cellular immunity is crucial for the successful control of infection, with the early development of cytotoxic T cells being linked to efficient viral clearance. Vaccination against SARS-CoV-2 induces both CD4+ and CD8+ T cell responses and permits protection from severe COVID-19, including infection with the currently circulating variants of concern. Nevertheless, in immunocompromised individuals, first data imply significantly impaired SARS-CoV-2-specific immune responses after both natural infection and vaccination. Hence, these high-risk groups require particular consideration, not only in routine clinical practice, but also in the development of future vaccination strategies. In order to assist physicians in the guidance of immunocompromised patients, concerning the management of infection or the benefit of (booster) vaccinations, this review aims to provide a concise overview of the current knowledge about SARS-CoV-2-specific cellular immune responses in the vulnerable cohorts of cancer patients, people living with HIV (PLWH), and solid organ transplant recipients (SOT). Recent findings regarding the virus-specific cellular immunity in these differently immunocompromised populations might influence clinical decision-making in the future.
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34
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McNerney KO, Richards RM, Aguayo-Hiraldo P, Calkoen FG, Talano JA, Moskop A, Balduzzi A, Krajewski J, Dave H, Vatsayan A, Callahan C, Liu H, Li Y, Davis KL, Maude SL. SARS-CoV-2 infections in pediatric and young adult recipients of chimeric antigen receptor T-cell therapy: an international registry report. J Immunother Cancer 2023; 11:jitc-2022-005957. [PMID: 36707090 PMCID: PMC9884906 DOI: 10.1136/jitc-2022-005957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Immunocompromised patients are at increased risk of SARS-CoV-2 infections. Patients undergoing chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory B-cell malignancies are uniquely immunosuppressed due to CAR T-mediated B-cell aplasia (BCA). While SARS-CoV-2 mortality rates of 33%-40% are reported in adult CAR T-cell recipients, outcomes in pediatric and young adult CAR T-cell recipients are limited. METHODS We created an international retrospective registry of CAR T recipients aged 0-30 years infected with SARS-CoV-2 within 2 months prior to or any time after CAR T infusion. SARS-CoV-2-associated illness was graded as asymptomatic, mild, moderate, or severe COVID-19, or multisystem inflammatory syndrome in children (MIS-C). To assess for risk factors associated with significant SARS-CoV-2 infections (infections requiring hospital admission for respiratory distress or supplemental oxygen), univariate and multivariable regression analyses were performed. RESULTS Nine centers contributed 78 infections in 75 patients. Of 70 SARS-CoV-2 infections occurring after CAR T infusion, 13 (18.6%) were classified as asymptomatic, 37 (52.9%) mild, 11 (15.7%) moderate, and 6 (8.6%) severe COVID-19. Three (4.3%) were classified as MIS-C. BCA was not significantly associated with infection severity. Prior to the emergence of the Omicron variant, of 47 infections, 19 (40.4%) resulted in hospital admission and 7 (14.9%) required intensive care, while after the emergence of the Omicron variant, of 23 infections, only 1 (4.3%) required admission and the remaining 22 (95.7%) had asymptomatic or mild COVID-19. Death occurred in 3 of 70 (4.3%); each death involved coinfection or life-threatening condition. In a multivariable model, factors associated with significant SARS-CoV-2 infection included having two or more comorbidities (OR 7.73, CI 1.05 to 74.8, p=0.048) and age ≥18 years (OR 9.51, CI 1.90 to 82.2, p=0.014). In the eight patients infected with SARS-CoV-2 before CAR T, half of these patients had their CAR T infusion delayed by 15-30 days. CONCLUSIONS In a large international cohort of pediatric and young adult CAR-T recipients, SARS-CoV-2 infections resulted in frequent hospital and intensive care unit admissions and were associated with mortality in 4.3%. Patients with two or more comorbidities or aged ≥18 years were more likely to experience significant illness. Suspected Omicron infections were associated with milder disease.
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Affiliation(s)
- Kevin Owen McNerney
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA,Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M Richards
- Hematology, Oncology, and Bone Marrow Transplant, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Friso G Calkoen
- Division of Pediatric Oncology, Princess Maxima Center, Utrecht, The Netherlands
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Moskop
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione IRCCS San Gerardo dai Tintori, Milan, Italy
| | - Jennifer Krajewski
- Pediatric Blood and Marrow Transplantation, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Hema Dave
- Cancer Immunology and Microbial Oncology Research Program, Children's National Hospital, Washington, District of Columbia, USA
| | - Anant Vatsayan
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hongyan Liu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kara Lynn Davis
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Shannon L Maude
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Hernandez SPA, Hersby DS, Munk KK, Tamhane T, Trubach D, Tagliamonte M, Buonaguro L, Gang AO, Hadrup SR, Saini SK. Three doses of BNT162b2 COVID-19 mRNA vaccine establish long-lasting CD8 + T cell immunity in CLL and MDS patients. Front Immunol 2023; 13:1035344. [PMID: 36703960 PMCID: PMC9873231 DOI: 10.3389/fimmu.2022.1035344] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Patients with hematological malignancies are prioritized for COVID-19 vaccine due to their high risk for severe SARS-CoV-2 infection-related disease and mortality. To understand T cell immunity, its long-term persistence, and its correlation with antibody response, we evaluated the BNT162b2 COVID-19 mRNA vaccine-specific immune response in chronic lymphocytic leukemia (CLL) and myeloid dysplastic syndrome (MDS) patients. Longitudinal analysis of CD8+ T cells using DNA-barcoded peptide-MHC multimers covering the full SARS-CoV-2 Spike-protein (415 peptides) showed vaccine-specific T cell activation and persistence of memory T cells up to six months post-vaccination. Surprisingly, a higher frequency of vaccine-induced antigen-specific CD8+ T cells was observed in the patient group compared to a healthy donor group. Furthermore, and importantly, immunization with the second booster dose significantly increased the frequency of antigen-specific CD8+ T cells as well as the total number of T cell specificities. Altogether 59 BNT162b2 mRNA vaccine-derived immunogenic responses were identified, of which 23 established long-term CD8+ T cell memory response with a strong immunodominance for NYNYLYRLF (HLA-A24:02) and YLQPRTFLL (HLA-A02:01) epitopes. In summary, we mapped the vaccine-induced antigen-specific CD8+ T cells and showed a booster-specific activation and enrichment of memory T cells that could be important for long-term disease protection in this patient group.
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Affiliation(s)
- Susana Patricia Amaya Hernandez
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ditte Stampe Hersby
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kamilla Kjærgaard Munk
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Tripti Tamhane
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Darya Trubach
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Tagliamonte
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Luigi Buonaguro
- Innovative Immunological Models Unit, National Cancer Institute Pascale Foundation – IRCCS, Napoli, Italy
| | - Anne Ortved Gang
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sine Reker Hadrup
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sunil Kumar Saini
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark,*Correspondence: Sunil Kumar Saini,
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Ljungman P, Tridello G, Piñana JL, Ciceri F, Sengeloev H, Kulagin A, Mielke S, Yegin ZA, Collin M, Einardottir S, Lepretre SD, Maertens J, Campos A, Metafuni E, Pichler H, Folber F, Solano C, Nicholson E, Yüksel MK, Carlson K, Aguado B, Besley C, Byrne J, Heras I, Dignan F, Kröger N, Robin C, Khan A, Lenhoff S, Grassi A, Dobsinska V, Miranda N, Jimenez MJ, Yonal-Hindilerden I, Wilson K, Averbuch D, Cesaro S, Xhaard A, Knelange N, Styczynski J, Mikulska M, de la Camara R. Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry. Front Immunol 2023; 14:1125824. [PMID: 36960069 PMCID: PMC10028143 DOI: 10.3389/fimmu.2023.1125824] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. Methods This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic. Results The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022. Discussion Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.
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Affiliation(s)
- Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Per Ljungman,
| | - Gloria Tridello
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Jose Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Fabio Ciceri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Henrik Sengeloev
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexander Kulagin
- Raisa Memorial (RM) Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Zeynep Arzu Yegin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Matthew Collin
- Translational and Clinical Research Institute and The National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre, Newcastle, United Kingdom
| | - Sigrun Einardottir
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Maertens
- Department of Hematology University Hospital Gasthuisberg, Leuven, Belgium
| | - Antonio Campos
- Marrow Transplant Department Inst. Português de Oncologia do Porto, Porto, Portugal
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Herbert Pichler
- St. Anna Children’s Hospital, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Frantisek Folber
- Department of Internal Medicine, Hematology and Oncology University Hospital Brno, Brno, Czechia
- Department of Internal Medicine, Hematology and Oncology Masaryk University, Brno, Czechia
| | - Carlos Solano
- European Society for Blood and Marrow Transplantation (EBMT) Data Office, Department of Medical Statistics & Bioinformatics, Leiden, Netherlands
| | - Emma Nicholson
- Haematology-oncology Unit Royal Marsden Hospital, London, United Kingdom
| | - Meltem Kurt Yüksel
- Department of Hematology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Beatriz Aguado
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Caroline Besley
- University Hospitals Bristol and Weston National Health Service (NHS) Foundation Trust, Bristol, United Kingdom
| | - Jenny Byrne
- Department of Haematology Nottingham University Hospital, Nottingham, United Kingdom
| | - Immaculada Heras
- Department of Hematology, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Fiona Dignan
- Clinical Haematology Department Manchester Royal Infirmary, Manchester, United Kingdom
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Christine Robin
- Assistance Publique-Hôpitaux de Paris (APHP), Henri Mondor Hospital, Department of Hematology, Créteil, France
| | - Anjum Khan
- Department of Haematology Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Stig Lenhoff
- Department of Hematology Skåne’s University Hospital, Lund, Sweden
| | - Anna Grassi
- Bone Marrow Transplantation Unit, Azienda Sociosanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Veronika Dobsinska
- Department of Pediatric Hematology and Oncology, National Institute of Children’s Diseases, Comenius University, Bratislava, Slovakia
| | - Nuno Miranda
- Department of Haematology Inst. Portugues Oncologia, Lisbon, Portugal
| | - Maria-Jose Jimenez
- Department of Clinical Haematology Institut Catala d'Oncologia (ICO)-Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ipek Yonal-Hindilerden
- Istanbul Medical Faculty, Adult Hematopoietic Stem Cell Transplant Center, Istanbul University, Istanbul, Türkiye
| | - Keith Wilson
- Blood and Bone Marrow Transplantation Department University of Cardiff, Cardiff, United Kingdom
| | - Dina Averbuch
- Pediatric Infectious Diseases Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alienor Xhaard
- Hematology-Transplantation Unit, Department of Hematology: Hôpital St. Louis, Paris, France
| | - Nina Knelange
- European Society for Blood and Marrow Transplantation (EBMT) Leiden Study Unit, European Society for Blood and Marrow Transplantation (EBMT) Data Office, Leiden, Netherlands
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain
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Bordat J, Maury S, Leclerc M. Allogeneic hematopoietic stem cell transplantation in the COVID-19 era. Front Immunol 2023; 14:1100468. [PMID: 36911678 PMCID: PMC9993088 DOI: 10.3389/fimmu.2023.1100468] [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: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) recipients are especially vulnerable to coronavirus disease 19 (COVID-19), because of their profound immunodeficiency. Indeed, the first pandemic wave was marked by a high mortality rate in this population. Factors increasing immunodepression such as older age, immunosuppressive treatments or a short delay between transplant and infection appear to worsen the prognosis. Many changes in clinical practice had to be implemented in order to limit this risk, including postponing of transplant for non-malignant diseases, preference for local rather than international donations and for peripheral blood as stem cell source, and the widespread use of cryopreservation. The great revolution in the COVID-19 pandemic came from the development of mRNA vaccines that have shown to be able to prevent severe forms of the disease. More than 75% of allo-HSCT recipients develop seroconversion after 2 doses of vaccine. Multiple studies have identified lymphopenia, exposure to immunosuppressive or anti-CD20 therapies, and a short post-transplant period as factors associated with a poor response to vaccination. The use of repeated injections of the vaccine, including a third dose, not only improves the seroconversion rate but also intensifies the immune response, both in B cells and T cells. Vaccines are an effective and well-tolerated method in this high-risk population. Some studies investigated the possibility of immune protection being transferred from a vaccinated donor to a recipient, with encouraging initial results. However, dynamic mutations and immune escape of the virus can lead to breakthrough infections with new variants in vaccinated individuals and still represent a threat of severe disease in allo-HSCT recipients. New challenges include the need to adapt vaccine protection to emerging variants.
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Affiliation(s)
- Jonathan Bordat
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France
| | - Sébastien Maury
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France.,Institut Mondor de Recherche Biomédicale, équipe Immunorégulation et Biothérapies, INSERM U955, Créteil, France.,Faculté de Médecine, Paris-Est Créteil University, Créteil, France
| | - Mathieu Leclerc
- Hematology Department, Henri Mondor Hospital, Assistance Publique/Hôpitaux de Paris, Créteil, France.,Institut Mondor de Recherche Biomédicale, équipe Immunorégulation et Biothérapies, INSERM U955, Créteil, France.,Faculté de Médecine, Paris-Est Créteil University, Créteil, France
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38
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Mori Y, Uchida N, Harada T, Katayama Y, Wake A, Iwasaki H, Eto T, Morishige S, Fujisaki T, Ito Y, Kamimura T, Takahashi T, Imamura Y, Tanimoto K, Ishitsuka K, Sugita J, Kawano N, Tanimoto K, Yoshimoto G, Choi I, Hidaka T, Ogawa R, Takamatsu Y, Miyamoto T, Akashi K, Nagafuji K. Predictors of impaired antibody response after SARS-CoV-2 mRNA vaccination in hematopoietic cell transplant recipients: A Japanese multicenter observational study. Am J Hematol 2023; 98:102-111. [PMID: 36260658 PMCID: PMC9874814 DOI: 10.1002/ajh.26769] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 02/04/2023]
Abstract
HCT recipients reportedly have a high mortality rate after developing COVID-19. SARS-CoV-2 vaccination is generally useful to prevent COVID-19. However, its safety and efficacy among HCT recipients remain elusive. This large-scale prospective observational study including 543 HCT recipients with 37-months interval from transplant demonstrated high safety profiles of mRNA vaccine: only 0.9% of patients avoided the second dose due to adverse event or GVHD aggravation following the first dose. Regarding the efficacy, serological response with a clinically relevant titer (≥250 BAU/mL) was obtained in 397 (73.1%) patients. We classified the remaining 146 patients as impaired responders and compared the clinical and immunological parameters between two groups. In allogeneic HCT recipients, multivariable analysis revealed the risk factors for impaired serological response as follows: age (≥60, 1 points), HLA-mismatched donor (1 points), use of systemic steroids (1 points), absolute lymphocyte counts (<1000/μL, 1 points), absolute B-cell counts (<100/μL, 1 points), and serum IgG level (<500 mg/dL, 2 points). Notably, the incidence of impaired serological response increased along with the risk scores: patients with 0, 1-3, and 4-7 points were 3.9%, 21.8%, and 74.6%, respectively. In autologous HCT recipients, a shorter interval from transplant to vaccination was the only risk factor for impaired serological response. Our findings indicate that two doses of SARS-CoV-2 vaccine are safe but insufficient for a part of HCT recipients with higher risk scores. To improve this situation, we should consider additional treatment options, including booster vaccination and prophylactic neutralizing antibodies during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Yasuo Mori
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical ScienceFukuokaJapan
| | | | - Takuya Harada
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical ScienceFukuokaJapan
| | - Yuta Katayama
- Department of HematologyHiroshima Red Cross Hospital and Atomic‐Bomb Survivors HospitalHiroshimaJapan
| | - Atsushi Wake
- Department of HematologyToranomon Hospital KajigayaKawasakiJapan
| | - Hiromi Iwasaki
- Departments of HematologyNational Hospital Organization, Kyushu Medical CenterFukuokaJapan
| | - Tetsuya Eto
- Department of HematologyHamanomachi HospitalFukuokaJapan
| | - Satoshi Morishige
- Division of Hematology and Oncology, Department of MedicineKurume University School of MedicineKurumeJapan
| | - Tomoaki Fujisaki
- Department of Internal MedicineMatsuyama Red Cross HospitalMatsuyamaJapan
| | - Yoshikiyo Ito
- Department of HematologyImamura General HospitalKagoshimaJapan
| | | | | | | | - Kazushi Tanimoto
- Department of Hematology, Clinical Immunology, and Infectious DiseasesEhime University Graduate School of MedicineEhimeJapan
| | - Kenji Ishitsuka
- Department of Hematology and RheumatologyKagoshima University HospitalKagoshimaJapan
| | - Junichi Sugita
- Department of HematologyHokkaido University HospitalSapporoJapan
| | - Noriaki Kawano
- Department of Internal MedicineMiyazaki Prefectural Miyazaki HospitalMiyazakiJapan
| | - Kazuki Tanimoto
- Department of HematologyFukuoka Red Cross HospitalFukuokaJapan
| | - Goichi Yoshimoto
- Department of HematologySaga‐Ken Medical Center KoseikanSagaJapan
| | - Ilseung Choi
- Department of HematologyNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Tomonori Hidaka
- Department of Gastroenterology and Hematology, Faculty of MedicineUniversity of MiyazakiMiyazakiJapan
| | - Ryosuke Ogawa
- Department of Hematology and OncologyJCHO Kyushu HospitalFukuokaJapan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Faculty of MedicineFukuoka UniversityFukuokaJapan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical ScienceFukuokaJapan,Division of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
| | - Koichi Akashi
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical ScienceFukuokaJapan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of MedicineKurume University School of MedicineKurumeJapan
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Neutropenia Secondary to SARS-Cov2 Vaccination in Post-Hematopoietic Stem Cell Transplant (HSCT) Patients. Mediterr J Hematol Infect Dis 2023; 15:e2023014. [PMID: 36908872 PMCID: PMC10000821 DOI: 10.4084/mjhid.2023.014] [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: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
SARS-Cov2 s, caused a high mortality in patients with some degree of immunosuppression, like those that receive a hematopoietic progenitor transplant. Since December 2020, several vaccines have been developed having been key in decreasing complications and mortality in this group of patients. Different articles have described the presence of thrombopenia related to the administration of vaccines, however, there are few data on the occurrence of neutropenia as a side effect after administration. We present several cases of neutropenia (defined as absolute neutrophil count (ANC) less than 2,000/mm3), after vaccination in hematopoietic progenitor transplant (HPT) recipients performed in our center during 2021.
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Miller P, Patel SR, Skinner R, Dignan F, Richter A, Jeffery K, Khan A, Heath PT, Clark A, Orchard K, Snowden JA, de Silva TI. Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients: Prepared on behalf of the British society of blood and marrow transplantation and cellular therapy (BSBMTCT), the Children's cancer and Leukaemia Group (CCLG), and British Infection Association (BIA). J Infect 2023; 86:1-8. [PMID: 36400155 DOI: 10.1016/j.jinf.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Haematopoietic stem cell transplant (HSCT) recipients have deficiencies in their adaptive immunity against vaccine preventable diseases. National and International guidance recommends that HSCT recipients are considered 'never vaccinated' and offered a comprehensive course of revaccination. This position statement aims to draw upon the current evidence base and existing guidelines, and align this with national vaccine availability and licensing considerations in order to recommend a pragmatic and standardised re-vaccination schedule for adult and paediatric HSCT recipients in the UK.
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Affiliation(s)
- Pde Miller
- British Society of Blood and Marrow Transplantation and Cellular Therapy, UK
| | - S R Patel
- Paediatric Department, Croydon Health Services NHS Trust, Croydon, UK
| | - R Skinner
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - F Dignan
- Department of Clinical Haematology, University of Manchester, Manchester, UK
| | - A Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - K Jeffery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Khan
- St. James' Hospital, Leeds, UK
| | - P T Heath
- Vaccine Institute, Institute of Infection and Immunity, St. George's, University of London, London, UK
| | - A Clark
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - K Orchard
- Wessex Blood and Marrow Transplant and Cellular Therapy Program, Department of Haematology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Department of Oncology and Metabolism, Medical School, The University of Sheffield, Sheffield, UK
| | - T I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, The University of Sheffield, Sheffield, UK.
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Uaprasert N, Pitakkitnukun P, Tangcheewinsirikul N, Chiasakul T, Rojnuckarin P. Immunogenicity and risks associated with impaired immune responses following SARS-CoV-2 vaccination and booster in hematologic malignancy patients: an updated meta-analysis. Blood Cancer J 2022; 12:173. [PMID: 36550105 PMCID: PMC9780106 DOI: 10.1038/s41408-022-00776-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with hematologic malignancies (HM) have demonstrated impaired immune responses following SARS-CoV-2 vaccination. Factors associated with poor immunogenicity remain largely undetermined. A literature search was conducted using PubMed, EMBASE, Cochrane, and medRxiv databases to identify studies that reported humoral or cellular immune responses (CIR) following complete SARS-CoV-2 vaccination. The primary aim was to estimate the seroconversion rate (SR) following complete SARS-CoV-2 vaccination across various subtypes of HM diseases and treatments. The secondary aims were to determine the rates of development of neutralizing antibodies (NAb) and CIR following complete vaccination and SR following booster doses. A total of 170 studies were included for qualitative and quantitative analysis of primary and secondary outcomes. A meta-analysis of 150 studies including 20,922 HM patients revealed a pooled SR following SARS-CoV-2 vaccination of 67.7% (95% confidence interval [CI], 64.8-70.4%; I2 = 94%). Meta-regression analysis showed that patients with lymphoid malignancies, but not myeloid malignancies, had lower seroconversion rates than those with solid cancers (R2 = 0.52, P < 0.0001). Patients receiving chimeric antigen receptor T-cells (CART), B-cell targeted therapies or JAK inhibitors were associated with poor seroconversion (R2 = 0.39, P < 0.0001). The pooled NAb and CIR rates were 52.8% (95% CI; 45.8-59.7%, I2 = 87%) and 66.6% (95% CI, 57.1-74.9%; I2 = 86%), respectively. Approximately 20.9% (95% CI, 11.4-35.1%, I2 = 90%) of HM patients failed to elicit humoral and cellular immunity. Among non-seroconverted patients after primary vaccination, only 40.5% (95% CI, 33.0-48.4%; I2 = 87%) mounted seroconversion after the booster. In conclusion, HM patients, especially those with lymphoid malignancies and/or receiving CART, B-cell targeted therapies, or JAK inhibitors, showed poor SR after SARS-CoV-2 vaccination. A minority of patients attained seroconversion after booster vaccination. Strategies to improve immune response in these severely immunosuppressed patients are needed.
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Affiliation(s)
- Noppacharn Uaprasert
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Palada Pitakkitnukun
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nuanrat Tangcheewinsirikul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thita Chiasakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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42
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Benitez Fuentes JD, Mohamed Mohamed K, de Luna Aguilar A, Jiménez García C, Guevara-Hoyer K, Fernandez-Arquero M, Rodríguez de la Peña MA, Garciía Bravo L, Jiménez Ortega AF, Flores Navarro P, Bartolome Arcilla J, Alonso Arenilla B, Baos Muñoz E, Delgado-Iribarren García-Campero A, Montealegre Sanz M, Sanchez-Ramon S, Perez Segura P. Evidence of exhausted lymphocytes after the third anti-SARS-CoV-2 vaccine dose in cancer patients. Front Oncol 2022; 12:975980. [PMID: 36605446 PMCID: PMC9808030 DOI: 10.3389/fonc.2022.975980] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Evidence is scant regarding the long-term humoral and cellular responses Q7 triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in cancer patients after repeated booster doses. The possibility of T-cell exhaustion following these booster doses in this population has not yet been fully studied and remains uncertain. Methods In this single-center prospective observational study, we explored the specific humoral and cellular response to S1 antigen in 36 patients with solid malignancies at baseline, and after the second and third doses of the mRNA-1273 vaccine. Results A dual behavior was observed: 24 (66.7%) patients showed partial specific IFN-γ response after the second dose that was further enhanced after the third dose; and 11 (30.5%) already showed an optimal response after the second dose and experienced a marked fall-off of specific IFN-γ production after the third (4 patients negativization), which might suggest T cell exhaustion due to repetitive priming to the same antigen. One (2.8%) patient had persistently negative responses after all three doses. Seroconversion occurred in all patients after the second dose. We then studied circulating exhausted CD8+ T-cells in 4 patients from each of the two response patterns, those with increase and those with decrease in cellular response after the third booster. The patients with decreased cellular response after the booster had a higher expression of PD1+CD8+ and CD57+PD1+CD8+ exhausted T cells compared with those with an increased cellular response both in vivo and in vitro. The proportion of PD1+CD8+ and CD57+PD1+CD8+ exhausted T cells inversely correlated with IFN-γ production. Discussion Our preliminary data show that the two-dose SARS-CoV-2 vaccine regimen was beneficial in all cancer patients of our study. An additional booster seems to be beneficial in suboptimal vaccine seroconverters, in contrast to maximal responders that might develop exhaustion. Our data should be interpreted with caution given the small sample size and highlight the urgent need to validate our results in other independent and larger cohorts. Altogether, our data support the relevance of immunological functional studies to personalize preventive and treatment decisions in cancer patients.
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Affiliation(s)
- Javier David Benitez Fuentes
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain,*Correspondence: Javier David Benitez Fuentes,
| | - Kauzar Mohamed Mohamed
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain
| | - Alicia de Luna Aguilar
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
| | - Carlos Jiménez García
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain
| | - Kissy Guevara-Hoyer
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain,Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Miguel Fernandez-Arquero
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain,Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | | | - Laura Garciía Bravo
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain
| | | | - Paloma Flores Navarro
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
| | - Jorge Bartolome Arcilla
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
| | - Bárbara Alonso Arenilla
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain
| | - Elvira Baos Muñoz
- Department of Microbiology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain
| | | | - María Montealegre Sanz
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
| | - Silvia Sanchez-Ramon
- Department of Immunology, IML and IdISSC, Hospital Cliínico San Carlos, Calle Profesor Martín Lagos, Madrid, Spain,Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Pedro Perez Segura
- Department of Medical Oncology, Hospital Clinico San Carlos, IdISSC, Calle Profesor Martín Lagos, Madrid, Spain
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Chong SH, Burn LA, Cheng TKM, Warr IS, Kenyon JC. A review of COVID vaccines: success against a moving target. Br Med Bull 2022; 144:12-44. [PMID: 36335919 DOI: 10.1093/bmb/ldac025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/11/2022] [Accepted: 08/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple vaccine platforms against COVID-19 have been developed and found safe and efficacious at a record speed. Although most are effective, they vary in their ease of production and distribution, their potential speed of modification against new variants, and their durability of protection and safety in certain target groups. SOURCES OF DATA Our discussion is based on published reports of clinical trials and analyses from national and global health agencies. AREAS OF AGREEMENT The production of neutralizing antibodies against the viral spike protein is protective, and all vaccines for which published data exist have been found to be effective against severe disease caused by the viral strain they target. AREAS OF CONTROVERSY The degree to which vaccines protect against emerging variants, moderate disease and asymptomatic infection remains somewhat unclear. GROWING POINTS Knowledge of the duration of protection and its decay is increasing, and discussions of booster frequency and target strains are ongoing. AREAS TIMELY FOR DEVELOPING RESEARCH The global effort to combat transmission and disease continues to rely upon intense epidemiological surveillance, whilst real-world data and clinical trials shape vaccination schedules and formulae.
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Affiliation(s)
- S H Chong
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - L A Burn
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - T K M Cheng
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK.,Department of Medicine, Level 5 Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK.,Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge CB2 0AW, UK
| | - I S Warr
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - J C Kenyon
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK.,Department of Medicine, Level 5 Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK.,Division of Virology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
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44
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Wang X, Sima L. Antibody response after vaccination against SARS-CoV-2 in adults with hematological malignancies: a systematic review and meta-analysis. J Infect 2022:S0163-4453(22)00674-0. [PMID: 36417984 PMCID: PMC9675635 DOI: 10.1016/j.jinf.2022.11.013] [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: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against coronavirus disease 2019 (COVID-19), especially in fragile patients. We aimed to systematically analyze the outcomes of patients with hematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (2 doses of mRNA or one dose of vector- based vaccines). We identified 49 studies comprising 11,086 individuals. Overall risk of bias was low. The pooled response for hematological malignancies was 64% (95% confidence interval [CI]: 59-69; I²=93%) versus 96% (95% CI: 92-97; I²=44%) for solid cancer and 98% (95% CI: 96-99; I²=55%) for healthy controls (P<0.001). Outcome was different across hematological malignancies (P<0.001). The pooled response was 50% (95% CI: 43-57; I²=84%) for chronic lymphocytic leukemia, 76% (95% CI: 67-83; I²=92%) for multiple myeloma, 83% (95% CI: 69-91; I²=85%) for myeloproliferative neoplasms, 91% (95% CI: 82-96; I²=12%) for Hodgkin lymphoma, and 58% (95% CI: 44-70; I²=84%) for aggressive and 61% (95% CI: 48-72; I²=85%) for indolent non-Hodgkin lymphoma. The pooled response for allogeneic and autologous hematopoietic cell transplantation was 82% and 83%, respectively. Being in remission and prior COVID-19 showed significantly higher responses. Low pooled response was identified for active treatment (35%), anti-CD20 therapy ≤1 year (15%), Bruton kinase inhibition (23%), venetoclax (26%), ruxolitinib (42%), and chimeric antigen receptor T-cell therapy (42%). Studies on timing, value of boosters, and long-term efficacy are needed. This study is registered with PROSPERO (clinicaltrials gov. Identifier: CRD42021279051).
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Laozei Sima
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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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46
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Sun H, Bu F, Li L, Zhang X, Yan J, Huang T. COVID-19 vaccine response and safety in patients with cancer: An overview of systematic reviews. Front Public Health 2022; 10:1072137. [PMID: 36457318 PMCID: PMC9707626 DOI: 10.3389/fpubh.2022.1072137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background To date, the COVID-19 pandemic does not appear to be overcome with new variants continuously emerging. The vaccination against COVID-19 has been the trend, but there are multiple systematic reviews on COVID-19 vaccines in patients with cancer, resulting in redundant and sub-optimal systematic reviews. There are still some doubts about efficacy and safety of the COVID-19 vaccine in cancer patients. Purpose To identify, summarize and synthesize the available evidence of systematic reviews on response and COVID-19 vaccine safety in patients with cancer. Methods Multiple databases were searched from their inception to May 1, 2022 to fetch the relevant articles. Study quality was assessed by AMSTAR2. The protocol of this study was registered on PROSPERO (CRD42022327931). Results A total of 18 articles were finally included. The seroconversion rates after first dose were ranged from 37.30-54.20% in all cancers, 49.60-62.00% in solid cancers and 33.30-56.00% in hematological malignancies. The seroconversion rates after second dose were ranged from 65.30-87.70% in all cancers, 91.60-96.00% in solid cancers and 58.00-72.60% in hematological malignancies. Cancer types and types of therapy could influence vaccine response. COVID-19 vaccines were safe and well-tolerated. Conclusions This study suggests COVID-19 vaccine response is significantly lower in cancer patients. Number of received doses, cancer types and treatment strategies could influence response of COVID-19 vaccine in cancer patients. COVID-19 vaccines are safe and well-tolerated. Considering the emergence of several new variants of SARS-CoV-2 with potential influence on ongoing vaccination programs, there is a need for booster doses to increase the effectiveness of COVID-19 vaccines. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022327931, identifier CRD42022327931.
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47
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Kos IA, Kiefer M, Brill K, Cetin O, Bittenbring JT, Ahlgrimm M, Smola S, Lohse S, Christofyllakis K, Kaddu-Mulindwa D, Neumann F, Bewarder M, Thurner L. Adaptive humoral immune response and cellular immune status in cancer patients and patients under immunosuppression vaccinated against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1683-1689. [PMID: 35994606 DOI: 10.1080/14760584.2022.2116009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with cancer and autoimmune diseases are at higher risk of severe COVID-19. They may not develop protective immune responses following vaccination. We investigated patients' cellular and humoral immune response after two COVID-19 vaccine doses. RESEARCH DESIGN AND METHODS Subjects were stratified into subgroups according to therapy and grade of immunosuppression at time of vaccination. RESULTS Antibody titers were compared to healthy controls. 32/122 (26%) did not develop detectable antibody titers. Of these, 22 (66.6%) had active therapy. Patients showed significant lower antibody titers compared to controls (median 790 vs. 3923 AU/mL, p = 0.026). Patients with active therapy had significant lower antibody titers compared to those without (median 302 vs. 3952 U/L P < 0.001). B-cell count was lower in the group without antibody titers (median 29.97 vs. 152.8; p = 0.002). 100% of patients under anti-CD20 therapy had no detectable antibody titer, followed by anti-TNF (66%), BTK inhibitors (50%), ruxolitinib (35.5%), TKI (14.2%), and lenalidomide (12.5%). Anti-CD20 therapy, ruxolitinib, BTK inhibitors, and anti-CD38 therapy presented significant lower antibody titers compared to controls. CONCLUSIONS Patients undergoing therapy for cancer or autoimmune diseases are at higher risk of insufficient humoral immune response following COVID-19 vaccination. Furthermore, alterations in the B-cell compartment correlate with lower antibody titers.
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Affiliation(s)
- Igor Age Kos
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Maximilian Kiefer
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Katharina Brill
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Onur Cetin
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Joerg Thomas Bittenbring
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Manfred Ahlgrimm
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Stefan Lohse
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Konstantinos Christofyllakis
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Frank Neumann
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Moritz Bewarder
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Lorenz Thurner
- Department of Internal Medicine I, Hematology and Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
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Watanabe M, Yakushijin K, Funakoshi Y, Ohji G, Ichikawa H, Sakai H, Hojo W, Saeki M, Hirakawa Y, Matsumoto S, Sakai R, Nagao S, Kitao A, Miyata Y, Koyama T, Saito Y, Kawamoto S, Yamamoto K, Ito M, Murayama T, Matsuoka H, Minami H. A Third Dose COVID-19 Vaccination in Allogeneic Hematopoietic Stem Cell Transplantation Patients. Vaccines (Basel) 2022; 10:1830. [PMID: 36366338 PMCID: PMC9695068 DOI: 10.3390/vaccines10111830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 10/06/2023] Open
Abstract
We previously reported that a second dose of BNT162b2 was safe and effective for allogeneic hematopoietic stem cell transplantation (HSCT) patients. Here, we investigated the safety and efficacy of a third dose of COVID-19 mRNA vaccine in allogeneic HSCT patients. Antibody titers against the S1 spike protein were measured using the QuaResearch COVID-19 Human IgM IgG ELISA kit. The previous study included 25 allogeneic HSCT patients who received two doses of BNT162b2. Following the exclusion of three patients because of the development of COVID-19 (n = 2) and loss to follow-up (n = 1), the study evaluated 22 allogeneic HSCT patients who received a third dose of COVID-19 mRNA vaccine (BNT162b2 [n = 15] and mRNA-1273 [n = 7]). Median age at the time of the first vaccination was 56 (range, 23-71) years. Five patients were receiving immunosuppressants at the third vaccination, namely calcineurin inhibitors (CI) alone (n = 1), steroids alone (n = 2), or CI combined with steroids (n = 2). Twenty-one patients (95%) seroconverted after the third dose. None of our patients had serious adverse events, new-onset graft-versus-host disease (GVHD), or GVHD exacerbation after vaccination. A third dose of the BNT162b2 and mRNA-1273 COVID-19 vaccines was safe and effective for allogeneic HSCT patients.
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Affiliation(s)
- Marika Watanabe
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yohei Funakoshi
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Goh Ohji
- Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroya Ichikawa
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | | | - Wataru Hojo
- R&D, Cellspect Co., Ltd., Morioka 020-0857, Japan
| | - Miki Saeki
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuri Hirakawa
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Sakuya Matsumoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Rina Sakai
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Shigeki Nagao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Akihito Kitao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiharu Miyata
- BioResource Center, Kobe University Hospital, Kobe 650-0047, Japan
| | - Taiji Koyama
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yasuyuki Saito
- Division of Molecular and Cellular Signaling, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Shinichiro Kawamoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Katsuya Yamamoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
| | - Mitsuhiro Ito
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
- Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
| | - Tohru Murayama
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
- Department of Hematology, Hyogo Cancer Center, Akashi 673-0021, Japan
| | - Hiroshi Matsuoka
- BioResource Center, Kobe University Hospital, Kobe 650-0047, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital Graduate School of Medicine, Kobe 650-0017, Japan
- Cancer Center, Kobe University Hospital, Kobe 650-0017, Japan
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49
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Meyer T, Ihorst G, Bartsch I, Zeiser R, Wäsch R, Bertz H, Finke J, Huzly D, Wehr C. Cellular and Humoral SARS-CoV-2 Vaccination Responses in 192 Adult Recipients of Allogeneic Hematopoietic Cell Transplantation. Vaccines (Basel) 2022; 10:1782. [PMID: 36366291 PMCID: PMC9699205 DOI: 10.3390/vaccines10111782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 09/29/2023] Open
Abstract
To determine factors influencing the vaccination response against SARS-CoV-2 is of importance in recipients of allogeneic hematopoietic cell transplantation (allo-HCT) as they display an increased mortality after SARS-CoV-2 infection, an increased risk of extended viral persistence and reduced vaccination response. Real-life data on anti-SARS-CoV-2-S1-IgG titers (n = 192) and IFN-γ release (n = 110) of allo-HCT recipients were obtained using commercially available, validated assays after vaccination with either mRNA (Comirnaty™, Pfizer-BioNTech™, NY, US and Mainz, Germany or Spikevax™, Moderna™, Cambridge, Massachusetts, US) or vector-based vaccines (Vaxzevria™,AstraZeneca™, Cambridge, UK or Janssen COVID-19 vaccine™Johnson/Johnson, New Brunswick, New Jersey, US), or after a heterologous protocol (vector/mRNA). Humoral response (78% response rate) was influenced by age, time after transplantation, the usage of antithymocyte globulin (ATG) and ongoing immunosuppression, specifically corticosteroids. High counts of B cells during the vaccination period correlated with a humoral response. Only half (55%) of participants showed a cellular vaccination response. It depended on age, time after transplantation, ongoing immunosuppression with ciclosporin A, chronic graft-versus-host disease (cGvHD) and vaccination type, with vector-based protocols favoring a response. Cellular response failure correlated with a higher CD8+ count and activated/HLA-DR+ T cells one year after transplantation. Our data provide the basis to assess both humoral and cellular responses after SARS-CoV2 vaccination in daily practice, thereby opening up the possibility to identify patients at risk.
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Affiliation(s)
- Thomas Meyer
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Ingrid Bartsch
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Robert Zeiser
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Claudia Wehr
- Department of Medicine I/Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
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50
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Toya T, Atsuta Y, Sanada T, Honda T, Sadato D, Sekiya N, Kogure H, Takakuwa S, Onai D, Shingai N, Shimizu H, Najima Y, Kobayashi T, Ohashi K, Harada Y, Kohara M, Doki N. Attenuated humoral response against SARS-CoV-2 mRNA vaccination in allogeneic stem cell transplantation recipients. Cancer Sci 2022; 114:586-595. [PMID: 36161681 PMCID: PMC9538567 DOI: 10.1111/cas.15603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023] Open
Abstract
Antibody persistence several months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in allogeneic stem cell transplantation recipients remains largely unknown. We sequentially evaluated the humoral response to two doses of mRNA vaccines in 128 adult recipients and identified the risk factors involved in a poor response. The median interval between stem cell transplantation and vaccination was 2.7 years. The SARS-CoV-2 S1 Ab became positive after the second vaccination dose in 87.6% of the recipients, and the median titer was 1235.4 arbitrary units (AU)/ml. In patients on corticosteroid treatment, the corticosteroid dose inversely correlated with Ab titer. Multivariate analysis identified risk factors for poor peak response such as an interval from stem cell transplantation ≤1 year, history of clinically significant CMV infection, and use of >5 mg/day prednisolone at vaccination. Six months after vaccination, the median titer decreased to 185.15 AU/ml, and use of >5 mg/day prednisolone at vaccination was significantly associated with a poor response. These results indicate that early vaccination after stem cell transplantation (<12 months) and CMV infection are risk factors for poor peak response, while steroid use is important for a peak as well as a persistent response. In conclusion, although humoral response is observed in many stem cell transplantation recipients after two doses of vaccination, Ab titers diminish with time, and factors associated with persistence and a peak immunity should be considered separately.
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Affiliation(s)
- Takashi Toya
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Yuya Atsuta
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Takahiro Sanada
- Department of Microbiology and Cell BiologyTokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Tomoko Honda
- Department of Microbiology and Cell BiologyTokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Daichi Sadato
- Clinical Research Support Center, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan,Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Hiroko Kogure
- Clinical Research Support Center, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Sonomi Takakuwa
- Clinical Research Support Center, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Daishi Onai
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Naoki Shingai
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Hiroaki Shimizu
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Yuho Najima
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Takeshi Kobayashi
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Kazuteru Ohashi
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Yuka Harada
- Clinical Research Support Center, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Michinori Kohara
- Department of Microbiology and Cell BiologyTokyo Metropolitan Institute of Medical ScienceTokyoJapan
| | - Noriko Doki
- Hematology Division,Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
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