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Akhmedov M, Zeynalova P, Fedenko A. Multiple myeloma and infections in the era of novel treatment modalities. Leuk Res 2024; 143:107544. [PMID: 38963989 DOI: 10.1016/j.leukres.2024.107544] [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: 02/07/2024] [Revised: 05/14/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
Infections are major cause of morbidity and mortality in patients with multiple myeloma. Current treatment landscape of newly-diagnosed multiple myeloma includes different classes of drugs, such as proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, all of which are characterized by specific risk and pattern of infectious complications. Additionally, autologous and allogeneic hematopoietic cell transplantation, widely used in the treatment of multiple myeloma, are complex procedures, carrying a significant risk of complications, and mainly infections. Finally, novel treatment modalities such as bispecific T-cell engagers and chimeric antigen receptor T-lymphocytes have been changing the paradigm of myeloma treatment in relapsed-refractory setting. These agents due to unique mechanism of action carry distinct pattern of infectious complications. In this review, an attempt has been made to summarize the incidence, risk factors, and patterns of infections during different stages of myeloma treatment including novel treatment modalities, and to provide evidence underlying the current concept of infectious disease prophylaxis in this category of patients.
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Affiliation(s)
- Mobil Akhmedov
- Department of High-dose Chemotherapy and Bone Marrow Transplantation, P.A. Herzen Moscow Oncology Research Institute, branch of the National Medical Radiology Research Center, Russian Federation; Department of Oncology and Oncosurgery, Russian University of Medicine, Russian Federation.
| | - Pervin Zeynalova
- Department of Oncology, Sechenov University, Russian Federation; Department of Oncology, Lapino Clinical Hospital, Russian Federation
| | - Alexander Fedenko
- Department of High-dose Chemotherapy and Bone Marrow Transplantation, P.A. Herzen Moscow Oncology Research Institute, branch of the National Medical Radiology Research Center, Russian Federation
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2
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Muhsen IN, Heslop HE. Time to optimize vaccination strategies in blood cancer patients. Br J Haematol 2024; 205:406-408. [PMID: 38895787 DOI: 10.1111/bjh.19598] [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: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Immune response to vaccinations is dampened in patients with indolent lymphomas due to disease and treatment-related factors. The study by Lim et al. demonstrated impaired humoral response but intact cellular response to the SARS-CoV2 vaccine in patients with follicular lymphoma receiving front-line therapy. The results highlight the importance of several factors in predicting immune response to vaccination and provide estimates of immune response for different clinical scenarios and treatment points. Commentary on: Lim et al. Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy. Br J Haematol 2024;205:440-451.
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Affiliation(s)
- Ibrahim N Muhsen
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Helen E Heslop
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Texas, USA
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3
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Bhella S, Wilkin AM, Hueniken K, Vijenthira A, Sebag M, Wang P, Hicks LK, Hay AE, Assouline S, Fraser G, Balitsky A, Mangel J, Owen C, Reiman A, Sehn L, Sutherland H, Zhang T, Arnold C, Leite T, McCarthy E, Cooper C, Langlois MA, Arianne Buchan C. COVID-19 vaccine immunogenicity and safety surrounding fourth and subsequent vaccine doses in patients with hematologic malignancies. Vaccine 2024:S0264-410X(24)00715-1. [PMID: 38944577 DOI: 10.1016/j.vaccine.2024.06.041] [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: 02/29/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Immune response to COVID-19 vaccine is diminished in patients with hematologic malignancy. There is limited data regarding response to vaccine doses in these patients. PURPOSE To quantify the humoral immune response engendered by 4th and subsequent doses of SARS-CoV-2 vaccination as measured by anti-Spike (anti-S) antibody levels, based on dried blood spot (DBS) testing, in patients with hematologic malignancies. Anti-S binds to the spike protein of the SARS-CoV-2 virus and is indicative of vaccine immunogenicity. METHODS We conducted a prospective study of hematologic malignancies between August 2021 and January 2023 at 12 sites across Canada. Participants were followed longitudinally and submitted finger-prick DBS cards at set intervals associated with vaccination. Samples were processed via high throughput ELISA assay to detect serum antibodies against nucleocapsid (N) and spike (S) proteins. RESULTS We obtained 3071 samples on 790 unique patients. Of these, 372 unique participants with 1840 samples had anti-S results available post-4th, 5th or 6th COVID-19 vaccine dose and were included for analysis. Three hundred thirty-three patients of the 372 participants submitted a DBS sample post 4th dose. Of these, 257 patients (77.2%) had a positive anti-S antibody. A total of 198 patients had paired samples pre- and post-dose 4, of which 59 (29.7%) had a negative anti-S antibody pre-dose 4. Of these, 20 (33.4%) developed positive anti-S antibody post-dose 4. One hundred forty-nine patients submitted a DBS sample post-dose 5. Of these, 135 patients (90.6%) had positive anti-S antibody. A total of 52 had paired samples pre- and post-dose 5. Six (8.7%) had a negative anti-S antibody pre-dose 5, of which two (33.3%) developed positive anti-S antibody post-dose 5. Of these 372 patients, 123 (34%) reported COVID-19 infection and 4 (1%) had a COVID-19 related hospitalization. There were no reported deaths from COVID-19. CONCLUSIONS This prospective cohort study showed that humoral immune response improved with subsequent doses of COVID-19 vaccines.
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Affiliation(s)
- Sita Bhella
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada.
| | | | - Katrina Hueniken
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Abi Vijenthira
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Peng Wang
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa K Hicks
- Division of Hematology/Oncology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | - Graeme Fraser
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Amaris Balitsky
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Joy Mangel
- Division of Hematology, Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Carolyn Owen
- University of Calgary, Tom Baker Cancer Centre, Division of Hematology and Hematological Malignancies, Calgary, AB, Canada
| | - Anthony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | - Laurie Sehn
- BC Cancer Centre for Lymphoma Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Heather Sutherland
- Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Tinghua Zhang
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Tamara Leite
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Erinn McCarthy
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada
| | - Curtis Cooper
- Ottawa Hospital Research Institute, Ottawa ON, Canada
| | - Marc-Andre Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
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4
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Fedele PL, Opat S. Chronic Lymphocytic Leukemia: Time to Care for the Survivors. J Clin Oncol 2024; 42:2005-2011. [PMID: 38489567 DOI: 10.1200/jco.23.02738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Pasquale L Fedele
- Lymphoma Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Stephen Opat
- Lymphoma Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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5
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Crom DB, Walters LA, Li Y, Liang J, Hijano DR, Mulrooney DA, Carmichael LA, Ford SL, Andrews SJ, Smith D, Hudson MM, Mandrell BN. Seroprevalence of Measles (Rubeola) Antibodies in Childhood Cancer Survivors. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024:27527530231221145. [PMID: 38715372 DOI: 10.1177/27527530231221145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background: Measles is reemerging as a public health threat, raising important questions about disease vulnerability among childhood cancer survivors. This secondary analysis assessed the seroprevalence of anti-measles immunoglobulin G (IgG) antibodies as a marker of immune status in survivors of childhood cancer and associated demographic/treatment variables. Method: Participants were childhood cancer survivors who were free of active disease, having routine blood studies drawn, and could provide documentation of having received two doses of measles, mumps, and rubella vaccine before their cancer diagnosis. Patient record review documented demographic and treatment variables. Antimeasles (rubeola) IgG antibody seroprevalence was assessed by enzyme immunoassay for vaccine-specific antibodies. Results: Of 270 survivors evaluated, 110 (42%) were female, 196 (75%) were White, and 159 (61%) were leukemia/lymphoma survivors. Of these 262, 110 (42%) had negative measles seroprevalence, suggesting loss of immunity. Conclusion: Measles antibody surveillance and the need for reimmunization for survivors of childhood cancer survivors outside the transplant setting remains controversial. Our analysis indicates that a substantial proportion of survivors lose vaccine-related immunity to measles. Pediatric oncology nurses play important roles in educating cancer survivors regarding their risk of measles infection, evaluating the need for reimmunization, correcting misinformation about vaccine safety and effectiveness, and working to optimize community herd-based immunity.
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Affiliation(s)
- Deborah B Crom
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa A Walters
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jai Liang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Diego R Hijano
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lee Ann Carmichael
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sarah L Ford
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shekinah J Andrews
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Daniel Smith
- Center for Advanced Practice, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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6
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Merli M, Costantini A, Tafuri S, Bavaro DF, Minoia C, Meli E, Luminari S, Gini G. Management of vaccinations in patients with non-Hodgkin lymphoma. Br J Haematol 2024; 204:1617-1634. [PMID: 38532527 DOI: 10.1111/bjh.19422] [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: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
Vaccinations are fundamental tools in preventing infectious diseases, especially in immunocompromised patients like those affected by non-Hodgkin lymphomas (NHLs). The COVID-19 pandemic made clinicians increasingly aware of the importance of vaccinations in preventing potential life-threatening SARS-CoV-2-related complications in NHL patients. However, several studies have confirmed a significant reduction in vaccine-induced immune responses after anti-CD20 monoclonal antibody treatment, thus underscoring the need for refined immunization strategies in NHL patients. In this review, we summarize the existing data about COVID-19 and other vaccine's efficacy in patients with NHL and propose multidisciplinary team-based recommendations for the management of vaccines in this specific group of patients.
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Affiliation(s)
- Michele Merli
- Division of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Costantini
- Clinical Immunology Unit, Azienda Ospedaliero Universitaria delle Marche - Università Politecnica delle Marche, Ancona, Italy
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Carla Minoia
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Erika Meli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Guido Gini
- Clinic of Hematology, Azienda Ospedaliero Universitaria Delle Marche - Università Politecnica Delle Marche, Ancona, Italy
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Mikulska M, Oltolini C, Zappulo E, Bartoletti M, Frustaci AM, Visentin A, Vitale C, Mauro FR. Prevention and management of infectious complications in patients with chronic lymphocytic leukemia (CLL) treated with BTK and BCL-2 inhibitors, focus on current guidelines. Blood Rev 2024; 65:101180. [PMID: 38331696 DOI: 10.1016/j.blre.2024.101180] [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: 12/08/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
CLL is associated with an increased risk of infectious complications. Treatment with BTK or BCL-2 inhibitors does not seem to increase significantly the risk of opportunistic infections, but the role of combination therapies including BTK and/or BCL-2 inhibitors remains to be established. Various infectious complications can be successfully prevented with appropriate risk management strategies. In this paper we reviewed the international guidelines on prevention and management of infectious complications in patients with CLL treated with BTK or BCL-2 inhibitors. Universal pharmacological anti-herpes, antibacterial or antifungal prophylaxis is not warranted. Reactivation of HBV should be prevented in HBsAg-positive subjects. For HBsAg-negative/HBcAb-positive patients recommendations differ, but in case of combination treatment should follow those for other, particularly anti-CD20, agent. Immunization should be provided preferably before the onset of treatment. Immunoglobulin therapy has favourable impact on morbidity but not mortality in patients with hypogammaglobulinemia and severe or recurrent infections. Lack of high-quality data and heterogeneity of patients or protocols included in the studies might explain differences among the main guidelines. Better data collection is warranted.
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Affiliation(s)
- Malgorzata Mikulska
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | | | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milan, Italy; Infectious Disease Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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8
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Óskarsson Ý, Thors V, Vias RD, Lúðvíksson BR, Brynjólfsson SF, Gianchecchi E, Razzano I, Montomoli E, Gísli Jónsson Ó, Haraldsson Á. Adequate immune responses to vaccines after chemotherapy for leukaemia diagnosed in childhood. Acta Paediatr 2024; 113:606-614. [PMID: 38140806 DOI: 10.1111/apa.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
AIM The survival rate after treatment for childhood leukaemia has greatly improved, but could result in protracted immune deficiency. This study examined the immune status of children after chemotherapy and evaluated their responses to immunisation. METHODS Subjects who had completed their treatment for acute lymphoblastic leukaemia at The Children's Hospital Reykjavík, Iceland, during 2011-2020 had blood drawn and were then immunised for influenza in October 2021. Blood was drawn again 4 weeks later and their humoral and cellular responses were measured with a haemagglutination inhibition assay and lymphocyte stimulation test. Antibodies to other immunisations were also evaluated. RESULTS We studied 18 patients (10 male) who had completed their treatment at 3.7-20.3 years of age (mean 9.1), 11-84 months (mean 36.9) before enrolment. Conventional immunological evaluation did not reveal notable abnormalities. The responses to several childhood vaccinations, including the pneumococcal conjugate vaccination, were adequate in most patients. Humoral responses to the influenza vaccine confirmed adequate reactions in all but one patient. Considerable variations were observed in the lymphocyte stimulations tests. CONCLUSION Most patients reacted adequately to immunisation, especially against annual influenza and Streptococcus pneumoniae, reiterating the usefulness of vaccinations. The most appropriate timing for vaccination after treatment still needs to be determined.
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Affiliation(s)
- Ýmir Óskarsson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Valtýr Thors
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Rafael Daníel Vias
- Department of Mathematics, Faculty of Physical Sciences, University of Iceland, Reykjavík, Iceland
| | - Björn Rúnar Lúðvíksson
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Immunology, Landspítali University Hospital, Reykjavík, Iceland
| | - Siggeir Fannar Brynjólfsson
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Immunology, Landspítali University Hospital, Reykjavík, Iceland
| | | | | | - Emanuele Montomoli
- VisMederi Srl, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Ólafur Gísli Jónsson
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ásgeir Haraldsson
- The Children's Hospital Iceland, Landspítali University Hospital, Reykjavík, Iceland
- Department of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
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9
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Cetin M, Gumy-Pause F, Gualtieri R, Posfay-Barbe KM, Blanchard-Rohner G. Vaccine Immunity in Children After Hematologic Cancer Treatment: A Retrospective Single-center Study. J Pediatr Hematol Oncol 2024; 46:e51-e59. [PMID: 37922437 PMCID: PMC10756701 DOI: 10.1097/mph.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/20/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Children lose their vaccine-induced protection and are particularly vulnerable to vaccine-preventable diseases after chemotherapy. However, revaccination guidelines are heterogeneous, and there is often a lack of revaccination post-treatment. AIMS We conducted a retrospective study of children with hematologic cancer to evaluate vaccine immunity before and after the end of treatment and to determine whether the current institutional revaccination program based on vaccine serology results was followed and effective. MATERIALS AND METHODS Data of all children treated by chemotherapy between April 2015 and July 2021 were extracted from hospital medical records for analysis. Serum antibody levels and time of vaccination were evaluated for diphtheria, tetanus, Streptococcus pneumoniae , Haemophilus influenzae type b (Hib), measles, varicella, and hepatitis B. RESULTS We included 31 patients (median age, 9 years). At cancer diagnosis, 90% of children were protected against tetanus, diphtheria, and measles; 65% to 67% were protected against pneumococcus and varicella; and 25% against hepatitis B. At the end of chemotherapy, 67% to 71% of patients were protected against tetanus, varicella, and measles; 40% remained protected against hepatitis B; and 27% to 33% against pneumococcus and diphtheria. Patients were revaccinated at various times after the end of treatment but not systematically. During the first-year post-treatment, 20% to 25% of children remained unprotected against pneumococcus, measles, and hepatitis B, one third against diphtheria, but all were protected against tetanus and varicella. CONCLUSIONS An effective individualized vaccination program post-cancer based on serology results should be accompanied by an appropriate serology tracking method and follow-up to assess if booster doses are necessary. Our study supports vaccinating all children with a dose of the 13-valent pneumococcal conjugate at cancer diagnosis and at 3 months post-treatment with the combined diphtheria-tetanus-acellular pertussis/poliomyelitis vaccine/hepatitis B virus plus or minus Hib and 13-valent pneumococcal conjugate and meningococcal vaccine, including measles/mumps/rubella-varicella zoster virus vaccine if good immune reconstitution is present.
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Affiliation(s)
| | - Fabienne Gumy-Pause
- Pediatric Oncology and Hematology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva
| | - Renato Gualtieri
- Pediatric Platform for Clinical Research, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gynecology and Obstetrics, Division of General Pediatrics, Geneva University Hospitals and Faculty of Medicine
| | - Geraldine Blanchard-Rohner
- Immunology and Vaccinology Unit, Department of Pediatrics, Gynecology and Obstetrics, Division of General Pediatrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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10
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Rivero Calle I, Del Rosal Rabes T, Garrote Llanos E, Núñez Cuadros E, Navarro Gómez ML, Ramos Amador JT, Calvo C, Álvarez García F. Consensus document of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Association of Pediatrics for vaccination of immunosuppressed individuals. An Pediatr (Barc) 2023; 99:403-421. [PMID: 38057232 DOI: 10.1016/j.anpede.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
The number of people with immunosuppression is increasing considerably due to their greater survival and the use of new immunosuppressive treatments for various chronic diseases. This is a heterogeneous group of patients in whom vaccination as a preventive measure is one of the basic pillars of their wellbeing, given their increased risk of contracting infections. This consensus, developed jointly by the Sociedad Española de Infectología Pediátrica (Spanish Society of Pediatric Infectious Diseases) and the Advisory Committee on Vaccines of the Asociación Española de Pediatría (Spanish Association of Paediatrics), provides guidelines for the development of a personalised vaccination schedule for patients in special situations, including general recommendations and specific recommendations for vaccination of bone marrow and solid organ transplant recipients, children with inborn errors of immunity, oncologic patients, patients with chronic or systemic diseases and immunosuppressed travellers.
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Affiliation(s)
- Irene Rivero Calle
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP), Instituto de Investigación Hospital Clínico Universitario de Santiago de Compostela (IdiCHUS), CIBERes Ciber de Respiratorio, Santiago de Compostela, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP.
| | - Teresa Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), CIBERER U767, Instituto de Salud Carlos III, Madrid, Spain; Sociedad Española de Infectología Pediátrica
| | - Elisa Garrote Llanos
- Sección de Infectología, Servicio de Pediatría, Hospital Universitario, OSI Bilbao-Basurto, Bilbao, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - Esmeralda Núñez Cuadros
- Sección de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Grupo multidisciplinar pediátrico IBIMA, Málaga, Spain; Sociedad Española de Infectología Pediátrica
| | - María Luisa Navarro Gómez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISGM), CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Complutense, Madrid, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - José Tomás Ramos Amador
- Servicio Pediatría y Áreas Específicas, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Departamento de Salud Pública y Maternoinfantil, Universidad Complutense, CIBERINFEC Ciber de Enfermedades Infecciosas, Madrid, Spain; Comité Asesor de Vacunas de la AEP
| | - Cristina Calvo
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Autónoma de Madrid, Madrid, Spain; Sociedad Española de Infectología Pediátrica
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11
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Pearson B, Pulley M, Diniz M, Baca N, Majlessipour F. Loss of humeral immunity in childhood cancer survivors not having undergone hematopoietic stem cell transplantation. Cancer Rep (Hoboken) 2023; 6:e1907. [PMID: 37867406 PMCID: PMC10728513 DOI: 10.1002/cnr2.1907] [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: 04/03/2023] [Revised: 08/04/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Data are limited and conflicting regarding loss of immunity in childhood cancer survivors who did not undergo hematopoietic stem cell transplantation. The purpose of this retrospective, single center study is to provide further data to help build unifying revaccination guidelines post-chemotherapy in childhood cancer survivors not having undergone hematopoietic stem cell transplantation. METHODS This retrospective study included 28 childhood cancer survivors, 14 males and 14 females, whose treatment consisted of at least 3 months of chemotherapy and with confirmation of completing their primary vaccination series prior to therapy. The rate of vaccine titer seropositivity for cancer survivors was compared with the expected general population, based on long-term studies of anti-body persistence. RESULTS Decreased seropositivity for measles, mumps, rubella, varicella, tetanus, and hepatitis B was found in patients across all categories of malignancy compared with the general population. However, tetanus was not statistically significant. Results were more pronounced for those with hematological malignancies. CONCLUSIONS This study indicates that pediatric cancer survivors, especially those with hematological malignancies, may have greater loss of protective antibodies from primary vaccinations. Further studies are needed to provide guidelines for revaccination of both hematologic malignancies and solid tumor childhood cancer survivors who did not undergo hematopoietic stem cell transplantation.
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Affiliation(s)
- Benjamin Pearson
- Department of Health StudiesUniversity of RichmondRichmondVirginiaUSA
| | - Michelle Pulley
- Department of PediatricsCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Marcio Diniz
- Biostatistics and Bioinformatics Research Center, Cedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Nicole Baca
- Department of Pediatric Hematology and Oncology, Cedars‐Sinai Samuel Oschin Comprehensive Cancer InstituteLos AngelesCaliforniaUSA
| | - Fataneh Majlessipour
- Department of Pediatric Hematology and Oncology, Cedars‐Sinai Samuel Oschin Comprehensive Cancer InstituteLos AngelesCaliforniaUSA
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12
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Huang CT, Lee CP, Chen TY, Liu YC, Cho SF, Du JS, Yu ML, Huang CF, Wang SF, Hsiao HH. Serological Responses and Predictive Factors of Booster COVID-19 Vaccines in Patients with Hematologic Malignancies. J Clin Med 2023; 12:5647. [PMID: 37685720 PMCID: PMC10488979 DOI: 10.3390/jcm12175647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Patients with hematologic malignancies are reported to have a more severe course of coronavirus disease 2019 (COVID-19) and be less responsive to vaccination. In this prospective study, we aimed to evaluate the serological responses to booster COVID-19 vaccines of Taiwanese patients with hematologic malignancies and identify potential predictive markers for effective neutralizing immunity. This study enrolled 68 patients with hematologic malignancies and 68 age- and gender-matched healthy control subjects who received three doses of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1 January 2022 to 31 October 2022. The SARS-CoV-2 immunoglobulin G (IgG) spike antibody level was measured with the Abbott assay. The effective neutralization capacity was defined as an anti-spike IgG level of ≥4160 AU/mL. Among the 68 patients with hematologic malignancies, 89.7% achieved seroconversion after booster doses. Seven patients with actively treated lymphoma remained seronegative and had the lowest humoral responses among patients with different types of hematologic malignancies. Despite comparable antibody titers between patients and healthy individuals, rates of effective neutralization (66.2% vs. 86.8%, respectively; p = 0.005) were significantly reduced in patients with hematologic malignancies. In a multivariate analysis, the independent predictors for effective neutralization were a lack of B-cell-targeted agents within six months of vaccination (odds ratio, 15.2; 95% confidence interval, 2.7-84.2; p = 0.002) and higher immunoglobulin levels (odds ratio, 4.4; 95% confidence interval, 1.3-14.7; p = 0.017). In conclusion, the majority of patients with hematologic malignancies achieved seroconversion after booster vaccination. Patients with ongoing B-cell depletion and hypogammaglobinemia were identified as having negative predictive markers for effective neutralization.
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Affiliation(s)
- Chien-Tzu Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ping Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
| | - Tzu-Yin Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Yi-Chang Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shih-Feng Cho
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Shiun Du
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ming-Lung Yu
- Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-L.Y.); (C.-F.H.)
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Chung-Feng Huang
- Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (M.-L.Y.); (C.-F.H.)
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University and Academia Sinica, Kaohsiung 807, Taiwan
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-T.H.); (C.-P.L.); (Y.-C.L.); (S.-F.C.); (J.-S.D.)
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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13
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Faizan U, Nair LG, Bou Zerdan M, Jaberi-Douraki M, Anwer F, Raza S. COVID-19 vaccine immune response in patients with plasma cell dyscrasia: a systematic review. Ther Adv Vaccines Immunother 2023; 11:25151355231190497. [PMID: 37645011 PMCID: PMC10461737 DOI: 10.1177/25151355231190497] [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: 11/08/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023] Open
Abstract
Background Patients with plasma cell dyscrasia are at a higher risk of developing a severe Coronavirus-2019 (COVID-19) infection. Here we present a systematic review of clinical studies focusing on the immune response to the COVID-19 vaccination in patients with plasma cell dyscrasia. Objectives This study aims to evaluate the immune response to COVID-19 vaccines in patients with plasma cell dyscrasia and to utilize the results to improve day-to-day practice. Design Systematic Review. Methods Online databases (PubMed, CINAHL, Ovid, and Cochrane) were searched following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Only articles published in the English language were included. Out of 59 studies, nine articles (seven prospective and two retrospective studies) were included in this systematic review. Abstracts, case reports, and case series were excluded. Results In all nine studies (N = 1429), seroconversion post-vaccination was the primary endpoint. Patients with plasma cell disorders had a lower seroconversion rate compared to healthy vaccinated individuals and the overall percentage of seroconversion ranged between 23% and 95.5%. Among patients on active therapy, lower seroconversion rates were seen on an anti-CD38 agent, ranging from 6.5 up to 100%. In addition, a significantly lower percentage was recorded in older patients, especially in those aged equal to or greater than 65 years and those who have been treated with multiple therapies previously. Only one study reported a statistically significant better humoral response rate with the mRNA vaccine compared to ADZ1222/Ad26.Cov.S. Conclusion Variable seropositive rates are seen in patients with plasma cell dyscrasia. Lower rates are reported in patients on active therapy, anti-CD38 therapy, and elderly patients. Hence, we propose patients with plasma cell dyscrasias should receive periodic boosters to maintain clinically significant levels of antibodies against COVID-19. Registration PROSPERO ID: CRD42023404989.
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Affiliation(s)
- Unaiza Faizan
- Department of Internal Medicine, Rochester General Hospital, 65 Onondaga Road, Apt B, Rochester, NY 14621, USA
| | - Lakshmi G. Nair
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Suny Upstate Medical University, Syracuse, NY, USA
| | | | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Shahzad Raza
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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14
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Haggenburg S, Garcia Garrido HM, Kant IMJ, Van der Straaten HM, De Boer F, Kersting S, Issa D, Te Raa D, Visser HPJ, Kater AP, Goorhuis A, De Heer K. Immunogenicity of the 13-Valent Pneumococcal Conjugated Vaccine Followed by the 23-Valent Polysaccharide Vaccine in Chronic Lymphocytic Leukemia. Vaccines (Basel) 2023; 11:1201. [PMID: 37515017 PMCID: PMC10385862 DOI: 10.3390/vaccines11071201] [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: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Patients with Chronic Lymphocytic Leukemia (CLL) have a 29- to 36-fold increased risk of invasive pneumococcal disease (IPD) compared to healthy adults. Therefore, most guidelines recommend vaccination with the 13-valent pneumococcal conjugated vaccine (PCV13) followed 2 months later by the 23-valent polysaccharide vaccine (PPSV23). Because both CLL as well as immunosuppressive treatment have been identified as major determinants of immunogenicity, we aimed to assess the vaccination schedule in untreated and treated CLL patients. We quantified pneumococcal IgG concentrations against five serotypes shared across both vaccines, and against four serotypes unique to PPSV23, before and eight weeks after vaccination. In this retrospective cohort study, we included 143 CLL patients, either treated (n = 38) or naive to treatment (n = 105). While antibody concentrations increased significantly after vaccination, the overall serologic response was low (10.5%), defined as a ≥4-fold antibody increase against ≥70% of the measured serotypes, and significantly influenced by treatment status and prior lymphocyte number. The serologic protection rate, defined as an antibody concentration of ≥1.3 µg/mL for ≥70% of serotypes, was 13% in untreated and 3% in treated CLL patients. Future research should focus on vaccine regimens with a higher immunogenic potential, such as multi-dose schedules with higher-valent T cell dependent conjugated vaccines.
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Affiliation(s)
- Sabine Haggenburg
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Hannah M Garcia Garrido
- Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Iris M J Kant
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | | | - Fransien De Boer
- Department of Internal Medicine, Ikazia Ziekenhuis, 3083 AN Rotterdam, The Netherlands
| | - Sabina Kersting
- Department of Hematology, HagaZiekenhuis, 2545 AA The Hague, The Netherlands
| | - Djamila Issa
- Department of Internal Medicine, Jeroen Bosch Ziekenhuis, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Doreen Te Raa
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, 6716 RP Ede, The Netherlands
| | - Hein P J Visser
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Koen De Heer
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Internal Medicine, Flevoziekenhuis, 1315 RA Almere, The Netherlands
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15
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Kättström M, Uggla B, Tina E, Kimby E, Norén T, Athlin S. Improved plasmablast response after repeated pneumococcal revaccinations following primary immunization with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia. Vaccine 2023; 41:3128-3136. [PMID: 37061372 DOI: 10.1016/j.vaccine.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients with chronic lymphocytic leukemia (CLL) show an immune dysfunction with increased risk of infections and poor response to vaccination. Streptococcus pneumoniae is a common cause of morbidity and mortality in CLL patients. In a previous randomized clinical trial, we found a superior immune response in CLL patients receiving conjugated pneumococcal vaccine compared to non-conjugated vaccine. The response to revaccination in CLL patients is scarcely studied. In this study, early humoral response to repeated revaccinations with pneumococcal vaccines was evaluated, by determination of B cell subsets and plasmablast dynamics in peripheral blood. METHOD CLL patients (n = 14) and immunocompetent controls (n = 31) were revaccinated with a 13-valent pneumococcal conjugate vaccine (PCV13) after previous primary immunization (3-6 years ago) with PCV13 or a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Eight weeks after the first revaccination, all CLL patients received a second revaccination with PCV13 or PPSV23. B cell subsets including plasmablasts were analyzed in peripheral blood by flow cytometry, before and after the first and the second revaccination. RESULTS None of the CLL patients, but all controls, had detectable plasmablasts at baseline (p < 0.001). After the first revaccination with PCV13, the plasmablast proportions did not increase in CLL patients (p = 0.13), while increases were seen in controls (p < 0.001). However, after a second revaccination with PCV13 or PPSV23, plasmablasts increased compared to baseline also in CLL patients (p < 0.01). If no response was evident after first revaccination, only a second revaccination with PCV13 increased plasmablasts in contrast to PPSV23 revaccination. Patients with hypogammaglobulinemia and ongoing/previous CLL specific treatment responded poorly, also to a second revaccination. CONCLUSION In CLL patients, pneumococcal revaccination induced minor early plasmablast response compared to controls, but the response improved using a strategy of repeated doses with of conjugated T cell dependent pneumococcal vaccine.
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Affiliation(s)
- Magdalena Kättström
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden.
| | - Bertil Uggla
- Section of Hematology, Department of Medicine, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
| | - Elisabet Tina
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Kimby
- Unit of Hematology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Norén
- Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Simon Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE 70185 Örebro, Sweden
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16
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Lee D, Jordan AI, Menges MA, Lazaryan A, Nishihori T, Gaballa SR, Shah BD, Pinilla-Ibarz J, Baluch A, Klinkova OV, Chavez JC, Jain MD, Locke FL. Pneumococcal Conjugate Vaccine Does Not Induce Humoral Response When Administrated Within the Six Months After CD19 CAR T-Cell Therapy. Transplant Cell Ther 2023; 29:277.e1-277.e9. [PMID: 35970303 DOI: 10.1016/j.jtct.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
CD19 targeted chimeric antigen receptor-modified T cell therapy (CAR-T) leads to B cell aplasia and low serum immunoglobulin levels. Long-lived CD19-negative plasma cells may persist through the therapy and generate antibodies. There is a paucity of data describing how CAR-T impacts the persistence of antibodies against vaccine-related antigens and the degree to which CAR-T recipients may respond to vaccines. We characterized the effect of CAR-T on pneumococcal immunoglobulin G (IgG) titers and determine whether pneumococcal conjugate vaccine (PCV13) administered after CAR-T develops long-term humoral protection against pneumococcus. A retrospective chart review was performed to identify CAR-T recipients who had serum pneumococcal IgG titers drawn before (baseline) or at days +90, +180, +270, +360, or +540 after CAR-T. We then determined whether they received PCV13 vaccination at these timepoints. IgG concentration ≥1.3 μg/mL was considered protective for that serotype, and patients with ≥6/11 tested vaccine-specific serotypes meeting this threshold were deemed to have humoral protection against pneumococcus. Absolute pneumococcal IgG titers and the proportion of patients with humoral protection, stratified by serotype, and vaccination status were compared by paired nonparametric t-tests. Absolute counts for lymphocyte, CD4 T-cell, and CD19 cell and total IgG level, along with the rate of invasive pneumococcal infections, were measured at these timepoints. A total of 148 CAR-T recipients with pneumococcal IgG titers measured for at least one of the defined time points were identified. At baseline, 25% (19/76) patients with evaluable pneumococcal IgG titers met the definition of humoral protection. Among 44 patients with paired pneumococcal IgG titers at baseline and day+90, absolute IgG titers of all serotypes decreased (geometric mean = 0.41 and 0.32 µg/mL, respectively; P < .001). Thirteen patients were vaccinated following the titer blood draw at day+90 and had paired pneumococcal IgG titers at day+90 and day180. Absolute IgG titers of all vaccine specific serotypes in these vaccinated patients decreased from day+90 to day+180 (geometric mean = 0.36 and 0.29 µg/mL, respectively; P = .03). The proportion of patients meeting the criteria of humoral protection remained the same at day+180 despite vaccination at day+90. The results were similar among 8 patients vaccinated at day+180, as well as 7 patients consecutively vaccinated at day+90 and day+180 with corresponding pneumococcal IgG titers. When all vaccine-specific pneumococcal IgG titers were pooled together by timepoint regardless of vaccination status, the proportion of patients with humoral protection decreased until day+540. Some patients developed humoral protection after vaccination at day+360, maintained seroprotective IgG titers from baseline, or developed protection after receiving intravenous immunoglobulin treatment secondary to recurrent infections. Our study demonstrated that few large B cell lymphoma patients had humoral protection against pneumococcus at baseline, and existing IgG titers decreased after CAR-T. PCV13 vaccination at day+90 or day+180 after CAR-T did not increase humoral protection against pneumococcus. Only at day+540 was there evidence of humoral protection against pneumococcus in a modest proportion of patients. Clinical trials are needed to determine the optimal timing of vaccination, before or after CAR-T, to develop protective immunity against Streptococcus pneumoniae infections.
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Affiliation(s)
- Dasom Lee
- Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Aryanna I Jordan
- Department of Internal Medicine, University of South Florida, Tampa, Florida
| | - Meghan A Menges
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Alexandr Lazaryan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Sameh R Gaballa
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Bijal D Shah
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | | | - Aliyah Baluch
- Infectious Disease Division, Moffitt Cancer Center, Tampa, Florida
| | - Olga V Klinkova
- Infectious Disease Division, Moffitt Cancer Center, Tampa, Florida
| | - Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Michael D Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
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17
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Pilmis B, Kherabi Y, Huriez P, Zahar JR, Mokart D. Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas. Cancers (Basel) 2023; 15:cancers15071989. [PMID: 37046650 PMCID: PMC10093532 DOI: 10.3390/cancers15071989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Infections are well known complications of some targeted drugs used to treat solid organ cancer and hematological malignancies. Furthermore, Individual patient risk factors are associated with underlying pathologies, concomitant immunosuppressive treatment, prior treatment and use of anti-infective prophylaxis. Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Objectives: In this narrative review, we present the current state of knowledge concerning the infectious complications occurring in patients treated with immune checkpoint inhibitors (ICIs), Bruton’s tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors or CAR-T cell infusion. Sources: We searched for studies treating infectious complications of ICIs, BTK inhibitors, PI3K inhibitors, antiapoptotic protein BCL-2 inhibitors and CAR-T cell therapy. We included randomized, observational studies and case reports. Content: Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Treatment of irAEs with corticosteroids and other immunosuppressive agents can lead to opportunistic infections. Bruton’s tyrosine kinase (BTK) inhibitors are associated with higher rate of infections, including invasive fungal infections. Implications: Infections, particularly fungal ones, are common in patients treated with BTK inhibitors even though most of the complications occurring among patients treated by ICIs or CART-cells infusion are associated with the treatment of side effects related to the use of these new treatments. The diagnosis of these infectious complications can be difficult and may require extensive investigations.
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Affiliation(s)
- Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
- UMR 1319, Institut Micalis, Université Paris-Saclay, INRAeChâtenay Malabry, AgroParisTech, 92290 Chatenay Malabry, France
- Correspondence: ; Tel.: +33-1-44-12-78-20; Fax: +33-1-44-12-35-13
| | - Yousra Kherabi
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Pauline Huriez
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Jean-Ralph Zahar
- Infection Control Unit, AP-HP Hôpital Avicenne, Université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Djamel Mokart
- Medical Surgical Intensive Care Unit, Institut Paoli Calmettes, 13009 Marseille, France
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18
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Hofmann G, Zierk J, Sobik B, Wotschofsky Z, Sembill S, Krumbholz M, Metzler M, Karow A. Temporal evolution and differential patterns of cellular reconstitution after therapy for childhood cancers. Sci Rep 2023; 13:4022. [PMID: 36899075 PMCID: PMC10006072 DOI: 10.1038/s41598-023-31217-3] [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: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The cellular reconstitution after childhood cancer therapy is associated with the risk of infection and efficacy of revaccination. Many studies have described the reconstitution after stem cell transplantation (SCT). The recovery after cancer treatment in children who have not undergone SCT has mainly been investigated in acute lymphoblastic leukemia (ALL), less for solid tumors. Here, we have examined the temporal evolution of total leukocyte, neutrophil and lymphocyte counts as surrogate parameters for the post-therapeutic immune recovery in a cohort of n = 52 patients with ALL in comparison to n = 58 patients with Hodgkin's disease (HD) and n = 22 patients with Ewing sarcoma (ES). Patients with ALL showed an efficient increase in blood counts reaching the age-adjusted lower limits of normal between 4 and 5 months after the end of maintenance therapy. The two groups of patients with HD and ES exhibited a comparably delayed recovery of total leukocytes due to a protracted post-therapeutic lymphopenia which was most pronounced in patients with HD after irradiation. Overall, we observed a clearly more efficient resurgence of total lymphocyte counts in patients aged below 12 years compared to patients aged 12 to 18 years. Our results underline that the kinetics of cellular reconstitution after therapy for HD and ES differ significantly from ALL and depend on treatment regimens and modalities as well as on patient age. This suggests a need for disease, treatment, and age specific recommendations concerning the duration of infection prophylaxis and the timing of revaccination.
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Affiliation(s)
- Gina Hofmann
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jakob Zierk
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Bettina Sobik
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Zofia Wotschofsky
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Stephanie Sembill
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Manuela Krumbholz
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Axel Karow
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
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19
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Furlong E, Kotecha RS. Lessons learnt from influenza vaccination in immunocompromised children undergoing treatment for cancer. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:199-213. [PMID: 36706776 DOI: 10.1016/s2352-4642(22)00315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023]
Abstract
Influenza infection contributes substantially to global morbidity and mortality, with children undergoing treatment for cancer among the most vulnerable due to immunosuppression associated with disease and treatment. However, influenza remains one of the most common vaccine-preventable diseases. Despite international guidelines recommending inactivated influenza vaccination on the basis of data supporting efficacy and an excellent safety profile in this population, uptake has often been suboptimal due to persisting hesitancy among both patients and oncologists regarding the ability of the vaccine to mount a sufficient immune response, the optimal vaccine schedule and timing, and the best method to assess response in immunocompromised populations. In this Review, we discuss the evidence regarding influenza vaccination in children with cancer, factors that influence response, and highlight strategies to optimise vaccination. Host immune factors play a substantial role, thus principles learnt from influenza vaccination can be broadly applied for the use of inactivated vaccines in children with cancer.
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Affiliation(s)
- Eliska Furlong
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia; Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Curtin Medical School, Curtin University, Perth, WA, Australia.
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20
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Chehab L, Doody DR, Esbenshade AJ, Guilcher GM, Dvorak CC, Fisher BT, Mueller BA, Chow EJ, Rossoff J. A Population-Based Study of the Long-Term Risk of Infections Associated With Hospitalization in Childhood Cancer Survivors. J Clin Oncol 2023; 41:364-372. [PMID: 35878085 PMCID: PMC9839247 DOI: 10.1200/jco.22.00230] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/28/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Infections pose a significant risk during therapy for childhood cancer. However, little is known about the risk of infection in long-term survivors of childhood cancer. METHODS We performed a retrospective observational study of children and adolescents born in Washington State diagnosed with cancer before age 20 years and who survived at least 5 years after diagnosis. Survivors were categorized as having a hematologic or nonhematologic malignancy and were matched to individuals without cancer in the state birth records by birth year and sex with a comparator:survivor ratio of 10:1. The primary outcome was incidence of any infection associated with a hospitalization using diagnostic codes from state hospital discharge records. Incidence was reported as a rate (IR) per 1,000 person-years. Multivariate Poisson regression was used to calculate incidence rate ratios (IRR) for cancer survivors versus comparators. RESULTS On the basis of 382 infection events among 3,152 survivors and 771 events among 31,519 comparators, the IR of all hospitalized infections starting 5 years after cancer diagnosis was 12.6 (95% CI, 11.4 to 13.9) and 2.4 (95% CI, 2.3 to 2.6), respectively, with an IRR 5.1 (95% CI, 4.5 to 5.8). The survivor IR during the 5- to 10-year (18.1, 95% CI, 15.9 to 20.5) and > 10-year postcancer diagnosis (8.3, 95% CI, 7.0 to 9.7) periods remained greater than comparison group IRs for the same time periods (2.3, 95% CI, 2.1 to 2.6 and 2.5, 95% CI, 2.3 to 2.8, respectively). When potentially vaccine-preventable infections were evaluated, survivors had a greater risk of infection relative to comparators (IRR, 13.1; 95% CI, 7.2 to 23.9). CONCLUSION Infectious complications continue to affect survivors of childhood cancer many years after initial diagnosis. Future studies are needed to better understand immune reconstitution to determine specific factors that may mitigate this risk.
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Affiliation(s)
- Leena Chehab
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David R. Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Adam J. Esbenshade
- Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Gregory M.T. Guilcher
- Section of Pediatric Oncology/Cellular Therapy, Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, University of California San Francisco, San Francisco, CA
| | - Brian T. Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Beth A. Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington (UW), Seattle, WA
| | - Eric J. Chow
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jenna Rossoff
- Division of Hematology/Oncology/Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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21
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Noto A, Cassin R, Mattiello V, Bortolotti M, Reda G, Barcellini W. Should treatment of hypogammaglobulinemia with immunoglobulin replacement therapy (IgRT) become standard of care in patients with chronic lymphocytic leukemia? Front Immunol 2023; 14:1062376. [PMID: 37122737 PMCID: PMC10140292 DOI: 10.3389/fimmu.2023.1062376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Hypogammaglobulinemia (HGG) is a frequent finding in patients with hematological malignancies, and is commonly described in chronic lymphocytic leukemia (CLL) before or after treatment. We reviewed published literature available online in the last thirty years through Medline search of indexed articles focusing on the main differences and advantages of the products now available on the market, namely intravenous Ig (IVIg) and subcutaneous Ig (SCIg) preparations. IgRT is effective and safe in the prophylaxis of infections in a selected group of patients with CLL and hypogammaglobulinemia and is therefore a valuable tool for clinicians in the everyday management of infectious risk. We encourage the use of SCIg formulations as they appear to have similar efficacy but better cost-effectiveness and tolerability.
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Affiliation(s)
- Alessandro Noto
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ramona Cassin
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bortolotti
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Gianluigi Reda,
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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22
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Mohamed S, Lucchini E, Sirianni F, Porrazzo M, Ballotta L, Ballerini M, De Sabbata GM, De Bellis E, Cappuccio I, Granzotto M, Toffoletto B, Fortunati I, Russignan A, Florea EE, Torelli L, Zaja F. Serological and cellular response to mRNA-SARS-CoV2 vaccine in patients with hematological lymphoid malignancies: Results of the study "Cervax". Front Oncol 2023; 13:1133348. [PMID: 36923438 PMCID: PMC10008958 DOI: 10.3389/fonc.2023.1133348] [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: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
messenger RNA (mRNA)-Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines such as BNT162b2 became available in late 2020, but hematological malignancy patients (HM pts) were not evaluated in initial registration trials. We hereby report the results of a prospective, unicentric, observational study Response to COVID-19 Vaccination in hEmatological malignancies (CERVAX) developed to assess the postvaccine serological and T-cell-mediated response in a cohort of SARS-CoV2-negative HM pts vaccinated with BNT162b2. Patients with lymphomas [non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL)], chronic lymphocytic leukemia (CLL), and multiple myeloma (MM); off-therapy for at least 3 months; in a watch-and-wait program; or in treatment with ibrutinib, venetoclax, and lenalidomide were included. Different time points were considered to assess the serological response to the vaccine: before the second dose (T1), at 3-6-12 months after the first dose (T2-3-4, respectively). Since March 2021, 39 pts have been enrolled: 15 (38%) NHL, 12 (31%) CLL, and 12 (31%) MM. There were 13 of the 39 pts (33%) seroconverted at T1; an increase of the serological response was registered after the second dose (T2) (22/39 pts, 56%) and maintained after 6 months (22/39 pts, 56%) and 12 months (24/39 pts, 61%) from the first dose (T3-T4, respectively). Non-serological responders at T4 were 7/39 (18%): 0/15 NHL, 1/12 MM (8%), and 6/12 CLL (50%). All of them were on therapy (one lenalidomide, three ibrutinib, and three venetoclax). SARS-CoV2-reactive T-cell analysis (interferon gamma release assays) was available since June 2022 and was evaluated at 12 months (T4) from the first dose of vaccine in 31/39 pts (79%). T-cell-mediated-responders were 17/31 (55%): most of them were NHL and MM (47%, 41% and 12% for NHL, MM, and CLL, respectively). Both serological and T-cell non-responders were represented by pts on active therapy (venetoclax/ibrutinib). During the period of observation, eight (20.5%) pts developed mild SARS-CoV2 infection; no coronavirus disease 19 (COVID-19)-related deaths or hospitalizations were registered. In conclusion, in our cohort of lymphoproliferative pts receiving BNT162b2, CLL diagnosis and venetoclax/ibrutinib seem to be related with a lower humoral or T-mediated response. Nevertheless, the efficacy of mRNA vaccine in HM pts and the importance to continue the vaccine program even in non-responders after the first dose are supported in our study by demonstrating that a humoral and T-cell-mediated seroconversion should be observed even in the subsets of heavily immunocompromised pts.
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Affiliation(s)
- Sara Mohamed
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Elisa Lucchini
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Francesca Sirianni
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marika Porrazzo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Laura Ballotta
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Mario Ballerini
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | - Eleonora De Bellis
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Ilaria Cappuccio
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marilena Granzotto
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Barbara Toffoletto
- SC Laboratorio Analisi, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Ilaria Fortunati
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Anna Russignan
- Dipartimento di Medicina, sezione Ematologia, University of Verona, Verona, Italy
| | | | - Lucio Torelli
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
| | - Francesco Zaja
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.,Dipartimento di Scienze Mediche, Chirurgiche e della Salute, University of Trieste, Trieste, Italy
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23
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Arad-Cohen N, Zeller B, Abrahamsson J, Fernandez Navarro JM, Cheuk D, Palmu S, Costa V, De Moerloose B, Hasle H, Jahnukainen K, Pronk CJ, Gísli Jónsson Ó, Kovalova Z, Lausen B, Munthe-Kaas M, Noren-Nyström U, Palle J, Pasauliene R, Saks K, Kaspers GJ. Supportive care in pediatric acute myeloid leukemia:Expert-based recommendations of the NOPHO-DB-SHIP consortium. Expert Rev Anticancer Ther 2022; 22:1183-1196. [PMID: 36191604 DOI: 10.1080/14737140.2022.2131544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Pediatric acute myeloid leukemia (AML) is the second most common type of pediatric leukemia. Patients with AML are at high risk for several complications such as infections, typhlitis, and acute and long-term cardiotoxicity. Despite this knowledge, there are no definite supportive care guidelines as to what the best approach is to manage or prevent these complications. AREA COVERED The NOPHO-DB-SHIP (Nordic-Dutch-Belgian-Spain-Hong-Kong-Israel-Portugal) consortium, in preparation for a new trial in pediatric AML patients, had dedicated meetings for supportive care. In this review, the authors discuss the available data and outline recommendations for the management of children and adolescents with AML with an emphasis on hyperleukocytosis, tumor lysis syndrome, coagulation abnormalities and bleeding, infection, typhlitis, malnutrition, cardiotoxicity, and fertility preservation. EXPERT OPINION Improved supportive care has significantly contributed to increased cure rates. Recommendations on supportive care are an essential part of treatment for this highly susceptible population and will further improve their outcome.
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Affiliation(s)
- Nira Arad-Cohen
- Department of Pediatric Hemato-Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Bernward Zeller
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Jonas Abrahamsson
- Department of Paediatrics, Queen Silvia Children's Hospital, Institution for Clinical Sciences, Gothenburg, Sweden
| | | | - Daniel Cheuk
- Department of Pediatrics, Queen Mary Hospital, Hong Kong Pediatric Hematology & Oncology Study Group (HKPHOSG), Hong Kong
| | - Sauli Palmu
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Vitor Costa
- Departament of Paediatrics, Instituto Português de Oncologia, FG-Porto, Portugal
| | | | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Zhanna Kovalova
- Department of Paediatrics, Children's Clinical University Hospital, Riga, Latvia
| | - Birgitte Lausen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Monica Munthe-Kaas
- Pediatric Department, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | | | - Josefine Palle
- Department of Woman's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ramune Pasauliene
- Center of Oncology and Hematology, BMT unit, Vilnius University Children's Hospital, Vilnius, Lithuania
| | - Kadri Saks
- Department of Paediatrics, SA Tallinna Lastehaigla, Tallinn, Estonia
| | - Gertjan Jl Kaspers
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
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24
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Saultier P, Simonin M, Beaumais TAD, Rialland F, Alby-Laurent F, Lubnau M, Desplantes C, Jacqz-Aigrain E, Rohrlich P, Reguerre Y, Rabian F, Sirvent N, Plat GW, Petit A. [Practical management during maintenance therapy of pediatric acute lymphoblastic leukemia: Recommendations of the French Society for Childhood and Adolescent Cancer and Leukemia (SFCE)]. Bull Cancer 2022; 109:1132-1143. [PMID: 35863954 DOI: 10.1016/j.bulcan.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
Maintenance therapy is the last phase of treatment for acute lymphoblastic leukemia in children and adolescents. Although maintenance therapy is associated with toxicities and specific management issues, it is an essential phase of treatment that reduces the risk of relapse. The objective of this work is to propose a guide for the initiation, administration, and monitoring of maintenance therapy, and for the management of food, schooling, leisure, community life, risk of infection and links with family medicine.
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Affiliation(s)
- Paul Saultier
- Hôpital de la Timone Enfants, APHM, service d'hématologie, immunologie et oncologie pédiatrique, Marseille, France.
| | - Mathieu Simonin
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | | | - Fanny Rialland
- CHU de Nantes, service d'onco-hématologie pédiatrique, Nantes, France
| | - Fanny Alby-Laurent
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
| | - Marion Lubnau
- CHU de Nancy, service d'onco-hématologie pédiatrique, Nancy, France
| | | | - Evelyne Jacqz-Aigrain
- AP-HP, hôpital Saint-Louis, département de pharmacologie et pharmacogénétique, Paris, France
| | - Pierre Rohrlich
- CHU de Nice, service d'hématologie pédiatrique, Nice, France
| | - Yves Reguerre
- CHU de la Réunion, service d'hémato-oncologie pédiatrique, Réunion, France
| | - Florence Rabian
- AP-HP, hôpital Saint-Louis, service d'hématologie adolescents et jeunes adultes, Paris, France
| | - Nicolas Sirvent
- CHU de Montpellier, service d'hématologie et oncologie pédiatrique, Montpellier, France
| | - Geneviève Willson Plat
- CHU de Toulouse, service d'hématologie oncologie et immunologie pédiatrique, Toulouse, France
| | - Arnaud Petit
- AP-HP, hôpital Armand-Trousseau, Sorbonne université, service d'hématologie et oncologie pédiatrique, Paris, France
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25
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Haggenburg S, Hofsink Q, Rutten CE, Nijhof IS, Hazenberg MD, Goorhuis A. SARS-CoV-2 vaccine-induced humoral and cellular immunity in patients with hematologic malignancies. Semin Hematol 2022; 59:192-197. [PMID: 36805887 PMCID: PMC9674560 DOI: 10.1053/j.seminhematol.2022.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Patients with hematologic conditions have a higher risk of severe COVID-19 and COVID-19-related death. This is related to immune deficiencies induced by hematologic conditions and/or the treatment thereof. Prospective vaccine immunogenicity studies have demonstrated that in the majority of patients, a 3-dose COVID-19 vaccination schedule leads to antibody concentrations comparable to levels obtained in healthy adults after a 2-dose schedule. In B cell depleted patients, humoral responses are poor, however vaccination did induce potent cellular immune responses. The effect of 3-dose vaccination schedules and COVID-19 booster vaccinations on the protection of patients with hematologic malignancies against severe COVID-19 and COVID-19 related death remains to be confirmed by population-based vaccine effectiveness studies.
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Affiliation(s)
- Sabine Haggenburg
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Quincy Hofsink
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands
| | - Caroline E. Rutten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger S. Nijhof
- Department of Hematology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands,Department of Internal Medicine-Hematology, St. Antonius Hospital, Nieuwegein, The Netherlands,Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mette D. Hazenberg
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands,Amsterdam institute for Infection and Immunity, Amsterdam UMC, Amsterdam, The Netherlands,Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands,Department of Hematopoiesis, Sanquin Research, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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26
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De Sarro C, Papadopoli R, Morgante MC, Nobile CGA, De Sarro G, Pileggi C. Vaccinations Status against Vaccine-Preventable Diseases and Willingness to Be Vaccinated in an Italian Sample of Frail Subjects. Vaccines (Basel) 2022; 10:vaccines10081311. [PMID: 36016199 PMCID: PMC9415941 DOI: 10.3390/vaccines10081311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Study aim was to investigate the vaccination status against vaccine-preventable diseases (VPD) of frail adults during the SARS-CoV-2 pandemic and, for those subjects eligible for at least one vaccine, with respect to the recommended vaccination in line with the Italian National Vaccination Prevention Plane (NPVP), to explore the willingness to be vaccinated. METHODS A cross-sectional study was carried out among adults aged ≥ 60, immunocompromised or subjects affected by chronic conditions. RESULTS Among the 427 participants, a vaccination coverage rate lower than the targets for all the vaccines considered was found. Of those, 72.6% of subjects stated their willingness to receive recommended vaccinations, and 75.2% of the respondents stated that the advice to undergo vaccinations was received by the General Practitioner (GP). In a multivariable logistic regression model, higher odds of recommended VPD vaccination uptake (defined as having two or more of the recommended vaccinations) were associated with the willingness towards recommended VPD vaccination (Odds Ratio = 3.55, 95% Confidence Interval: 1.39 to 9.07), university education (OR = 2.03, 95% CI: 1.03 to 3.97), but having another person in the household (OR = 0.52, 95% CI: 0.28 to 0.97), and history of oncological disease (OR = 0.39, 95% CI: 0.18 to 0.87) were predictive of lower odds of vaccination uptake. In another multivariable model, higher odds of willingness to receive vaccines were associated with kidney disease (OR = 3.3, 95% CI: 1.01 to 10.5), perceived risk of VPD (OR = 1.9, 95% CI: 1.02 to 3.3), previous influenza vaccination (OR = 3.4, 95% CI: 1.8 to 6.5), and previous pneumococcal vaccination (OR = 3.1, 95% CI: 1.3 to 7.7), but increasing age (OR = 0.93 per year, 95% CI: 0.91 to 0.97), working (OR = 0.40, 95% CI: 0.20 to 0.78), and fear of vaccine side effects (OR = 0.38, 95% CI: 0.21 to 0.68) were predictive of lower odds of willingness to receive vaccines. CONCLUSIONS Despite specific recommendations, vaccination coverage rates are far below international targets for frail subjects. Reducing missed opportunities for vaccination could be a useful strategy to increase vaccination coverage in frail patients during the routine checks performed by GPs and specialists.
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Affiliation(s)
- Caterina De Sarro
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-961-3644266
| | - Maria Carmela Morgante
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Carmelo Giuseppe Angelo Nobile
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata of Rende, 87036 Cosenza, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- FAS@UMG Research Center, Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- FAS@UMG Research Center, Department of Health Science, School of Medicine, University of Catanzaro, 88100 Catanzaro, Italy
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27
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Bellesi S, Sali M, Maiolo E, Pereyra Boza MDC, Alma E, Palucci I, Fatone F, De Maio F, Viscovo M, D'Alò F, De Stefano V, Hohaus S, Sanguinetti M. Anti CD20-based immunochemotherapy abolishes antibody response to Covid-19 mRNA vaccine in lymphoma patients vaccinated during active first line treatment. Leuk Lymphoma 2022; 63:1474-1478. [PMID: 35105258 DOI: 10.1080/10428194.2022.2032042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Silvia Bellesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Michela Sali
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di base, Cliniche intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Del Carmen Pereyra Boza
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Ivana Palucci
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Fatone
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavio De Maio
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Viscovo
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Alò
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di base, Cliniche intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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28
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Piñana JL, López-Corral L, Martino R, Vazquez L, Pérez A, Martin-Martin G, Gago B, Sanz-Linares G, Sanchez-Salinas A, Villalon L, Conesa-Garcia V, Olave MT, Corona M, Marcos-Corrales S, Tormo M, Hernández-Rivas JÁ, Montoro J, Rodriguez-Fernandez A, Risco-Gálvez I, Rodríguez-Belenguer P, Hernandez-Boluda JC, García-Cadenas I, Ruiz-García M, Muñoz-Bellido JL, Solano C, Cedillo Á, Sureda A, Navarro D. SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders. J Hematol Oncol 2022; 15:54. [PMID: 35526045 PMCID: PMC9077637 DOI: 10.1186/s13045-022-01275-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3–6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7–195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3–6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2–4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0–4854.93) vs 730.81 BAU/mL (range 0–56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01275-7.
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Affiliation(s)
- José Luis Piñana
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain. .,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Lucia López-Corral
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lourdes Vazquez
- Hematology Division, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ariadna Pérez
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Beatriz Gago
- Hematology Division, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | - Gabriela Sanz-Linares
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Andrés Sanchez-Salinas
- Hematology Division, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Lucia Villalon
- Hematology Division, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - María T Olave
- Hematology Division, Hospital Clínico Universitario Lozano Blesa, IIS Aragon, Saragossa, Spain
| | | | | | - Mar Tormo
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Juan Montoro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
| | | | | | - Pablo Rodríguez-Belenguer
- Research Program on Biomedical Informatics (GRIB), Department of Experimental and Health Sciences, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan Carlos Hernandez-Boluda
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | | | | | | | - Carlos Solano
- Division of Clinical Hematology, Hematology Department, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ángel Cedillo
- Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH) Office, Madrid, Spain
| | - Anna Sureda
- Hematology Division, Institut Català Oncologia-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - David Navarro
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.,Hospital Clinico Universitario de Valencia, Valencia, Spain
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29
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Kampouri E, Walti CS, Gauthier J, Hill JA. Managing Hypogammaglobulinemia in Patients Treated with CAR-T-cell Therapy: Key Points for Clinicians. Expert Rev Hematol 2022; 15:305-320. [PMID: 35385358 DOI: 10.1080/17474086.2022.2063833] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The unprecedented success of chimeric antigen receptor (CAR)-T-cell therapy in the management of B-cell malignancies comes with a price of specific side effects. Healthy B-cell depletion is an anticipated 'on-target' 'off-tumor' side effect and can contribute to severe and prolonged hypogammaglobulinemia. Evidence-based guidelines for the use of immunoglobulin replacement therapy (IGRT) for infection prevention are lacking in this population. AREAS COVERED This article reviews the mechanisms and epidemiology of hypogammaglobulinemia and antibody deficiency, association with infections, and strategies to address these issues in CD19- and BCMA-CAR-T-cell recipients. EXPERT OPINION CD19 and BCMA CAR-T-cell therapy result in unique immune deficits due to depletion of specific B-lineage cells and may require different infection prevention strategies. Hypogammaglobulinemia before and after CAR-T-cell therapy is frequent, but data on the efficacy and cost-effectiveness of IGRT are lacking. Monthly IGRT should be prioritized for patients with severe or recurrent bacterial infections. IGRT may be more broadly necessary to prevent infections in BCMA-CAR-T-cell recipients and children with severe hypogammaglobulinemia irrespective of infection history. Vaccinations are indicated to augment humoral immunity and can be immunogenic despite cytopenias; re-vaccination(s) may be required. Controlled trials are needed to better understand the role of IGRT and vaccines in this population.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carla S Walti
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Infectious Disease and Hospital Epidemiology Division, University Hospital Basel, Basel, Switzerland
| | - Jordan Gauthier
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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30
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Buske C, Dreyling M, Alvarez-Larrán A, Apperley J, Arcaini L, Besson C, Bullinger L, Corradini P, Giovanni Della Porta M, Dimopoulos M, D'Sa S, Eich HT, Foà R, Ghia P, da Silva MG, Gribben J, Hajek R, Harrison C, Heuser M, Kiesewetter B, Kiladjian JJ, Kröger N, Moreau P, Passweg JR, Peyvandi F, Rea D, Ribera JM, Robak T, San-Miguel JF, Santini V, Sanz G, Sonneveld P, von Lilienfeld-Toal M, Wendtner C, Pentheroudakis G, Passamonti F. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus. ESMO Open 2022; 7:100403. [PMID: 35272130 PMCID: PMC8795783 DOI: 10.1016/j.esmoop.2022.100403] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
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Affiliation(s)
- C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
| | - M Dreyling
- Department of Medicine III at LMU Hospital, Munich, Germany
| | - A Alvarez-Larrán
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - J Apperley
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Besson
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; UVSQ, Inserm, CESP, Villejuif, France
| | - L Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Corradini
- Hematology Division, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Giovanni Della Porta
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S D'Sa
- UCLH Centre for Waldenström and Neurohaematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Münster, Germany
| | - R Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - P Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia and Laboratory of B Cell Neoplasia, Division of Molecular Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - M G da Silva
- Department Of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - J Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - C Harrison
- Clinical Director - Haematology, Haemostasis, Palliative Care, Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | - B Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J J Kiladjian
- Université de Paris, APHP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, Paris, France
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - J R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - D Rea
- University Medical Department of Hematology and Immunology, France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - J-M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - V Santini
- MDS Unit, Hematology, DMSC, AOUC, University of Florence, Florence, Italy
| | - G Sanz
- Hematology Department, Hospital Univesitario y Politecnico La Fe, Valencia; CIBERONC, IS Carlos III, Madrid, Spain
| | - P Sonneveld
- Erasmus MC Cancer Institute, Department of Haematology, Rotterdam, The Netherlands
| | - M von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - C Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University, Munich, Germany
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - F Passamonti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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31
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Consensus on COVID-19 Vaccination in Pediatric Oncohematological Patients, on Behalf of Infectious Working Group of Italian Association of Pediatric Hematology Oncology. J Clin Med 2022; 11:jcm11051235. [PMID: 35268326 PMCID: PMC8911119 DOI: 10.3390/jcm11051235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/05/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
Vaccines represent the best tool to prevent the severity course and fatal consequences of the pandemic by the new Coronavirus 2019 infection (SARS-CoV-2). Considering the limited data on vaccination of pediatric oncohematological patients, we developed a Consensus document to support the Italian pediatric hematological oncological (AIEOP) centers in a scientifically correct communication with families and patients and to promote vaccination. The topics of the Consensus were: SARS-CoV-2 infection and disease (COVID-19) in the pediatric subjects; COVID-19 vaccines (type, schedule); who and when to vaccinate; contraindications and risk of serious adverse events; rare adverse events; third dose and vaccination after COVID-19; and other general prevention measures. Using the Delphi methodology for Consensus, 21 statements and their corresponding rationale were elaborated and discussed with the representatives of 31 centers, followed by voting. A high grade of Consensus was obtained on topics such as the potential risk of severe COVID-19 outcome in pediatric oncohematological patients, the need for vaccination as a preventative measure, the type, schedule and booster dose of vaccine, the eligibility of the patients for vaccination, and the timing, definition, and management of contraindications and serious adverse events, and other general prevention measures. All 21 of the statements were approved. This consensus document highlights that children and adolescents affected by hematological and oncological diseases are a fragile category. Vaccination plays an important role to prevent COVID-19, to permit the regular administration of chemotherapy or other treatments, to perform control visits and hospital admissions, and to prevent treatment delays.
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32
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Certan M, Garcia Garrido HM, Wong G, Heijmans J, Grobusch MP, Goorhuis A. Incidence and Predictors of Community-Acquired Pneumonia in Patients With Hematological Cancers Between 2016 and 2019. Clin Infect Dis 2022; 75:1046-1053. [PMID: 35195716 PMCID: PMC9522390 DOI: 10.1093/cid/ciac005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Patients with hematological cancers (HC) are at high risk of infections, in particular community-acquired pneumonia (CAP). Recent data on incidence and predictors of CAP among patients with HC are scarce. Methods We performed a cohort study (2016–2019) in 2 hospitals in the Netherlands among adults with HC to calculate incidence rates (IRs) of CAP. In addition, we performed a nested case-control study to identify predictors of CAP. Results We identified 275 CAP cases during 6264 patient-years of follow-up. The IR of CAP was 4390/100 000 patient-years of follow-up. Compared with the general population, IR ratios ranged from 5.4 to 55.3 for the different HCs. The case fatality and intensive care unit (ICU) admission rates were 5.5% and 9.8%, respectively. Predictors for CAP in patients with HC were male sex, anemia, lymphocytopenia, chronic kidney disease, cardiovascular disease, autologous and allogeneic stem cell transplantation, treatment with immunosuppressive medication for graft-vs-host disease, treatment with rituximab in the past year, and treatment with immunomodulators (lenalidomide, thalidomide, pomalidomide and/or methotrexate) in the past month. Independent predictors of a severe disease course (death or ICU admission) included neutropenia (odds ratio, 4.14 [95% confidence interval, 1.63–10.2]), pneumococcal pneumonia (10.24 [3.48–30.1]), chronic obstructive pulmonary disease (6.90 [2.07–23.0]), and the use of antibacterial prophylaxis (2.53 [1.05–6.08]). Conclusions The burden of CAP in patients with HC is high, with significant morbidity and mortality rates. Therefore, vaccination against respiratory pathogens early in the disease course is recommended, in particular before starting certain immunosuppressive therapies.
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Affiliation(s)
- Maria Certan
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Hannah M Garcia Garrido
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Gino Wong
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Jarom Heijmans
- Department of Hematology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
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33
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Kantarcioglu B, Iqbal O, Lewis J, Carter CA, Singh M, Lievano F, Ligocki M, Jeske W, Adiguzel C, Gerotziafas GT, Fareed J. An Update on the Status of Vaccine Development for SARS-CoV-2 Including Variants. Practical Considerations for COVID-19 Special Populations. Clin Appl Thromb Hemost 2022; 28:10760296211056648. [PMID: 35167393 PMCID: PMC8851053 DOI: 10.1177/10760296211056648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The progress in the development of various vaccine platforms against SARS-CoV-2 have been rather remarkable owing to advancement in molecular and biologic sciences. Most of the current vaccines and those in development focus on targeting the viral spike proteins by generating antibodies of varying spectrum. These vaccines represent a variety of platforms including whole virus vaccines, viral vector vaccines, nucleic acid vaccines representing RNA, DNA, and their hybrid forms.The therapeutic efficacy of these vaccines varies owing to their pharmacodynamic individualities. COVID-19 variants are capable of inducing different pathologic responses and some of which may be resistant to antibodies generated by current vaccines. The current clinical use of these vaccines has been through emergency use authorization until recently. Moreover, the efficacy and safety of these vaccines have been tested in substantial numbers of individuals but studies in special populations that better reflect the global population are pending results. These specialized populations include young children, immunocompromised patients, pregnant individuals, and other specialized groups. Combination approaches, molecularly modified vaccination approaches, and vaccines conferring longer periods of immunity are being currently being investigated, as well as pharmacovigilance studies.The continual transformation of SARS-CoV-2 and its variants are of concern along with the breakthrough infections. These considerations pose new challenges for the development of vaccination platforms. For this purpose, booster doses, combination vaccine approaches, and other modalities are being discussed. This review provides an updated account of currently available vaccines and those in advanced development with reference to their composition and mechanisms of action.A discussion on the use of vaccines in special populations including immunocompromised patients, pregnant women and other specialized populations are also included.
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Affiliation(s)
- Bulent Kantarcioglu
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Bulent Kantarcioglu, Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL 60153, USA.
| | - Omer Iqbal
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Joseph Lewis
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A. Carter
- Campbell University College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA
| | - Meharvan Singh
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | | | | | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | - Grigoris T. Gerotziafas
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Thrombosis Center, Service D’Hématologie Biologique Hôpital Tenon, Paris, France
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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34
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Quantitative analysis of mRNA-1273 COVID-19 vaccination response in immunocompromised adult hematology patients. Blood Adv 2022; 6:1537-1546. [PMID: 35114690 PMCID: PMC8816838 DOI: 10.1182/bloodadvances.2021006917] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 12/01/2022] Open
Abstract
Immunochemotherapy does not preclude adequate antibody responses in hematology patients, except when B cells are absent or dysfunctional. During the pandemic, COVID-19 vaccination should not be delayed in hematology patients.
Vaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. We prospectively quantified serum immunoglobulin G (IgG) antibodies to spike subunit 1 (S1) antigens during and after 2-dose mRNA-1273 (Spikevax/Moderna) vaccination in hematology patients. Obtaining S1 IgG ≥ 300 binding antibody units (BAUs)/mL was considered adequate as it represents the lower level of S1 IgG concentration obtained in healthy individuals, and it correlates with potent virus neutralization. Selected patients (n = 723) were severely immunocompromised owing to their disease or treatment thereof. Nevertheless, >50% of patients obtained S1 IgG ≥ 300 BAUs/mL after 2-dose mRNA-1273. All patients with sickle cell disease or chronic myeloid leukemia obtained adequate antibody concentrations. Around 70% of patients with chronic graft-versus-host disease (cGVHD), multiple myeloma, or untreated chronic lymphocytic leukemia (CLL) obtained S1 IgG ≥ 300 BAUs/mL. Ruxolitinib or hypomethylating therapy but not high-dose chemotherapy blunted responses in myeloid malignancies. Responses in patients with lymphoma, patients with CLL on ibrutinib, and chimeric antigen receptor T-cell recipients were low. The minimal time interval after autologous hematopoietic cell transplantation (HCT) to reach adequate concentrations was <2 months for multiple myeloma, 8 months for lymphoma, and 4 to 6 months after allogeneic HCT. Serum IgG4, absolute B- and natural killer–cell number, and number of immunosuppressants predicted S1 IgG ≥ 300 BAUs/mL. Hematology patients on chemotherapy, shortly after HCT, or with cGVHD should not be precluded from vaccination. This trial was registered at Netherlands Trial Register as #NL9553.
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Abdolkarimi B, Amanati A, Bahoush Mehdiabadi G. Cutaneous diphtheria complicated oncologic reconstruction surgery in osteosarcoma. Clin Case Rep 2022; 10:e05425. [PMID: 35154731 PMCID: PMC8829671 DOI: 10.1002/ccr3.5425] [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: 07/09/2021] [Revised: 09/15/2021] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
Diphtheria is an uncommon bacterial infection of the upper respiratory tract. We described a surgical site infection in a young adolescent female on maintenance chemotherapy. Corynebacterium diphtheriae was recovered from the wound, and she was treated with antibiotics and antitoxin. Cutaneous diphtheria should be considered in immunocompromised patients receiving chemotherapy.
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Affiliation(s)
- Babak Abdolkarimi
- Pediatric Hematology‐OncologyLorestan University of Medical SciencesKhorramabadIran
| | - Ali Amanati
- Professor Alborzi Clinical Microbiology Research CenterShiraz University of Medical SciencesShirazIran
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Marchesi F, Pimpinelli F, Giannarelli D, Ronchetti L, Papa E, Falcucci P, Pontone M, Di Domenico EG, di Martino S, Laquintana V, Mandoj C, Conti L, Cordone I, La Malfa A, Viggiani C, Renzi D, Palombi F, Romano A, Pisani F, Gumenyuk S, Di Bella O, Vujovic B, Morrone A, Ciliberto G, Ensoli F, Mengarelli A. Impact of anti-CD20 monoclonal antibodies on serologic response to BNT162b2 vaccine in B-cell Non-Hodgkin's lymphomas. Leukemia 2022; 36:588-590. [PMID: 34545184 PMCID: PMC8451738 DOI: 10.1038/s41375-021-01418-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Marchesi
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Fulvia Pimpinelli
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, IRCCS San Gallicano Institute, Rome, Italy
| | - Diana Giannarelli
- Clinical Trial Center, Biostatistics and Bioinformatics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Livia Ronchetti
- SAFU Unit, Department of Research and Innovative Technologies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Papa
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Falcucci
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Martina Pontone
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, IRCCS San Gallicano Institute, Rome, Italy
| | - Enea Gino Di Domenico
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, IRCCS San Gallicano Institute, Rome, Italy
| | - Simona di Martino
- Biological Tissue and Liquid Bank, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Laquintana
- Biological Tissue and Liquid Bank, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Mandoj
- Clinical Pathology and Cancer Biobank, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- Clinical Pathology and Cancer Biobank, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Iole Cordone
- Clinical Pathology and Cancer Biobank, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonia La Malfa
- Pharmacy Unit, Medical Direction, IRCCS Regina Elena National Cancer Institute and San Gallicano Institute, Rome, Italy
| | - Caterina Viggiani
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniela Renzi
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Palombi
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Atelda Romano
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Pisani
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Svitlana Gumenyuk
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ornella Di Bella
- Medical Direction, IRCCS Regina Elena National Cancer Institute and San Gallicano Institute, Rome, Italy
| | - Branka Vujovic
- Medical Direction, IRCCS Regina Elena National Cancer Institute and San Gallicano Institute, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, IRCCS San Gallicano Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabrizio Ensoli
- Microbiology and Virology Unit, Dermatological Clinical and Research Department, IRCCS San Gallicano Institute, Rome, Italy
| | - Andrea Mengarelli
- Hematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Arambulo S, Cabezas-Camarero S, Rojas H, Sotelo MJ. COVID-19 vaccination in cancer patients: Is it the time or should we wait? J Cancer Res Ther 2021; 17:1588-1589. [PMID: 34916405 DOI: 10.4103/jcrt.jcrt_464_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Stella Arambulo
- Department of Medical Oncology, Hospital María Auxiliadora, Madrid, Spain
| | | | - Heinz Rojas
- Department of Medical Oncology, Hospital María Auxiliadora, Madrid, Spain
| | - Miguel Jhonatan Sotelo
- Department of Medical Oncology, Hospital María Auxiliadora, Madrid, Spain; Aliada Oncological Center; Oncological Research Unit, Clínica San Gabriel, Lima, Peru
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Styczynski J, Cesaro S, von Lilienfeld-Toal M, Marchesi F, Gil L, Mikulska M, Knelange N, Wendel L, Averbuch D, de la Camara R. Current attitude to deferral of cellular therapy or non-transplant chemotherapy due to SARS-CoV-2 asymptomatic infection: survey of Infectious Diseases Working Party EBMT. Transpl Infect Dis 2021; 24:e13773. [PMID: 34918856 DOI: 10.1111/tid.13773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The objective of the study was to assess the current clinical practice and the attitude towards deferral of HCT/chemotherapy in patients with hematological diseases in cases of asymptomatic patients with a positive assay for SARS-CoV-2. METHODS In August 2021 we performed a survey among EBMT centers regarding their attitude towards deferral of HCT/chemotherapy in patients with a positive PCR result. RESULTS Centers were willing to defer the planned cellular therapy for patients with asymptomatic SARS-CoV-2 infection without previous COVID-19 disease, and patients who became asymptomatic after a previous COVID19 disease but persistently shed the virus, respectively, in case of: high-risk allo-HCT (90.2%/76.9%), low risk allo-HCT for malignant diseases (88.2%/83.7%), allo-HCT for non-malignant diseases (91.0%/91.0%), auto-HCT (88.0%/79.8%) and CAR-T therapy (83.1%/81.4%). The respective rates towards deferral of non-cellular therapy patients was lower for both groups of patients, and varied with the primary diagnosis and anti-malignant treatment. CONCLUSIONS There is a relatively high rate of willingness to defer treatment in asymptomatic patients being positive for SARS-CoV-2, planned for cellular therapy, regardless of previous history of vaccination or COVID-19. The same approach is presented for most of patients before non-cellular therapy. Nevertheless, each patient should be considered individually weighting risks and benefits. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, University Hospital, Bydgoszcz, Poland
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - 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
| | - Francesco Marchesi
- Haematology Unit, Department of Research and Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lidia Gil
- Department of Hematology and Transplantation, Medical University Poznan, Poland
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
- Infectious Diseases Unit, Department of Health Sciences [DISSAL], University of Genoa, Genoa, Italy
| | - Nina Knelange
- Infectious Disease Working Party EBMT Data Office, University of Leiden, Leiden, The Netherlands
| | - Lotus Wendel
- Infectious Disease Working Party EBMT Data Office, University of Leiden, Leiden, The Netherlands
| | - Diana Averbuch
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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The EHA Research Roadmap: Infections in Hematology. Hemasphere 2021; 5:e662. [PMID: 34877477 PMCID: PMC8639104 DOI: 10.1097/hs9.0000000000000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022] Open
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Pierron A, Bozon F, Berceanu A, Fontan J, Brion A, Deconinck E, Chirouze C, Brunel AS. Vaccination coverage in hematological patients undergoing chemotherapy: Should we move towards personalized vaccination? Vaccine 2021; 39:7036-7043. [PMID: 34740475 DOI: 10.1016/j.vaccine.2021.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Immunocompromised patients are at high-risk for severe influenza and invasive pneumococcal diseases (IPD). Despite the French Public Health Council (FPHC) and the 7th European Conference on Infections in Leukaemia (ECIL7) recommendations, vaccination coverage remains insufficient. This study aimed to estimate the coverage and determinants of influenza, pneumococcal and diphtheria-tetanus-poliomyelitis (dTP) vaccinations in hematological patients underlying chemotherapy. METHODS A survey was distributed to all patients of the hematology day hospital assessing vaccine uptakes and general opinion about vaccination. Vaccine uptakes were collected from medical and vaccination records; knowledge of and attitudes towards vaccinations in immunocompromised patients were evaluated for each general practitioner (GP) by phone call. Adequacy between vaccine uptakes and indication or not to vaccinate according to ECIL7 guidelines was assessed. Factors associated with vaccine uptakes were assessed by multivariate logistic regression. RESULTS Among 145 patients, 66 % were aged 65 years or older, 40 % were followed for lymphoma and 38 % for multiple myeloma, 39 % were treated with anti-CD20 antibodies. Vaccination coverage was suboptimal for influenza (45-56 %), dTP (44 %) and IPD (16-19 %) regardless of the guidelines followed, with a wide variation in rates by information source (19-76 %). Adequacy rate with ECIL7 recommendations were 63 % and 87 % for influenza and IPD respectively. Information of patients on specific vaccinations was positively associated with flu and IPD vaccinations, as well as favorable attitude toward vaccination and age ≥ 65 years for flu vaccination, and recommendation by hematologist for pneumococcal vaccination. CONCLUSION Despite vaccination opportunities, the complexity of these specific recommendations and the lack of communication between the health actors could explain the suboptimal vaccination coverage in this high-risk population. A proactive attitude of all actors in the city and hospital, including better patient information and a personalized and evolving vaccination schedule to help GPs to coordinate vaccination would allow to improve vaccine coverage.
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Affiliation(s)
- Alix Pierron
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Fabienne Bozon
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Ana Berceanu
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Jean Fontan
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Annie Brion
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Erick Deconinck
- Hematology Unit, Besancon University Hospital, Besancon, France
| | - Catherine Chirouze
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France
| | - Anne-Sophie Brunel
- Infectious Diseases Unit, Besancon University Hospital, Besancon, France.
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Marijanović I, Kraljević M, Buhovac T, Sokolović E. Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology Clinic of University Clinical Hospital Mostar, Bosnia and Herzegovina: A Cross-Sectional Study. Med Sci Monit 2021; 27:e932788. [PMID: 34772907 PMCID: PMC8596742 DOI: 10.12659/msm.932788] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The pandemic of Coronavirus infectious disease 2019 (COVID-19) poses a major public health challenge, and an effective vaccine is the potential mechanism to resolve this specific situation. The present study aimed to evaluate acceptance of COVID-19 vaccination among patients attending the Oncology Clinic of University Clinical Hospital Mostar. Material/Methods This cross-sectional observational study enrolled 364 patients with cancer from the Oncology Clinic of University Clinical Hospital Mostar during February 2021. Data were collected using a questionnaire that captured general information about the participants and their attitudes toward COVID-19 vaccination. Results Of the participants, 41.8% answered “Yes” when asked if they would take the vaccine once it becomes available, 37.6% answered “Not sure”, and 20.6% answered “No”. For patients in favor of vaccination, the main reasons reported were fear of getting sick (77.6%), the desire to contribute to herd immunity (57.8%), and trusting the recommendations of health professionals (57.2%). The main reasons for the patients’ vaccination refusal/indecision were doubts about the results from clinical trials of COVID-19 vaccines (49.1%), concerns about adverse effects (24.5%), and confusion about the various vaccine options (19.8%). The majority of participants (82.4%) stated that recommendation by their oncologist could influence their decision about vaccination. Of the participants who indicated unwillingness (refusal or indecision) to be vaccinated against COVID-19, 65.3% stated that recommendation by their oncologist could influence their decision about vaccination. Conclusions The findings from the present study showed most patients had refused or were indecisive regarding immunization with COVID-19 vaccine. Increasing physician awareness of this situation may result in higher rates of vaccination.
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Affiliation(s)
- Inga Marijanović
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Kraljević
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Teo Buhovac
- Oncology Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Emir Sokolović
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Piñana JL, Vázquez L, Martino R, de la Cámara R, Sureda A, Rodríguez-Veiga R, Garrido A, Sierra J, Ribera JM, Torrent A, Mateos MV, de la Rubia J, Tormo M, Díez-Campelo M, García-Gutiérrez V, Álvarez-Larrán A, Sancho JM, MartínGarcía-Sancho A, Yañez L, Pérez Simón JA, Barba P, Abrisqueta P, Álvarez-Twose I, Bonanad S, Lecumberri R, Ruiz-Camps I, Navarro D, Hernández-Rivas JÁ, Cedillo Á, García-Sanz R, Bosch F. Spanish Society of Hematology and Hemotherapy expert consensus opinion for SARS-CoV-2 vaccination in onco-hematological patients. Leuk Lymphoma 2021; 63:538-550. [PMID: 34668835 PMCID: PMC8544670 DOI: 10.1080/10428194.2021.1992619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.
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Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Lourdes Vázquez
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rodrigo Martino
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Sureda
- Hematology Department, Hematology Department, Institut Català d'Oncologia-Hospitalret, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Garrido
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hosptital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José-María Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | - Anna Torrent
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute, Badalona, Spain
| | | | - Javier de la Rubia
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Díez-Campelo
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Juan-Manuel Sancho
- Hematology Department, Hospital Universitario Ramón y Cajal. IRYCIS, Madrid, Spain
| | | | - Lucrecia Yañez
- Hematology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pere Barba
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Pau Abrisqueta
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Iván Álvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Santiago Bonanad
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Ruiz-Camps
- Infectious disease department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - David Navarro
- Department of Medicine, School of Medicine, Microbiology Service, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | | | - Ángel Cedillo
- Hematology Department, Hospital Clínico Universitario de Valencia, Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ramón García-Sanz
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesc Bosch
- Hematology Department, Hospital Universitario Vall d´Hebron, Barcelona, Spain
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Marasco V, Carniti C, Guidetti A, Farina L, Magni M, Miceli R, Calabretta L, Verderio P, Ljevar S, Serpenti F, Morelli D, Apolone G, Ippolito G, Agrati C, Corradini P. T-cell immune response after mRNA SARS-CoV-2 vaccines is frequently detected also in the absence of seroconversion in patients with lymphoid malignancies. Br J Haematol 2021; 196:548-558. [PMID: 34649298 PMCID: PMC8653177 DOI: 10.1111/bjh.17877] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
Patients affected by lymphoid malignancies (LM) are frequently immune‐compromised, suffering increased mortality from COVID‐19. This prospective study evaluated serological and T‐cell responses after complete mRNA vaccination in 263 patients affected by chronic lymphocytic leukaemia, B‐ and T‐cell lymphomas and multiple myeloma. Results were compared with those of 167 healthy subjects matched for age and sex. Overall, patient seroconversion rate was 64·6%: serological response was lower in those receiving anti‐cancer treatments in the 12 months before vaccination: 55% vs 81·9% (P < 0·001). Anti‐CD20 antibody plus chemotherapy treatment was associated with the lowest seroconversion rate: 17·6% vs. 71·2% (P < 0·001). In the multivariate analysis conducted in the subgroup of patients on active treatment, independent predictors for seroconversion were: anti‐CD20 treatment (P < 0·001), aggressive B‐cell lymphoma diagnosis (P = 0·002), and immunoglobulin M levels <40 mg/dl (P = 0·030). The T‐cell response was evaluated in 99 patients and detected in 85 of them (86%). Of note, 74% of seronegative patients had a T‐cell response, but both cellular and humoral responses were absent in 13·1% of cases. Our findings raise some concerns about the protection that patients with LM, particularly those receiving anti‐CD20 antibodies, may gain from vaccination. These patients should strictly maintain all the protective measures.
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Affiliation(s)
| | - Cristiana Carniti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Anna Guidetti
- School of Medicine, University of Milano, Italy.,Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Lucia Farina
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Martina Magni
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | | | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Silva Ljevar
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | | | - Daniele Morelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani" I.R.C.C.S, Italy
| | - Chiara Agrati
- Cellular Immunology Laboratory, INMI L Spallanzani, Rome, Italy
| | - Paolo Corradini
- School of Medicine, University of Milano, Italy.,Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
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Philadelphia-Negative Chronic Myeloproliferative Neoplasms during the COVID-19 Pandemic: Challenges and Future Scenarios. Cancers (Basel) 2021; 13:cancers13194750. [PMID: 34638236 PMCID: PMC8507529 DOI: 10.3390/cancers13194750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022] Open
Abstract
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) started in December 2019 in China and then become pandemic in February 2020. Several publications investigated the possible increased rate of COVID-19 infection in hematological malignancies. Based on the published data, strategies for the management of chronic Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are provided. The risk of severe COVID-19 seems high in MPN, particularly in patients with essential thrombocythemia, but not negligible in myelofibrosis. MPN patients are at high risk of both thrombotic and hemorrhagic complications and this must be accounted in the case of COVID-19 deciding on a case-by-case basis. There are currently no data to suggest that hydroxyurea or interferon may influence the risk or severity of COVID-19 infection. Conversely, while the immunosuppressive activity of ruxolitinib might pose increased risk of infection, its abrupt discontinuation during COVID-19 syndrome is associated with worse outcome. All MPN patients should receive vaccine against COVID-19; reassuring data are available on efficacy of mRNA vaccines in MPNs.
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Suttorp M, Webster Carrion A, Hijiya N. Chronic Myeloid Leukemia in Children: Immune Function and Vaccinations. J Clin Med 2021; 10:jcm10184056. [PMID: 34575167 PMCID: PMC8470625 DOI: 10.3390/jcm10184056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/26/2022] Open
Abstract
Children with CML need TKI treatment for many years, and the lack of knowledge about immune dysfunction with TKI has hindered routine immunizations. This review attempts to provide an overview of the effects of TKIs licensed for children (e.g., imatinib, dasatinib, and nilotinib) on immune function, as well as its implications on immunizations. We discuss surveillance strategies (e.g., immunoglobulin blood serum levels and hepatitis B reactivation) and immunizations. All inactivated vaccines (e.g., influenza, pneumococcal, and streptococcal) can be given during the treatment of CML in the chronic phase, although their efficacy may be lower. As shown in single cases of children and adults with CML, live vaccines (e.g., varicella, measles, mumps, rubella, and yellow fever) may be administered under defined circumstances with great precautions. We also highlight important aspects of COVID-19 in this patient population (e.g., the outcome of COVID-19 infection in adults with CML and in children with varying hemato-oncological diseases) and discuss the highly dynamic field of presently available different vaccination options. In conclusion, TKI treatment for CML causes humoral and cellular immune dysfunction, which is mild in most patients, and thus infectious complications are rare. Routine immunizations are important for health maintenance of children, but vaccinations for children with CML on TKI therapy should be carefully considered.
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Affiliation(s)
- Meinolf Suttorp
- Hematology and Oncology, Medical Faculty, Technical University, D-01307 Dresden, Germany
- Correspondence:
| | - Andrea Webster Carrion
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, NY 10032, USA; (A.W.C.); (N.H.)
| | - Nobuko Hijiya
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, NY 10032, USA; (A.W.C.); (N.H.)
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Spadaccini M, Canziani L, Aghemo A, Lleo A, Maselli R, Anderloni A, Carrara S, Fugazza A, Pellegatta G, Galtieri PA, Hassan C, Greenwald D, Pochapin M, Wallace M, Sharma P, Roesch T, Bhandari P, Emura F, Raju GS, Repici A. What gastroenterologists should know about SARS-CoV 2 vaccine: World Endoscopy Organization perspective. United European Gastroenterol J 2021; 9:787-796. [PMID: 34102015 PMCID: PMC8242672 DOI: 10.1002/ueg2.12103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The novel Coronavirus (SARS-CoV-2) has caused almost 2 million deaths worldwide. Both Food and Drug Administration and European Medicines Agency have recently approved the first COVID-19 vaccines, and a few more are going to be approved soon. METHODS Several different approaches have been used to stimulate the immune system in mounting a humoral response. As more traditional approaches are under investigation (inactivated virus vaccines, protein subunit vaccines, recombinant virus vaccines), more recent and innovative strategies have been tried (non-replicating viral vector vaccines, RNA based vaccines, DNA based vaccines). RESULTS Since vaccinations campaigns started in December 2020 in both the US and Europe, gastroenterologists will be one of the main sources of information regarding SARS-CoV 2 vaccination for patients in their practice, including vulnerable patients such as those with Inflammatory Bowel Disease (IBD), patients with chronic liver disease, and GI cancer patients. CONCLUSIONS Thus, we must ourselves be well educated and updated in order to provide unambiguous counseling to these categories of vulnerable patients. In this commentary, we aim to provide a comprehensive review of both approved COVID-19 vaccines and the ones still under development, and explore potential risks, benefits and prioritization of vaccination.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Lorenzo Canziani
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of Internal MedicineHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Alessio Aghemo
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of GastroenterologyDivision of Internal Medicine and HepatologyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Ana Lleo
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of GastroenterologyDivision of Internal Medicine and HepatologyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Roberta Maselli
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Andrea Anderloni
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Silvia Carrara
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Alessandro Fugazza
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Gaia Pellegatta
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Piera Alessia Galtieri
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Cesare Hassan
- Digestive Endoscopy UnitNuovo Regina MargheritaRomeItaly
| | - David Greenwald
- Division of GastroenterologyIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
| | - Mark Pochapin
- Division of Gastroenterology and HepatologyNYU Langone HealthNew YorkNew YorkUSA
| | - Michael Wallace
- Division of Gastroenterology and HepatologyMayo ClinicJacksonvilleFloridaUSA
| | - Prateek Sharma
- Digestive Endoscopy UnitKansas City VA Medical CenterKansas CityMissouriUSA
| | - Thomas Roesch
- Division of Gastroenterology & HepatologyUniversity Medical Center Hamburg ‐ EppendorfHamburgGermany
| | - Pradeep Bhandari
- Division of Gastroenterology and HepatologyQueen Alexandra HospitalPortsmouthUK
| | - Fabian Emura
- Division of GastroenterologyUniversidad de La SabanaChíaColombia
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and NutritionThe University of TexasMD Anderson Cancer CenterHoustonTexasUSA
| | - Alessandro Repici
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
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The neutralizing antibody response post COVID-19 vaccination in patients with myeloma is highly dependent on the type of anti-myeloma treatment. Blood Cancer J 2021; 11:138. [PMID: 34341335 PMCID: PMC8327056 DOI: 10.1038/s41408-021-00530-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022] Open
Abstract
Recent data suggest a suboptimal antibody response to COVID-19 vaccination in patients with hematological malignancies. Neutralizing antibodies (NAbs) against SARS-CoV-2 were evaluated in 276 patients with plasma cell neoplasms after vaccination with either the BNT162b2 or the AZD1222 vaccine, on days 1 (before the first vaccine shot), 22, and 50. Patients with MM (n = 213), SMM (n = 38), and MGUS (n = 25) and 226 healthy controls were enrolled in the study (NCT04743388). Vaccination with either two doses of the BNT162b2 or one dose of the AZD1222 vaccine leads to lower production of NAbs in patients with MM compared with controls both on day 22 and on day 50 (p < 0.001 for all comparisons). Furthermore, MM patients showed an inferior NAb response compared with MGUS on day 22 (p = 0.009) and on day 50 (p = 0.003). Importantly, active treatment with either anti-CD38 monoclonal antibodies (Mabs) or belantamab mafodotin and lymphopenia at the time of vaccination were independent prognostic factors for suboptimal antibody response following vaccination. In conclusion, MM patients have low humoral response following SARS-CoV-2 vaccination, especially under treatment with anti-CD38 or belamaf. This underlines the need for timely vaccination, possibly during a treatment-free period, and for continuous vigilance on infection control measures in non-responders.
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Eberhardt CS, Balletto E, Cornberg M, Mikulska M. Coronavirus disease 2019 vaccination in transplant recipients. Curr Opin Infect Dis 2021; 34:275-287. [PMID: 34074880 DOI: 10.1097/qco.0000000000000739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) vaccination is considered one of the most promising and socioeconomically sustainable strategy to help control the pandemic and several vaccines are currently being distributed in nationwide mass immunization campaigns. Very limited data are available on benefits and risks of COVID-19 vaccination in immunocompromised patients and in particular in solid organ or hematopoietic stem cell transplant recipients as they were excluded from phase III trials. This review summarizes current knowledge, international guidelines and controversies regarding COVID-19 vaccination in these vulnerable populations. RECENT FINDINGS Various COVID-19 vaccine platforms showed good efficacy in phase III trials in the immunocompetent and there are data arising on the safety and immunogenicity of these vaccines in the immunocompromised population. SUMMARY Transplant recipients could benefit significantly from COVID-19 vaccination, both through active immunization provided they elicit protective vaccine responses, and probably through cocooning by immunization of caregivers and healthcare personnel and thus reducing the risk of SARS-coronavirus-2 exposure. Although awaiting more data on the safety and efficacy of COVID-19 vaccines to inform potential adaptations of vaccine regimens, we strongly recommend prioritizing COVID-19 vaccination of solid and hematopoietic stem cell transplant recipients to decrease COVID-19-related morbidity and mortality.
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Affiliation(s)
- Christiane S Eberhardt
- Center for Vaccinology, University Hospitals of Geneva
- Division of General Pediatrics, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Elisa Balletto
- Department of Health Sciences (DISSAL), University of Genoa
- Division of Infectious Diseases, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School
- Centre for Individualised Infection Medicine (CiiM), A Joint Venture of Helmholtz Centre for Infection Research and Hannover Medical School
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa
- Division of Infectious Diseases, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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Negahdaripour M, Shafiekhani M, Moezzi SMI, Amiri S, Rasekh S, Bagheri A, Mosaddeghi P, Vazin A. Administration of COVID-19 vaccines in immunocompromised patients. Int Immunopharmacol 2021; 99:108021. [PMID: 34352567 PMCID: PMC8316069 DOI: 10.1016/j.intimp.2021.108021] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022]
Abstract
Since the beginning of vaccination programs against COVID-19 in different countries, several populations such as patients with specific immunological conditions have been considered as the priorities for immunization. In this regard, patients with autoimmune diseases or those receiving immunosuppressive agents and anti-cancer therapies, need special attention. However, no confirmed data is presently available regarding COVID-19 vaccines in these populations due to exclusion from the conducted clinical trials. Given the probable suppression or over-activation of the immune system in such patients, reaching a consensus for their vaccination is critical, besides gathering data and conducting trials, which could probably clarify this matter in the future. In this review, besides a brief on the available COVID-19 vaccines, considerations and available knowledge about administering similar vaccines in patients with cancer, hematopoietic stem cell transplantation, solid organ transplantation, multiple sclerosis (MS), inflammatory bowel disease (IBD), and rheumatologic and dermatologic autoimmune disorders are summarized to help in decision making. As discussed, live-attenuated viruses, which should be avoided in these groups, are not employed in the present COVID-19 vaccines. Thus, the main concern regarding efficacy could be met using a potent COVID-19 vaccine. Moreover, the vaccination timing for maximum efficacy could be decided according to the patient’s condition, indicated medications, and the guides provided here. Post-vaccination monitoring is also advised to ensure an adequate immune response. Further studies in this area are urgently warranted.
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Affiliation(s)
- Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Iman Moezzi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sogand Amiri
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Rasekh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Bagheri
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Mosaddeghi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsaneh Vazin
- Clinical Pharmacy Department, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
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Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study. LANCET HAEMATOLOGY 2021; 8:e583-e592. [PMID: 34224668 PMCID: PMC8253543 DOI: 10.1016/s2352-3026(21)00169-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022]
Abstract
Background Haematological malignancies and their treatments are likely to affect SARS-CoV-2 vaccine efficacy. We aimed to evaluate serological response to BNT162b2 vaccine in patients with haematological malignancies by type of treatment. Methods Our national prospective cohort study was done in Lithuania and assessed serological response to one and two BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccine doses in healthy health-care workers and in patients with haematological malignancies. Eligible participants were aged 18 years or older, had received both vaccine doses, and had available biobanked blood samples from before vaccination and after the second dose. Biobanked samples and health data were obtained from Vilnius University Hospital Santaros Klinikos Biobank. Abbott Architect SARS-CoV-2 IgG Quant II chemiluminescent microparticle assay was used to quantify serum anti-SARS-CoV-2-S1 IgG antibody (anti-S1 IgG antibody) concentrations 0–10 days before the first BNT162b2 vaccine, on the day of second immunisation (around day 21), and 7 to 21 days after the second immunisation. Adverse events were assessed by a standardised questionnaire. Breakthrough infections were characterised clinically and by SARS-CoV-2 genotyping whenever possible. This study is registered with ClinicalTrials.gov, NCT04871165. Findings Between Jan 8 and April 21, 2021, 885 participants with haematological malignancies were included in the study. 857 patients were anti-S1 IgG seronegative at timepoint 0 and constituted the main analysis cohort. The age-matched comparison was made between 315 patients with haematological malignancies who were aged 18–60 years and 67 healthy health-care workers in the same age group. Patients aged 18–60 years with haematological malignancies had lower median anti-S1 IgG antibody responses after two BNT162b2 vaccine doses than did health-care workers of the same age group (median 6961 AU/mL [IQR 1292–20 672] vs 21 395 AU/mL [14 831–33 553]; p<0·0001). Compared with untreated patients with haematological malignancies (n=53; median 5761 AU/mL [629–16 141]), patients actively treated with Bruton tyrosine kinase inhibitors (BTKIs; n=44; 0 AU/mL [0–7]; p<0·0001), ruxolitinib (n=16; 10 AU/mL [0–45]; p<0·0001), venetoclax (n=10; 4 AU/mL [0–1218]; p=0·0005), or anti-CD20 antibody therapy (n=87; 17 AU/mL [1–2319]; p<0·0001) showed particularly poor anti-S1 IgG antibody responses following two BNT162b2 doses. Patients being treated with tyrosine kinase inhibitors (n=41; 10 537 AU/mL [IQR 2335–19 388]) or patients who received autologous haematopoietic stem-cell transplantation (HSCT; n=192; 6203 AU/mL [1451–16 834]) or allogeneic HSCT (n=122; 6304 AU/mL [1120–16 913]) were among the subgroups with the highest numerical responses. Nine SARS-CoV-2 infections and three COVID-19 deaths were observed among fully vaccinated patients with haematological malignancies. Interpretation Patients with haematological malignancies mount blunted and heterogeneous antibody responses to the full course of BNT162b2 mRNA vaccination. Patients who are actively treated with BTKIs, ruxolitinib, venetoclax, or anti-CD20 antibody therapies seem to be the most negatively affected and might be left unprotected from SARS-CoV-2 infection. Breakthrough severe SARS-CoV-2 infections in fully vaccinated patients with haematological malignancies emphasise the importance of ongoing strict adherence to non-pharmacological interventions and household vaccination while SARS-CoV-2 is circulating in the community. Funding Vilnius University Hospital Santaros Klinikos. Translation For the Lithuanian translation of the abstract see Supplementary Materials section.
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