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Zhu H, Lu X, Zhang X, Hua H, Zhang J, Miao Y, Gu W, Xu M, Lu X, Li B, Wang C, Ni H, Qian J, Shi J, Xu M, Wu G, Zhang Y, Shen Q, Wang Z, Zhu J, Cheng Z, Zhuang W, Lin G, Hu Y, Shan Q, Chen Y, Qiu H, Li J, Shi W. Multi-center study of COVID-19 infection in elderly patients with lymphoma: on behalf of Jiangsu Cooperative Lymphoma Group (JCLG). Ann Hematol 2024:10.1007/s00277-024-05744-6. [PMID: 38649594 DOI: 10.1007/s00277-024-05744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Elderly patients with lymphoproliferative diseases (LPD) are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we retrospectively described the clinical features and outcomes of the first time infection of Omicron SARS-CoV-2 in 364 elderly patients with lymphoma enrolled in Jiangsu Cooperative Lymphoma Group (JCLG) between November 2022 and April 2023 in China. Median age was 69 years (range 60-92). 54.4% (198/364) of patients were confirmed as severe and critical COVID-19 infection. In univariable analysis, Age > 70 years (OR 1.88, p = 0.003), with multiple comorbidities (OR 1.41, p = 0.005), aggressive lymphoma (OR 2.33, p < 0.001), active disease (progressive or relapsed/refractory, OR 2.02, p < 0.001), and active anti-lymphoma therapy (OR 1.90, p < 0.001) were associated with severe COVID-19. Multiple (three or more) lines of previous anti-lymphoma therapy (OR 3.84, p = 0.021) remained an adverse factor for severe COVID-19 in multivariable analysis. Moreover, CD20 antibody (Rituximab or Obinutuzumab)-based treatments within the last 6 months was associated with severe COVID-19 in the entire cohort (OR 3.42, p < 0.001). Continuous BTK inhibitors might be protective effect on the outcome of COVID-19 infection (OR 0.44, p = 0.043) in the indolent lymphoma cohort. Overall, 7.7% (28/364) of the patients ceased, multiple lines of previous anti-lymphoma therapy (OR 3.46, p = 0.016) remained an adverse factor for mortality.
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Affiliation(s)
- Huayuan Zhu
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
| | - Xiao Lu
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Xiaoping Zhang
- Department of Hematology, The Affiliated Zhongda Hospital of Southeast University Medical College, Nanjing, 210044, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Haiying Hua
- Department of Hematology, Wuxi Third People's Hospital, Wuxi, 214045, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, 226001, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yuqing Miao
- Department of Hematology, Yancheng First People's Hospital, Yancheng, 224006, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Weiying Gu
- Department of Hematology, The First People's Hospital of Changzhou and The Third Affiliated Hospital of Soochow University, Changzhou, 213004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Min Xu
- Department of Hematology, Zhangjiagang First Affiliated Hospital of Soochow University, Zhangjiagang, 215699, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Xuzhang Lu
- Department of Hematology, Affiliated Changzhou Second Hospital of Nanjing Medical University, Changzhou, 213004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Bingzong Li
- Department of Hematology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Chunling Wang
- Department of Hematology, The First People's Hospital of Huai'an, Huai'an, 223399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Haiwen Ni
- Department of Hematology, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, 210004, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jun Qian
- Department of Hematology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jinning Shi
- Department of Hematology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211199, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Maozhong Xu
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, 214433, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Guangqi Wu
- Department of Hematology, The First People's Hospital of Suqian, Suqian, 223812, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yunping Zhang
- Department of Hematology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214206, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Qiudan Shen
- Department of Hematology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215008, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Zhi Wang
- Department of Hematology, Wuxi Second People's Hospital, Wuxi, 214001, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jianfeng Zhu
- Department of Hematology, The People's Hospital of Taizhou, Taizhou, 225399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Zhen Cheng
- Department of Hematology, Taicang Hospital Affiliated to Soochow University, Taicang, 215488, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Wanchuan Zhuang
- Department of Hematology, The Second People's Hospital of Lianyungang, Lianyungang, 222002, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Guoqiang Lin
- Department of Hematology, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, 223022, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yongjun Hu
- Department of Hematology, Huaiyin Hospital of Huai'an, Huai'an, 223399, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Qiurong Shan
- Department of Hematology, Shuyang Traditional Chinese Medicine Hospital, Shuyang, 223614, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Yifei Chen
- Department of Hematology, Jiangdu People's Hospital of Yangzhou, Yangzhou, 225202, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Hongchun Qiu
- Department of Hematology, The Third People's Hospital of Kunshan, Kunshan, 215316, China
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China
| | - Jianyong Li
- Department of Hematology, Lymphoma Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
| | - Wenyu Shi
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, 226001, China.
- Department of Hematology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, Jiangsu, China.
- Jiangsu Cooperative Lymphoma Group (JCLG), Nanjing, China.
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Francis ER, Vu J, Perez CO, Sun C. Vaccinations in patients with chronic lymphocytic leukemia. Semin Hematol 2024; 61:131-138. [PMID: 38302313 PMCID: PMC11162341 DOI: 10.1053/j.seminhematol.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by immune dysfunction resulting in heightened susceptibility to infections and elevated rates of morbidity and mortality. A key strategy to mitigate infection-related complications has been immunization against common pathogens. However, the immunocompromised status of CLL patients poses challenges in eliciting an adequate humoral and cellular immune response to vaccination. Most CLL-directed therapy disproportionately impairs humoral immunity. Vaccine responsiveness also depends on the phase and type of immune response triggered by immunization. In this review, we discuss the immune dysfunction, vaccine responsiveness, and considerations for optimizing vaccine response in patients with CLL.
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Affiliation(s)
| | - Jennifer Vu
- Rosalind Franklin University of Medicine and Science, Chicago Medical School
| | | | - Clare Sun
- National Institutes of Health, National Heart, Lung, and Blood Institute.
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3
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Demel I, Skopal D, Šafránková E, Rozsívalová P, Jindra P, Šrámek J, Turková A, Vydra J, Labská K, Vedrová J, Čerňan M, Szotkowski T, Móciková H, Hynková L, Šušol O, Kováčová I, Belada D, Hájek R. Effectiveness of tixagevimab/cilgavimab in patients with hematological malignancies as a pre-exposure prophylaxis to prevent severe COVID-19: a Czech retrospective multicenter study. Ann Hematol 2024; 103:981-992. [PMID: 38092996 PMCID: PMC10866774 DOI: 10.1007/s00277-023-05572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/28/2023] [Indexed: 02/15/2024]
Abstract
Despite lower virulence, the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) still poses a relevant threat for immunocompromised patients. A retrospective multicentric study was conducted to evaluate the efficacy of pre-exposure prophylaxis with tixagevimab/cilgavimab (Evusheld) with a 6-month follow-up for preventing severe COVID-19 in adult patients with hematology malignancy. Among the 606 patients in the cohort, 96 (16%) contracted COVID-19 with a median of 98.5 days after Evusheld administration. A total of 75% of patients had asymptomatic or mild severity of COVID-19, while just 25% of patients with SARS-CoV-2 positivity had to be hospitalized. Two patients (2%) died directly, and one patient (1%) in association with COVID-19. Eight patients (1.3%) of every cohort experienced adverse events related to Evusheld, mostly grade 1 and of reversible character. It was found that complete vaccination status or positive seroconversion was not associated with lower risk of COVID-19 infection. Previous treatment with an anti-CD20 monoclonal antibody was associated with higher rates of COVID-19, while previous treatment with anti-CD38 monoclonal antibody was not, as was the case for recipients of hematopoietic stem cell transplantation or CAR-T cell therapy. Presence of other comorbidities was not associated with more severe COVID-19. The results support the growing evidence for Evusheld's efficacy against severe COVID-19 in patients with hematology malignancies.
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Affiliation(s)
- Ivo Demel
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic.
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - David Skopal
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Eliška Šafránková
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Petra Rozsívalová
- Hospital Pharmacy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Pavel Jindra
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jiří Šrámek
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
- Department of Histology and Embryology, Faculty of Medicine, Pilsen, Czech Republic
| | - Adéla Turková
- Department of Haematology & Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Vydra
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Klára Labská
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Jana Vedrová
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Martin Čerňan
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Tomáš Szotkowski
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Heidi Móciková
- Department of Internal Medicine and Haematology, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lenka Hynková
- Department of Internal Medicine and Haematology, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ondrej Šušol
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ingrid Kováčová
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Haematology, Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Tandler C, Heitmann JS, Michel TM, Marconato M, Jaeger SU, Tegeler CM, Denk M, Richter M, Oezbek MT, Maringer Y, Schroeder SM, Schneiderhan-Marra N, Wiesmüller KH, Bitzer M, Ruetalo N, Schindler M, Meisner C, Fischer I, Rammensee HG, Salih HR, Walz JS. Long-term efficacy of the peptide-based COVID-19 T cell activator CoVac-1 in healthy adults. Int J Infect Dis 2024; 139:69-77. [PMID: 38016500 DOI: 10.1016/j.ijid.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: 08/28/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES T cell immunity is key for the control of viral infections including SARS-CoV-2, in particular with regard to immune memory and protection against arising genetic variants. METHODS We recently evaluated a peptide-based SARS-CoV-2 T cell activator termed CoVac-1 in a first-in-human trial in healthy adults. Here, we report on long-term safety and efficacy data of CoVac-1 until month 12. RESULTS CoVac-1 is well tolerated without long-term immune-related side effects and induces long-lasting anti-viral T cell responses in 100% of study participants, with potent expandability of clusters of differentiation (CD4+) and CD8+ T cells targeting multiple different CoVac-1 T cell epitopes. T cell responses were associated with stronger injection site reaction. Beyond induction of T cell immunity, 89% of subjects developed CoVac-1-specific immunoglobulin G antibodies which associated with the intensity of the T cell response, indicating that CoVac-1-specific CD4+ T cells support the induction of B-cell responses. Vaccination with approved COVID-19 vaccines boosted CoVac-1-specific T cell responses. Overall, a low SARS-CoV-2 infection rate (8.3%) was observed. CONCLUSION Together, a single application of CoVac-1 elicits long-lived and broad SARS-CoV-2-specific T cell immunity, which further supports the current evaluation of our T cell activator in patients with congenital or acquired B-cell defects.
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Affiliation(s)
- Claudia Tandler
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Jonas S Heitmann
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Tanja M Michel
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Maddalena Marconato
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Simon U Jaeger
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany; Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany; Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
| | - Christian M Tegeler
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany; Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Monika Denk
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Marion Richter
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Melek Tutku Oezbek
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Yacine Maringer
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Sarah M Schroeder
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University of Hospital Tübingen, Tübingen, Germany
| | | | | | - Michael Bitzer
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Natalia Ruetalo
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Michael Schindler
- Institute for Medical Virology and Epidemiology of Viral Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Meisner
- Robert Bosch Hospital, Robert Bosch Society for Medical Research, Stuttgart, Germany
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Georg Rammensee
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Helmut R Salih
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Juliane S Walz
- Department of Peptide-based Immunotherapy, Institute of Immunology, University and University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany.
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5
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Xie H, Zhang J, Luo R, Qi Y, Lin Y, Han C, Li X, Zeng D. IgG antibody response to SARS-CoV-2 infection and its influencing factors in lymphoma patients. BMC Immunol 2024; 25:5. [PMID: 38218761 PMCID: PMC10788029 DOI: 10.1186/s12865-024-00596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The ability of generating effective humoral immune responses to SARS-CoV-2 infection has not been clarified in lymphoma patients. The study aimed to investigate the antibody (Ab) production after SARS-Cov-2 infection and clarify the factors affecting the Ab generation in these patients. PATIENTS & METHODS 80 lymphoma patients and 51 healthy controls were included in this prospective observational study. Clinical factors and treatment regimens affecting Ab positive rate (APR) and Ab levels were analyzed by univariate and multivariate methods. RESULTS The anti-SARS-CoV-2 IgG APR and Ab levels in lymphoma patients were significantly lower than those in healthy controls. Lymphoma patients with COVID-19 vaccination had significantly higher APR and Ab levels compared with those without vaccination. Additionally, the use of dexamethasone for COVID-19 treatment had a negative impact on Ab levels. For the impact of treatment regimens on the APR and Ab levels, the results showed that patients treated with ≥ 6 times CD20 monoclonal Ab (mAb) and patients treated with autologous hematopoietic stem cell transplantation (ASCT) prior to infection produced a statistically lower APR and Ab levels compared with those treated with 1-5 times CD20 mAb and those treated without ASCT, respectively. Furthermore, multiple regression analysis indicated that the number of anti-CD20 treatment was an independent predictor for both APR and Ab levels. CONCLUSIONS Humoral immune response to SARS-CoV-2 infection was impaired in lymphoma patients partly due to anti-CD20 and ASCT treatment. COVID-19 vaccination may be more needed for these patients.
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Affiliation(s)
- Huan Xie
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Jing Zhang
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Ran Luo
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Yan Qi
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Yizhang Lin
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Changhao Han
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China
| | - Xi Li
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
| | - Dongfeng Zeng
- Department of Hematology, Daping Hospital, Army Medical University, No. 10, Daping Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
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6
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Sun P, Cheng B, Ru J, Li X, Fang G, Xie Y, Shi G, Hou J, Zhao L, Gan L, Ma L, Liang C, Chen Y, Li Z. Nano-carrier DMSN for effective multi-antigen vaccination against SARS-CoV-2. J Nanobiotechnology 2024; 22:11. [PMID: 38167103 PMCID: PMC10763455 DOI: 10.1186/s12951-023-02271-w] [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: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
The pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has had a profound impact on the global health and economy. While mass vaccination for herd immunity is effective, emerging SARS-CoV-2 variants can evade spike protein-based COVID-19 vaccines. In this study, we develop a new immunization strategy by utilizing a nanocarrier, dendritic mesoporous silica nanoparticle (DMSN), to deliver the receptor-binding domain (RBD) and conserved T-cell epitope peptides (DMSN-P-R), aiming to activate both humoral and cellular immune responses in the host. The synthesized DMSN had good uniformity and dispersion and showed a strong ability to load the RBD and peptide antigens, enhancing their uptake by antigen-presenting cells (APCs) and promoting antigen delivery to lymph nodes. The DMSN-P-R vaccine elicited potent humoral immunity, characterized by highly specific RBD antibodies. Neutralization tests demonstrated significant antibody-mediated neutralizing activity against live SARS-CoV-2. Crucially, the DMSN-P-R vaccine also induced robust T-cell responses that were specifically stimulated by the RBD and conserved T-cell epitope peptides of SARS-CoV-2. The DMSN demonstrated excellent biocompatibility and biosafety in vitro and in vivo, along with degradability. Our study introduces a promising vaccine strategy that utilizes nanocarriers to deliver a range of antigens, effectively enhancing both humoral and cellular immune responses to prevent virus transmission.
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Affiliation(s)
- Peng Sun
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Bingsheng Cheng
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Jiaxi Ru
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Xiaoyan Li
- Key Laboratory of Public Health Detection and Etiological Research of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China
| | - Guicun Fang
- Microscopy Core Facility, Westlake University, Hangzhou, Zhejiang, 310030, China
| | - Yinli Xie
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Guangjiang Shi
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Jichao Hou
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Longwei Zhao
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Lipeng Gan
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Lina Ma
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Chao Liang
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China
| | - Yin Chen
- Key Laboratory of Public Health Detection and Etiological Research of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310051, China.
| | - Zhiyong Li
- School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
- Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, 315302, China.
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7
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Li J, Liu Y, Wei X, Liu Z, Yang Z, Liu L, Zhou M, Xu G, Chen L, Ding Y, Lei H, Yang Z, Chen S, Zhang X, Tang Y, Fu H, He S, Guo B, Liang X, Zhang L, Zhang W, Wu J, Wang C, Hu C, Hu R, Luo X, Quan X, Zeng C, Liang S, Liu T, Lv J, Luo Q, Qi Q, Xu L, Xiong Y, Liu J, Huang D, Xiao C, Liu J, Yang T, Xiang Y, Li Q, Nan Y, Li J, Zhang Y, Wu Y, Liu Y. Antibody responses to SARS-CoV-2 Omicron infection in patients with hematological malignancies: A multicenter, prospective cohort study. J Med Virol 2023; 95:e29300. [PMID: 38063070 DOI: 10.1002/jmv.29300] [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: 08/13/2023] [Revised: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
Little is known about antibody responses to natural Omicron infection and the risk factors for poor responders in patients with hematological malignancies (HM). We conducted a multicenter, prospective cohort study during the latest Omicron wave in Chongqing, China, aiming to compare the antibody responses, as assessed by IgG levels of anti-receptor binding domain of spike protein (anti-S-RBD), to Omicron infection in the HM cohort (HMC) with healthy control cohort (HCC), and solid cancer cohort (SCC). In addition, we intend to explore the risk factors for poor responders in the HMC. Among the 466 HM patients in this cohort, the seroconversion rate was 92.7%, no statistically difference compared with HCC (98.2%, p = 0.0513) or SCC (100%, p = 0.1363). The median anti-S-RBD IgG titer was 29.9 ng/mL, significantly lower than that of HCC (46.9 ng/mL, p < 0.0001) or SCC (46.2 ng/mL, p < 0.0001). Risk factors associated with nonseroconversion included no COVID-19 vaccination history (odds ratio [OR] = 4.58, 95% confidence interval [CI]: 1.75-12.00, p = 0.002), clinical course of COVID-19 ≤ 7 days (OR = 2.86, 95% CI: 1.31-6.25, p = 0.008) and severe B-cell reduction (0-10/μL) (OR = 3.22, 95% CI: 1.32-7.88, p = 0.010). Risk factors associated with low anti-S-RBD IgG titer were clinical course of COVID-19 ≤ 7 days (OR = 2.58, 95% CI: 1.59-4.18, p < 0.001) and severe B-cell reduction (0-10/μL) (OR = 2.87, 95% CI: 1.57-5.24, p < 0.001). This study reveals a poor antibody responses to Omicron (BA.5.2.48) infection in HM patients and identified risk factors for poor responders. Highlights that HM patients, especially those with these risk factors, may be susceptible to SARS-CoV-2 reinfection, and the postinfection vaccination strategies for these patients should be tailored. Clinical trial: ChiCTR2300071830.
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Affiliation(s)
- Jun Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yi Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xia Wei
- Department of Hematology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhanshu Liu
- Department of Hematology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zailiang Yang
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Ling Liu
- Department of Medical Laboratory, People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Meiyu Zhou
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Guofa Xu
- Department of Hematology and Medical Oncology, Chongqing University Fuling Hospital, Chongqing, China
| | - Lanting Chen
- Department of Hematology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Ding
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Haike Lei
- Department of Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Zailin Yang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Shuang Chen
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaomei Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yifeng Tang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Huihui Fu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Sanxiu He
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Bingling Guo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiping Liang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lingqian Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wenjun Zhang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jing Wu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyu Wang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chongling Hu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Renzhi Hu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xin Luo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xi Quan
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chensi Zeng
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Shunsi Liang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tingting Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jing Lv
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qin Luo
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qin Qi
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Luxiang Xu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yan Xiong
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jueyin Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Dehong Huang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chunyan Xiao
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jun Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tao Yang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Xiang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qiying Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yingyu Nan
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jieping Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yong Zhang
- Department of Hematology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongzhong Wu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yao Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
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8
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Doukas PG, St. Pierre F, Karmali R, Mi X, Boyer J, Nieves M, Ison MG, Winter JN, Gordon LI, Ma S. Humoral Immunity After COVID-19 Vaccination in Chronic Lymphocytic Leukemia and Other Indolent Lymphomas: A Single-Center Observational Study. Oncologist 2023; 28:e930-e941. [PMID: 37141401 PMCID: PMC10546828 DOI: 10.1093/oncolo/oyad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) and other non-Hodgkin's lymphomas (NHLs) lead to broad immunosuppression, conferring a greater risk for morbidity and mortality from SARS-CoV-2. Our study analyzed antibody (Ab) seropositivity from SARS-CoV-2 vaccination in patients with these cancers. METHODS In the final analysis, 240 patients were involved, and seropositivity was defined as a positive total or spike protein Ab. RESULTS Seropositivity was 50% in CLL, 68% in WM, and 70% in the remaining NHLs. Moderna vaccination led to higher seropositivity compared to Pfizer vaccination across all cancers (64% vs. 49%; P = .022) and specifically CLL patients (59% vs. 43%; P = .029). This difference was not explainable by differences in treatment status or prior anti-CD20 monoclonal Ab therapy. In CLL patients, current or prior cancer therapy led to lower seropositivity compared to treatment-naïve patients (36% vs. 68%; P = .000019). CLL patients treated with Bruton's tyrosine kinase (BTK) inhibitors had better seropositivity after receiving the Moderna vaccination compared to Pfizer (50% vs. 23%; P = .015). Across all cancers, anti-CD20 agents within 1 year led to a lower Ab response compared to greater than one year (13% vs. 40%; P = .022), a difference which persisted after booster vaccination. CONCLUSION Antibody response is lower in patients with indolent lymphomas compared to the general population. Lower Ab seropositivity was found in patients with a history of anti-leukemic agent therapy or those immunized with Pfizer vaccine. This data suggests that Moderna vaccination may confer a greater degree of immunity against SARS-CoV-2 in patients with indolent lymphomas.
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Affiliation(s)
- Peter G Doukas
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Frederique St. Pierre
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Reem Karmali
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Xinlei Mi
- Department of Preventive Medicine and Biostatistics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Boyer
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Mariana Nieves
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jane N Winter
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Leo I Gordon
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Shuo Ma
- Division of Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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9
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Grech L, Loe BS, Day D, Freeman D, Kwok A, Nguyen M, Bain N, Segelov E. The Disease Influenced Vaccine Acceptance Scale-Six (DIVAS-6): Validation of a Measure to Assess Disease-Related COVID-19 Vaccine Attitudes and Concerns. Behav Med 2023; 49:402-411. [PMID: 35703037 DOI: 10.1080/08964289.2022.2082358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
Patients with underlying comorbidities are particularly vulnerable to poor outcomes from SARS-CoV-2 infection. Despite the context-specific nature of vaccine hesitancy, there are currently no scales that incorporate disease or treatment-related hesitancy factors. We developed a six-item scale assessing disease-related COVID-19 vaccine attitudes and concerns (The Disease Influenced COVID-19 Vaccine Acceptance Scale-Six: DIVAS-6). A survey incorporating the DIVAS-6 was completed by 4683 participants with severe and/or chronic illness (3560 cancer; 842 diabetes; 281 multiple sclerosis (MS)). The survey included the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, demographic, disease-related, and vaccination status questions. The six items loaded onto two factors (disease complacency and vaccine vulnerability) using exploratory factor analysis and exploratory structural equation modeling. The two factors were internally consistent. Measurement invariance analysis showed the two factors displayed psychometric equivalence across the patient groups. Each factor significantly correlated with the two Oxford COVID-19 Vaccine scales, showing convergent validity. The summary score showed acceptable ability to discriminate vaccination status across diseases, with the total sample providing good-to-excellent discriminative ability. The DIVAS-6 has two factors measuring COVID-19 vaccine attitudes and concerns relating to potential complications of SARS-CoV-2 infection due to underlying disease (disease complacency) and vaccine-related impact on disease progression and treatment (vaccine vulnerability). This is the first validated scale to measure disease-related COVID-19 vaccine concerns and has been validated in people with cancer, diabetes, and MS. It is quick to administer and should assist with guiding information delivery about COVID-19 vaccination in medically vulnerable populations.
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Affiliation(s)
- Lisa Grech
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bao Sheng Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - Daphne Day
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Oncology, Monash Health, Melbourne, Australia
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Alastair Kwok
- Department of Oncology, Monash Health, Melbourne, Australia
| | - Mike Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Oncology, Monash Health, Melbourne, Australia
| | - Nathan Bain
- Department of Oncology, Monash Health, Melbourne, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Oncology, Monash Health, Melbourne, Australia
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10
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Alshemmari SH, Siddiqui MA, Pandita R, Osman HY, Cherif H, O'Brien S, Marashi M, Al Farsi K. Evidence-Based Management of Chronic Lymphocytic Leukemia: Consensus Statements from the Gulf Region. Acta Haematol 2023; 147:260-279. [PMID: 37751733 DOI: 10.1159/000531675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/16/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Despite recent advances in diagnosis, prognostication, and treatment options, chronic lymphocytic leukemia (CLL) is still a largely incurable disease. New concepts on diagnosis, staging, treatment, and follow-up on CLL have been incorporated throughout recent years. The lack of regional consensus guidelines has led to varying practices in the management of patients with CLL in the region. This manuscript aims to reach a consensus among expert hematologists regarding the definitions, classifications, and related practices of CLL. The experts developed a set of statements utilizing their personal experience together with the current literature on CLL management. This consensus aims to provide guidance for healthcare professionals involved in the management of CLL and serves as a step in developing regional guidelines. METHODS Eight experts responded to 50 statements regarding the diagnosis, staging, treatment, and prognosis of CLL with three potential answering alternatives ranging between agree, disagree, and abstain. This consensus adopted a modified Delphi consensus methodology. A consensus was reached when at least 75% of the agreement to the answer was reached. This manuscript presents the scientific insights of the participating attendees, panel discussions, and the supporting literature review. RESULTS Of the 50 statements, a consensus was reached on almost all statements. Statements covered CLL-related topics, including diagnostic evaluation, staging, risk assessment, different patient profiles, prognostic evaluation, treatment decisions, therapy sequences, response evaluation, complications, and CLL during the COVID-19 pandemic. CONCLUSION In recent years, CLL management has progressed significantly, with many diagnostic tests and several novel treatments becoming available. This consensus gathers decades of consolidated principles, novel research, and promising prospects for the management of this disease.
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Affiliation(s)
- Salem H Alshemmari
- Department of Medicine, Faculty of Medicine and Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh, Kuwait
| | - Mustaqeem A Siddiqui
- Hematology and Oncology Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
- Mayo Clinic Division of Hematology, Rochester, Minnesota, USA
| | - Ramesh Pandita
- Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh, Kuwait
| | - Hani Y Osman
- Oncology Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Honar Cherif
- Departmant of Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA
| | - Mahmoud Marashi
- Department of Hematology, Dubai Healthcare Authority, Dubai, United Arab Emirates
| | - Khalil Al Farsi
- Department of Hematology, Sultan Qaboos University Hospital Muscat, Seeb, Oman
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11
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Heitmann JS, Tandler C, Marconato M, Nelde A, Habibzada T, Rittig SM, Tegeler CM, Maringer Y, Jaeger SU, Denk M, Richter M, Oezbek MT, Wiesmüller KH, Bauer J, Rieth J, Wacker M, Schroeder SM, Hoenisch Gravel N, Scheid J, Märklin M, Henrich A, Klimovich B, Clar KL, Lutz M, Holzmayer S, Hörber S, Peter A, Meisner C, Fischer I, Löffler MW, Peuker CA, Habringer S, Goetze TO, Jäger E, Rammensee HG, Salih HR, Walz JS. Phase I/II trial of a peptide-based COVID-19 T-cell activator in patients with B-cell deficiency. Nat Commun 2023; 14:5032. [PMID: 37596280 PMCID: PMC10439231 DOI: 10.1038/s41467-023-40758-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
T-cell immunity is central for control of COVID-19, particularly in patients incapable of mounting antibody responses. CoVac-1 is a peptide-based T-cell activator composed of SARS-CoV-2 epitopes with documented favorable safety profile and efficacy in terms of SARS-CoV-2-specific T-cell response. We here report a Phase I/II open-label trial (NCT04954469) in 54 patients with congenital or acquired B-cell deficiency receiving one subcutaneous CoVac-1 dose. Immunogenicity in terms of CoVac-1-induced T-cell responses and safety are the primary and secondary endpoints, respectively. No serious or grade 4 CoVac-1-related adverse events have been observed. Expected local granuloma formation has been observed in 94% of study subjects, whereas systemic reactogenicity has been mild or absent. SARS-CoV-2-specific T-cell responses have been induced in 86% of patients and are directed to multiple CoVac-1 peptides, not affected by any current Omicron variants and mediated by multifunctional T-helper 1 CD4+ T cells. CoVac-1-induced T-cell responses have exceeded those directed to the spike protein after mRNA-based vaccination of B-cell deficient patients and immunocompetent COVID-19 convalescents with and without seroconversion. Overall, our data show that CoVac-1 induces broad and potent T-cell responses in patients with B-cell/antibody deficiency with a favorable safety profile, which warrants advancement to pivotal Phase III safety and efficacy evaluation. ClinicalTrials.gov identifier NCT04954469.
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Affiliation(s)
- Jonas S Heitmann
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Claudia Tandler
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Maddalena Marconato
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Annika Nelde
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Timorshah Habibzada
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Susanne M Rittig
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité -Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Berlin, Germany
| | - Christian M Tegeler
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Department of Obstetrics and Gynecology, University Hospital Tübingen, Tübingen, Germany
| | - Yacine Maringer
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Simon U Jaeger
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
| | - Monika Denk
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Marion Richter
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Melek T Oezbek
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | | | - Jens Bauer
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Jonas Rieth
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Marcel Wacker
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Sarah M Schroeder
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Naomi Hoenisch Gravel
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Jonas Scheid
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- Quantitative Biology Center (QBiC), University of Tübingen, Tübingen, Germany
| | - Melanie Märklin
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Annika Henrich
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Boris Klimovich
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Kim L Clar
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Martina Lutz
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Samuel Holzmayer
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Sebastian Hörber
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Meisner
- Robert Bosch Hospital, Robert Bosch Society for Medical Research, Stuttgart, Germany
| | - Imma Fischer
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Tübingen, Germany
| | - Markus W Löffler
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Caroline Anna Peuker
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité -Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Berlin, Germany
| | - Stefan Habringer
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité -Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Berlin, Germany
| | - Thorsten O Goetze
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Elke Jäger
- Department for Oncology and Hematology, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Hans-Georg Rammensee
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Helmut R Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Juliane S Walz
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany.
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany.
- Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany.
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12
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Ammad Ud Din M, Shahzad M, Ashraf A, Liaqat H, Jaan A, Anwer F. Clinical Research in Chronic Lymphocytic Leukemia in Pakistan; A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1483. [PMID: 37629773 PMCID: PMC10456454 DOI: 10.3390/medicina59081483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Background: Significant advances have been made in the treatment of chronic lymphocytic leukemia (CLL) since the turn of the new millennium. However, most clinical trials were done in developed countries where minority ethnicities were underrepresented. Materials and Methods: To gauge the quality of research in CLL being done in Pakistan, we conducted a comprehensive literature search using PubMed, Clinicaltrials.gov, and Google Scholar on 14 January 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Results: A total of 16 studies met the inclusion criteria. The most common study design was cross-sectional. Eight studies evaluated the clinicohematological profile of CLL patients and the effect of various cytogenic abnormalities through fluorescence in situ hybridization (FISH) technique on disease progression and prognosis. Five studies discussed the prevalence of abnormalities such as autoimmune cytopenias and other serum chemistry derangements. Only two studies evaluated treatment outcomes, among which one study reported a 2-year overall survival of 65% among patients with 17p deletion. None of the studies had patients on novel targeted agents. No pharmaceutical sponsored or funded clinical trials were found. Conclusions: Our review suggests that although small clinical studies continue to be performed across the country, multiple financial and logistical barriers need to be addressed for larger, more impactful clinical trials to be conducted that will help answer demographic-specific questions and decrease reliance on foreign studies.
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Affiliation(s)
- Mohammad Ammad Ud Din
- Hematology/ Oncology, Moffitt Cancer Center, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Hematology/ Oncology, University of South Florida, Tampa, FL 33612, USA
| | - Moazzam Shahzad
- Hematology/ Oncology, Moffitt Cancer Center, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Hematology/ Oncology, University of South Florida, Tampa, FL 33612, USA
| | - Aqsa Ashraf
- Internal Medicine, Northwell Health Mather Hospital, Port Jefferson, New York, NY 11777, USA
| | - Hania Liaqat
- Internal Medicine, Rochester General Hospital, Rochester, New York, NY 14621, USA
| | - Ali Jaan
- Internal Medicine, Rochester General Hospital, Rochester, New York, NY 14621, USA
| | - Faiz Anwer
- Hematology/ Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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13
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Baratè C, Caruso T, Mavilia F, Sammuri P, Pratesi F, Motta G, Guerri V, Galimberti S, Migliorini P. Induction of neutralizing antibodies in CLL patients after SARS-CoV-2 mRNA vaccination: a monocentric experience. Clin Exp Med 2023; 23:1197-1203. [PMID: 36074205 PMCID: PMC9453722 DOI: 10.1007/s10238-022-00877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
Vaccination represents the best strategy to fight COVID-19 pandemics, especially in immune compromised subjects. In chronic lymphatic leukemia patients, a marked impairment of the immune response to mRNA SARS-CoV-2 vaccine was observed. In this report, we analyzed anti-RBD and neutralizing antibodies in CLL patients after two doses of mRNA SARS CoV 2 vaccine and evaluated the impact of Bruton kinase inhibitory agents. Twenty-seven CLL patients vaccinated with mRNA vaccines against SARS CoV-2 were recruited. Serum IgG, IgM and IgA anti-RBD antibodies and neutralizing antibodies were detected, and antibody avidity was measured. Peripheral blood leukocytes subsets were evaluated by flow cytometry. After two vaccine doses anti-RBD IgG were produced in 11/27 (40.5%) of patients and levels of IgG and IgA anti RBD in CLL patients were sensibly lower than in controls. Neutralizing antibodies were detectable in 12/27 (44.5%) of the patients and their level was lower than that observed in controls. Disease burden and treatment with Bruton kinases inhibitors markedly impaired vaccine induced antibody response. However, in responder patients, antibody avidity was comparable to normal subjects, indicating that the process of clonal selection and affinity maturation takes place as expected. Taken together, these data confirm the impact of disease burden and therapy on production of anti-RBD and neutralizing antibodies and support the current policy of vaccinating CLL patients.
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Affiliation(s)
- Claudia Baratè
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresita Caruso
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Fabrizio Mavilia
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Sammuri
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Pratesi
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
- General Pathology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Motta
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Valentina Guerri
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
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14
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Del Poeta G, Laureana R, Bomben R, Rossi FM, Pozzo F, Zaina E, Cattarossi I, Varaschin P, Nanni P, Boschian Boschin R, Nunzi A, Postorino M, Pasqualone G, Brisotto G, Steffan A, Muraro E, Zucchetto A, Del Principe MI, Gattei V. COVID-19 vaccination: Evaluation of humoral and cellular immunity after the booster dose in chronic lymphocytic leukemia patients. Hematol Oncol 2023; 41:559-562. [PMID: 36585917 PMCID: PMC9880611 DOI: 10.1002/hon.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Giovanni Del Poeta
- HematologyDepartment of Biomedicine and PreventionUniversity of Tor VergataRomeItaly
| | - Roberta Laureana
- HematologyDepartment of Biomedicine and PreventionUniversity of Tor VergataRomeItaly
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Federico Pozzo
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Eva Zaina
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Ilaria Cattarossi
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Paola Varaschin
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Paola Nanni
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Romina Boschian Boschin
- Immunopathology and Cancer BiomarkersCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Andrea Nunzi
- HematologyDepartment of Biomedicine and PreventionUniversity of Tor VergataRomeItaly
| | | | - Gianmario Pasqualone
- HematologyDepartment of Biomedicine and PreventionUniversity of Tor VergataRomeItaly
| | - Giulia Brisotto
- Immunopathology and Cancer BiomarkersCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Agostino Steffan
- Immunopathology and Cancer BiomarkersCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Elena Muraro
- Immunopathology and Cancer BiomarkersCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
| | | | - Valter Gattei
- Clinical and Experimental Onco‐Hematology UnitCentro di Riferimento Oncologico di Aviano (CRO)IRCCSAvianoPordenoneItaly
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15
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Russo F, Santi F, Sirchio A, Lazzeri L, DE Piano E, Taddeucci P, Rubegni P. Skin reaction following SARS-CoV-2 vaccine BNT162b2. Ital J Dermatol Venerol 2023; 158:360-361. [PMID: 37387638 DOI: 10.23736/s2784-8671.23.07429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Filomena Russo
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy -
| | - Francesco Santi
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Azzurra Sirchio
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Laura Lazzeri
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Ernesto DE Piano
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Paolo Taddeucci
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
| | - Pietro Rubegni
- Section of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy
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16
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Ayers E, Canderan G, Williams ME, Keshavarz B, Portell CA, Wilson JM, Woodfolk JA. In-depth cellular and humoral dynamics of the response to COVID-19 vaccine booster in patients with chronic B-cell neoplasms. Blood Cancer J 2023; 13:114. [PMID: 37495573 PMCID: PMC10372059 DOI: 10.1038/s41408-023-00884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Emily Ayers
- Division of Hematology and Oncology and Comprehensive Cancer Center, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Glenda Canderan
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Michael E Williams
- Division of Hematology and Oncology and Comprehensive Cancer Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Behnam Keshavarz
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Craig A Portell
- Division of Hematology and Oncology and Comprehensive Cancer Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeffrey M Wilson
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Judith A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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17
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Fattizzo B, Rampi N, Barcellini W. Vaccinations in hematological patients in the era of target therapies: Lesson learnt from SARS-CoV-2. Blood Rev 2023; 60:101077. [PMID: 37029066 PMCID: PMC10043962 DOI: 10.1016/j.blre.2023.101077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023]
Abstract
Novel targeting agents for hematologic diseases often exert on- or off-target immunomodulatory effects, possibly impacting on response to anti-SARS-CoV-2 vaccinations and other vaccines. Agents that primarily affect B cells, particularly anti-CD20 monoclonal antibodies (MoAbs), Bruton tyrosine kinase inhibitors, and anti-CD19 chimeric antigen T-cells, have the strongest impact on seroconversion. JAK2, BCL-2 inhibitors and hypomethylating agents may hamper immunity but show a less prominent effect on humoral response to vaccines. Conversely, vaccine efficacy seems not impaired by anti-myeloma agents such as proteasome inhibitors and immunomodulatory agents, although lower seroconversion rates are observed with anti-CD38 and anti-BCMA MoAbs. Complement inhibitors for complement-mediated hematologic diseases and immunosuppressants used in aplastic anemia do not generally affect seroconversion rate, but the extent of the immune response is reduced under steroids or anti-thymocyte globulin. Vaccination is recommended prior to treatment or as far as possible from anti-CD20 MoAb (at least 6 months). No clearcut indications for interrupting continuous treatment emerged, and booster doses significantly improved seroconversion. Cellular immune response appeared preserved in several settings.
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Affiliation(s)
- Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Nicolò Rampi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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18
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Zhou Q, Zeng F, Meng Y, Liu Y, Liu H, Deng G. Serological response following COVID-19 vaccines in patients living with HIV: a dose-response meta-analysis. Sci Rep 2023; 13:9893. [PMID: 37336939 DOI: 10.1038/s41598-023-37051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
To quantify the pooled rate and risk ratio of seroconversion following the uncomplete, complete, or booster dose of COVID-19 vaccines in patients living with HIV. PubMed, Embase and Cochrane library were searched for eligible studies to perform a systematic review and meta-analysis based on PRIMSA guidelines. The pooled rate and risk ratio of seroconversion were assessed using the Freeman-Tukey double arcsine method and Mantel-Haenszel approach, respectively. Random-effects model was preferentially used as the primary approach to pool results across studies. A total of 50 studies involving 7160 patients living with HIV were analyzed. We demonstrated that only 75.0% (56.4% to 89.9%) patients living with HIV achieved a seroconversion after uncomplete vaccination, which improved to 89.3% (84.2% to 93.5%) after complete vaccination, and 98.4% (94.8% to 100%) after booster vaccination. The seroconversion rates were significantly lower compared to controls at all the stages, while the risk ratios for uncomplete, complete, and booster vaccination were 0.87 (0.77 to 0.99), 0.95 (0.92 to 0.98), and 0.97 (0.94 to 0.99), respectively. We concluded that vaccine doses were associated with consistently improved rates and risk ratios of seroconversion in patients living with HIV, highlighting the significance of booster vaccination for patients living with HIV.
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Affiliation(s)
- Qian Zhou
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Furong Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yu Meng
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yihuang Liu
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Hong Liu
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Guangtong Deng
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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19
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Wu X, Manske MK, Ruan GJ, Witter TL, Nowakowski KE, Abeykoon JP, Tang X, Yu Y, Gwin KA, Wu A, Taupin V, Bhardwaj V, Paludo J, Dasari S, Dong H, Ansell SM, Badley AD, Schellenberg MJ, Witzig TE. Secreted ORF8 induces monocytic pro-inflammatory cytokines through NLRP3 pathways in patients with severe COVID-19. iScience 2023; 26:106929. [PMID: 37260746 PMCID: PMC10193824 DOI: 10.1016/j.isci.2023.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/06/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
Despite extensive research, the specific factor associated with SARS-CoV-2 infection that mediates the life-threatening inflammatory cytokine response in patients with severe COVID-19 remains unidentified. Herein we demonstrate that the virus-encoded Open Reading Frame 8 (ORF8) protein is abundantly secreted as a glycoprotein in vitro and in symptomatic patients with COVID-19. ORF8 specifically binds to the NOD-like receptor family pyrin domain-containing 3 (NLRP3) in CD14+ monocytes to induce inflammasomal cytokine/chemokine responses including IL1β, IL8, and CCL2. Levels of ORF8 protein in the blood correlate with severity and disease-specific mortality in patients with acute SARS-CoV-2 infection. Furthermore, the ORF8-induced inflammasome response was readily inhibited by the NLRP3 inhibitor MCC950 in vitro. Our study identifies a dominant cause of pathogenesis, its underlying mechanism, and a potential new treatment strategy for severe COVID-19.
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Affiliation(s)
- Xiaosheng Wu
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Michelle K Manske
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Gordon J Ruan
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Taylor L Witter
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kevin E Nowakowski
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jithma P Abeykoon
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Xinyi Tang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Yue Yu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Kimberly A Gwin
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Annie Wu
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vanessa Taupin
- Electron Microscopy Core, University of California San Diego, La Jolla, CA, USA
| | - Vaishali Bhardwaj
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jonas Paludo
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Haidong Dong
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Stephen M Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew D Badley
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Thomas E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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20
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Liatsou E, Ntanasis-Stathopoulos I, Lykos S, Ntanasis-Stathopoulos A, Gavriatopoulou M, Psaltopoulou T, Sergentanis TN, Terpos E. Adult Patients with Cancer Have Impaired Humoral Responses to Complete and Booster COVID-19 Vaccination, Especially Those with Hematologic Cancer on Active Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15082266. [PMID: 37190194 DOI: 10.3390/cancers15082266] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
The exclusion of patients with cancer in clinical trials evaluating COVID-19 vaccine efficacy and safety, in combination with the high rate of severe infections, highlights the need for optimizing vaccination strategies. The aim of this study was to perform a systematic review and meta-analysis of the published available data from prospective and retrospective cohort studies that included patients with either solid or hematological malignancies according to the PRISMA Guidelines. A literature search was performed in the following databases: Medline (Pubmed), Scopus, Clinicaltrials.gov, EMBASE, CENTRAL and Google Scholar. Overall, 70 studies were included for the first and second vaccine dose and 60 studies for the third dose. The Effect Size (ES) of the seroconversion rate after the first dose was 0.41 (95%CI: 0.33-0.50) for hematological malignancies and 0.56 (95%CI: 0.47-0.64) for solid tumors. The seroconversion rates after the second dose were 0.62 (95%CI: 0.57-0.67) for hematological malignancies and 0.88 (95%CI: 0.82-0.93) for solid tumors. After the third dose, the ES for seroconversion was estimated at 0.63 (95%CI: 0.54-0.72) for hematological cancer and 0.88 (95%CI: 0.75-0.97) for solid tumors. A subgroup analysis was performed to evaluate potential factors affecting immune response. Production of anti-SARS-CoV-2 antibodies was found to be more affected in patients with hematological malignancies, which was attributed to the type of malignancy and treatment with monoclonal antibodies according to the subgroup analyses. Overall, this study highlights that patients with cancer present suboptimal humoral responses after COVID-19 vaccination. Several factors including timing of vaccination in relevance with active therapy, type of therapy, and type of cancer should be considered throughout the immunization process.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Stavros Lykos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Theodoros N Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Aigaleo, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece
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21
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Adverse Hematological Effects of COVID-19 Vaccination and Pathomechanisms of Low Acquired Immunity in Patients with Hematological Malignancies. Vaccines (Basel) 2023; 11:vaccines11030662. [PMID: 36992246 DOI: 10.3390/vaccines11030662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
The SARS-CoV-2 virus and the COVID-19 pandemic have spread across the world and severely impacted patients living with hematological conditions. Immunocompromised patients experience rapidly progressing symptoms following COVID-19 infection and are at high risk of death. In efforts to protect the vulnerable population, vaccination efforts have increased exponentially in the past 2 years. Although COVID-19 vaccination is safe and effective, mild to moderate side effects such as headache, fatigue, and soreness at the injection site have been reported. In addition, there are reports of rare side effects, including anaphylaxis, thrombosis with thrombocytopenia syndrome, Guillain-Barré Syndrome, myocarditis, and pericarditis after vaccination. Further, hematological abnormalities and a very low and transient response in patients with hematological conditions after vaccination raise concerns. The objective of this review is to first briefly discuss the hematological adverse effects associated with COVID-19 infection in general populations followed by critically analyzing the side effects and pathomechanisms of COVID-19 vaccination in immunocompromised patients with hematological and solid malignancies. We reviewed the published literature, with a focus on hematological abnormalities associated with COVID-19 infection followed by the hematological side effects of COVID-19 vaccination, and the mechanisms by which complications can occur. We extend this discussion to include the viability of vaccination efforts within immune-compromised patients. The primary aim is to provide clinicians with critical hematologic information on COVID-19 vaccination so that they can make informed decisions on how to protect their at-risk patients. The secondary goal is to clarify the adverse hematological effects associated with infection and vaccination within the general population to support continued vaccination within this group. There is a clear need to protect patients with hematological conditions from infection and modulate vaccine programs and procedures for these patients.
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22
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Schroeder SM, Nelde A, Walz JS. Viral T-cell epitopes - Identification, characterization and clinical application. Semin Immunol 2023; 66:101725. [PMID: 36706520 DOI: 10.1016/j.smim.2023.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
T-cell immunity, mediated by CD4+ and CD8+ T cells, represents a cornerstone in the control of viral infections. Virus-derived T-cell epitopes are represented by human leukocyte antigen (HLA)-presented viral peptides on the surface of virus-infected cells. They are the prerequisite for the recognition of infected cells by T cells. Knowledge of viral T-cell epitopes provides on the one hand a diagnostic tool to decipher protective T-cell immune responses in the human population and on the other hand various prophylactic and therapeutic options including vaccination approaches and the transfer of virus-specific T cells. Such approaches have already been proven to be effective against various viral infections, particularly in immunocompromised patients lacking sufficient humoral, antibody-based immune response. This review provides an overview on the state of the art as well as current studies regarding the identification and characterization of viral T-cell epitopes and approaches of clinical application. In the first chapter in silico prediction tools and direct, mass spectrometry-based identification of viral T-cell epitopes is compared. The second chapter provides an overview of commonly used assays for further characterization of T-cell responses and phenotypes. The final chapter presents an overview of clinical application of viral T-cell epitopes with a focus on human immunodeficiency virus (HIV), human cytomegalovirus (HCMV) and severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), being representatives of relevant viruses.
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Affiliation(s)
- Sarah M Schroeder
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany; Department for Otorhinolaryngology, Head, and Neck Surgery, University Hospital Tübingen, Tübingen, Germany; Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany
| | - Annika Nelde
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany; Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) 'Image-Guided and Functionally Instructed Tumor Therapies', University of Tübingen, Tübingen, Germany
| | - Juliane S Walz
- Department of Peptide-based Immunotherapy, University and University Hospital Tübingen, Tübingen, Germany; Institute for Cell Biology, Department of Immunology, University of Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC2180) 'Image-Guided and Functionally Instructed Tumor Therapies', University of Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany.
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23
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Effectiveness and Safety of COVID-19 Vaccination in Patients with Malignant Disease. Vaccines (Basel) 2023; 11:vaccines11020486. [PMID: 36851363 PMCID: PMC9962104 DOI: 10.3390/vaccines11020486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
A novel virus named SARS-CoV-2 has caused a worldwide pandemic, resulting in a disastrous impact to the public health since 2019. The disease is much more lethal among patients with malignant disease. Vaccination plays an important role in the prevention of infection and subsequent severe COVID-19. However, the efficacy and safety of vaccines for cancer patients needs further investigation. Encouragingly, there have been important findings deduced from research so far. In this review, an overview of the immunogenicity, effectiveness, and safeness of COVID-19 vaccines in patients with cancer to date is to be shown. We also highlight important questions to consider and directions that could be followed in future research.
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24
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Palumbo GA, Cambria D, La Spina E, Duminuco A, Laneri A, Longo A, Vetro C, Giallongo S, Romano A, Di Raimondo F, Tibullo D, Giallongo C. Ruxolitinib treatment in myelofibrosis and polycythemia vera causes suboptimal humoral immune response following standard and booster vaccination with BNT162b2 mRNA COVID-19 vaccine. Front Oncol 2023; 13:1117815. [PMID: 36865808 PMCID: PMC9974162 DOI: 10.3389/fonc.2023.1117815] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Patients affected by myelofibrosis (MF) or polycythemia vera (PV) and treated with ruxolitinib are at high risk for severe coronavirus disease 2019. Now a vaccine against the virus SARS-CoV-2, which is responsible for this disease, is available. However, sensitivity to vaccines is usually lower in these patients. Moreover, fragile patients were not included in large trials investigating the efficacy of vaccines. Thus, little is known about the efficacy of this approach in this group of patients. In this prospective single-center study, we evaluated 43 patients (30 MF patients and 13 with PV) receiving ruxolitinib as a treatment for their myeloproliferative disease. We measured anti-spike and anti-nucleocapsid IgG against SARS-CoV2 15-30 days after the second and the third BNT162b2 mRNA vaccine booster dose. Patients receiving ruxolitinib showed an impaired antibody response to complete vaccination (2 doses), as 32.5% of patients did not develop any response. After the third booster dose with Comirnaty, results slightly improved, as 80% of these patients produced antibodies above the threshold positivity. However, the quantity of produced antibodies was well below that reached than those reported for healthy individuals. PV patients elicited a better response than patients affected by MF. Thus, different strategies should be considered for this high-risk group of patients.
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Affiliation(s)
- Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy,*Correspondence: Giuseppe A. Palumbo, ; Daniele Tibullo,
| | - Daniela Cambria
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Enrico La Spina
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Andrea Duminuco
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Antonio Laneri
- Servizio Immuno-Trasfusionale, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Anna Longo
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Calogero Vetro
- Unità Operativa Complessa di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliero-Universitaria Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Sebastiano Giallongo
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, University of Catania, Catania, Italy
| | - Alessandra Romano
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, University of Catania, Catania, Italy
| | - Francesco Di Raimondo
- Dipartimento di Chirurgia Generale e Specialità Medico-Chirurgiche, University of Catania, Catania, Italy
| | - Daniele Tibullo
- Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, Catania, Italy,*Correspondence: Giuseppe A. Palumbo, ; Daniele Tibullo,
| | - Cesarina Giallongo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
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25
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Edelmann J, Malcikova J, Riches JC. Opinion: What defines high-risk CLL in the post-chemoimmunotherapy era? Front Oncol 2023; 13:1106579. [PMID: 36845738 PMCID: PMC9948015 DOI: 10.3389/fonc.2023.1106579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Affiliation(s)
- Jennifer Edelmann
- ClinSciNet - The Clinician Scientist Network, Münsingen, Germany,*Correspondence: Jennifer Edelmann,
| | - Jitka Malcikova
- Department of Internal Medicine – Hematology and Oncology, University Hospital Brno, Masaryk University, Brno, Czechia,Center of Molecular Medicine, Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - John C. Riches
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Department of Haemato-Oncology, Barts Health NHS Trust, St. Bartholomew’s Hospital, London, United Kingdom
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26
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Wirth SRM, Podar K, Pecherstorfer M, Wohlfarth P, Jaeger U, Singer J. Evaluation of Antibody Responses in Patients with B-Cell Malignancies after Two and Three Doses of Anti-SARS-CoV-2 S Vaccination-A Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15020524. [PMID: 36672473 PMCID: PMC9856293 DOI: 10.3390/cancers15020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Patients with B-cell malignancies are at a higher risk of severe SARS-CoV-2 infections. Nevertheless, extensive data on the immune responses of hematological patients and the efficacy of the third dose of the vaccine are scarce. The goal of this study was to determine standardized anti-SARS-CoV-2 S antibody levels and to evaluate differences between treatment modalities in response to the second and third vaccines among patients with B-cell malignancies treated at the University Hospital Krems and the University Hospital of Vienna. The antibody levels of a total of 80 patients were retrospectively analyzed. The results indicate a significant increase in antibody production in response to the third vaccination. The highest increases could be observed in patients in a "watchful-waiting" and "off-therapy" setting. Encouragingly, approximately one-third of patients who did not develop antibodies in response to two vaccinations achieved seroconversion after the third vaccination. "Watchful-waiting", "off-therapy" and treatment with BTK inhibitors were indicative for increased antibody response after the third dose compared to anti-CD19 CAR T-cell and anti-CD-20 antibody treatment. In summary, the results of this study underline the pre-eminent role of the need for complete vaccination with three doses for the development of protective immunity in patients with B-cell malignancies.
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Affiliation(s)
- Stella Rosa Maria Wirth
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Klaus Podar
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Division of Molecular Oncology and Hematology, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Martin Pecherstorfer
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Philipp Wohlfarth
- Department of Internal Medicine I, Hematopoietic Stem Cell Transplantation Unit, Medical University of Vienna, 1090 Vienna, Austria
| | - Ulrich Jaeger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria
| | - Josef Singer
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Internal Medicine II, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
- Correspondence:
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27
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Efficacy of tixagevimab-cilgavimab in preventing SARS-CoV-2 for patients with B-cell malignancies. Blood 2023; 141:200-203. [PMID: 36332185 PMCID: PMC9636601 DOI: 10.1182/blood.2022018283] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
COVID-19 still represents a major issue for patients with lymphoid malignancies, especially those on therapy, because of immune suppression and suboptimal responses to vaccination. Davis et al report on their experience with double dose tixagevimab-cilgavimab preexposure prophylaxis in a cohort of 251 patients with chronic lymphocytic leukemia, B-cell lymphomas, multiple myeloma, or B-cell acute lymphoblastic leukemia, 63% of whom had received 3 doses of the SARS-CoV-2 vaccine. Breakthrough infections within 3 months occur despite passive immunization, affecting 11% in this series; however, hospitalization rates are low, and mortality was avoided, suggesting benefit from this strategy.
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28
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Almeida Neto JBD, Arce IL, Figueiredo VLDP, Vicari P. Immunogenicity profile after COVID-19 vaccination in patients with onco-hematological diseases. EINSTEIN-SAO PAULO 2023; 21:eAO0089. [PMID: 36946824 PMCID: PMC10010256 DOI: 10.31744/einstein_journal/2023ao0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/27/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To evaluate the influence of onco-hematological pathologies on seroconversion to COVID-19 vaccines, in addition to the effects of chemotherapy treatment on this response. METHODS The present study evaluated the immunogenic response of 76 patients with onco-hematological diseases to multiple vaccine platforms compared to 25 control individuals. RESULTS Our results showed positive response rates of 74.02% in patients with onco-hematological diseases and 100% in controls. When analyzed according to etiological group, patients with lymphoproliferative disorders achieved a positive vaccine response rate of 58.7%, whereas those with myeloproliferative diseases achieved a 100% response rate. We also observed that patients previously exposed to COVID-19 presented a 75% increase in their antibody values after vaccination, and these values were 37% higher than those of patients who did not have such exposure. We found that patients who underwent B-lymphocyte-depleting therapy in the last 2 years before vaccination had a worse response rate of 18.75%. CONCLUSION Despite the immunosuppression of patients with onco-hematological diseases, caused by the biology of their diseases and treatment, benefit and safety in vaccinating these patients are observed, in view of the important recall immune response and incidence of adverse effects similar to those of the healthy population.
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Affiliation(s)
| | - Inara Lúcia Arce
- Hospital do Servidor Público Estadual de São Paulo , São Paulo , SP , Brazil
| | | | - Perla Vicari
- Hospital do Servidor Público Estadual de São Paulo , São Paulo , SP , Brazil
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29
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Wang KY, Shah P, Skavla B, Fayaaz F, Chi J, Rhodes JM. Vaccination efficacy in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2023; 64:42-56. [PMID: 36270021 DOI: 10.1080/10428194.2022.2133538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is a disorder of mature malignant B cells with multiple elements of immune dysfunction. Infections are common in CLL patients due to complex immunodeficiency. Vaccines are used as preventative measures for common diseases including influenza, pneumococcus, tetanus/diphtheria and shingles in the general population. Vaccines are utilized to mitigate this risk, although there have been some concerns regarding the efficacy of vaccines in the CLL population due to the inherent complex immune dysfunction associated with the disease. In this review, we describe the clinical and laboratory indicators for efficacy of the vaccines in the CLL population (including COVID-19, influenza, pneumonia, herpes zoster, and tetanus) and discuss immunization recommendations for patients with CLL.
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Affiliation(s)
- Kevin Y Wang
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Pratik Shah
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Brandon Skavla
- Department of Internal Medicine, Northwell Health, Manhasset, NY, USA
| | - Fatima Fayaaz
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Jeffrey Chi
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA
| | - Joanna M Rhodes
- Department of Hematology Oncology, Northwell Health, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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30
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COVID-19 Vaccination Response and Its Practical Application in Patients With Chronic Lymphocytic Leukemia. Hemasphere 2023; 7:e811. [PMID: 36570695 PMCID: PMC9771252 DOI: 10.1097/hs9.0000000000000811] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/09/2022] [Indexed: 12/27/2022] Open
Abstract
Patients with chronic lymphocyticleukemia (CLL) typically have innate/adaptive immune system dysregulation, thus the protective effect of coronavirus disease 2019 (COVID-19) vaccination remains uncertain. This prospective review evaluates vaccination response in these patients, including seropositivity rates by CLL treatment status, type of treatment received, and timing of vaccination. Antibody persistence, predictors of poor vaccine response, and severity of COVID-19 infection in vaccinated patients were also analyzed. Practical advice on the clinical management of patients with CLL is provided. Articles reporting COVID-19 vaccination in patients with CLL, published January 1, 2021-May 1, 2022, were included. Patients with CLL displayed the lowest vaccination responses among hematologic malignancies; however, seropositivity increased with each vaccination. One of the most commonly reported independent risk factors for poor vaccine response was active CLL treatment; others included hypogammaglobulinemia and age >65-70 years. Patients who were treatment-naive, off therapy, in remission, or who had a prior COVID-19 infection displayed the greatest responses. Further data are needed on breakthrough infection rates and a heterologous booster approach in patients with hematologic malignancies. Although vaccine response was poor for patients on active therapy regardless of treatment type, CLL management in the context of COVID-19 should aim to avoid delays in antileukemic treatment, especially with the advent of numerous strategies to mitigate risk of severe COVID-19 such as pre-exposure prophylaxis, and highly effective antivirals and monoclonal antibody therapy upon confirmed infection. Patients with CLL should remain vigilant in retaining standard prevention measures such as masks, social distancing, and hand hygiene.
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31
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Komissarov AA, Kislova M, Molodtsov IA, Petrenko AA, Dmitrieva E, Okuneva M, Peshkova IO, Shakirova NT, Potashnikova DM, Tvorogova AV, Ptushkin VV, Efimov GA, Nikitin EA, Vasilieva E. Coronavirus-Specific Antibody and T Cell Responses Developed after Sputnik V Vaccination in Patients with Chronic Lymphocytic Leukemia. Int J Mol Sci 2022; 24:ijms24010416. [PMID: 36613860 PMCID: PMC9820366 DOI: 10.3390/ijms24010416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The clinical course of the new coronavirus disease 2019 (COVID-19) has shown that patients with chronic lymphocytic leukemia (CLL) are characterized by a high mortality rate, poor response to standard treatment, and low virus-specific antibody response after recovery and/or vaccination. To date, there are no data on the safety and efficacy of the combined vector vaccine Sputnik V in patients with CLL. Here, we analyzed and compared the magnitudes of the antibody and T cell responses after vaccination with the Sputnik V vaccine among healthy donors and individuals with CLL with different statuses of preexposure to coronavirus. We found that vaccination of the COVID-19-recovered individuals resulted in the boosting of pre-existing immune responses in both healthy donors and CLL patients. However, the COVID-19-naïve CLL patients demonstrated a considerably lower antibody response than the healthy donors, although they developed a robust T cell response. Regardless of the previous infection, the individuals over 70 years old demonstrated a decreased response to vaccination, as did those receiving anti-CD20 therapy. In summary, we showed that Sputnik V, like other vaccines, did not induce a robust antibody response in individuals with CLL; however, it provided for the development of a significant anti-COVID-19 T cell response.
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Affiliation(s)
- Alexey A. Komissarov
- I.V. Davydovsky Clinical City Hospital, Moscow Department of Healthcare, 11/6 Yauzskaya Str., 109240 Moscow, Russia
- Laboratory of Atherothrombosis, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 20 Delegatskaya Str., 127473 Moscow, Russia
- Correspondence: (A.A.K.); (E.V.)
| | - Maria Kislova
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
| | - Ivan A. Molodtsov
- I.V. Davydovsky Clinical City Hospital, Moscow Department of Healthcare, 11/6 Yauzskaya Str., 109240 Moscow, Russia
| | - Andrei A. Petrenko
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, 2/1 Barrikadnaya Str., 123242 Moscow, Russia
| | - Elena Dmitrieva
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
| | - Maria Okuneva
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
| | - Iuliia O. Peshkova
- National Research Center for Hematology, 4a Novy Zykovsky Proezd, 125167 Moscow, Russia
| | - Naina T. Shakirova
- National Research Center for Hematology, 4a Novy Zykovsky Proezd, 125167 Moscow, Russia
| | - Daria M. Potashnikova
- I.V. Davydovsky Clinical City Hospital, Moscow Department of Healthcare, 11/6 Yauzskaya Str., 109240 Moscow, Russia
| | - Anna V. Tvorogova
- I.V. Davydovsky Clinical City Hospital, Moscow Department of Healthcare, 11/6 Yauzskaya Str., 109240 Moscow, Russia
| | - Vadim V. Ptushkin
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
| | - Grigory A. Efimov
- National Research Center for Hematology, 4a Novy Zykovsky Proezd, 125167 Moscow, Russia
| | - Eugene A. Nikitin
- Botkin City Hospital, 5/17 2nd Botkinsky Drive, 125284 Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, 2/1 Barrikadnaya Str., 123242 Moscow, Russia
| | - Elena Vasilieva
- I.V. Davydovsky Clinical City Hospital, Moscow Department of Healthcare, 11/6 Yauzskaya Str., 109240 Moscow, Russia
- Laboratory of Atherothrombosis, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, 20 Delegatskaya Str., 127473 Moscow, Russia
- Correspondence: (A.A.K.); (E.V.)
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Immunogenicity and risks associated with impaired immune responses following SARS-CoV-2 vaccination and booster in hematologic malignancy patients: an updated meta-analysis. Blood Cancer J 2022; 12:173. [PMID: 36550105 PMCID: PMC9780106 DOI: 10.1038/s41408-022-00776-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with hematologic malignancies (HM) have demonstrated impaired immune responses following SARS-CoV-2 vaccination. Factors associated with poor immunogenicity remain largely undetermined. A literature search was conducted using PubMed, EMBASE, Cochrane, and medRxiv databases to identify studies that reported humoral or cellular immune responses (CIR) following complete SARS-CoV-2 vaccination. The primary aim was to estimate the seroconversion rate (SR) following complete SARS-CoV-2 vaccination across various subtypes of HM diseases and treatments. The secondary aims were to determine the rates of development of neutralizing antibodies (NAb) and CIR following complete vaccination and SR following booster doses. A total of 170 studies were included for qualitative and quantitative analysis of primary and secondary outcomes. A meta-analysis of 150 studies including 20,922 HM patients revealed a pooled SR following SARS-CoV-2 vaccination of 67.7% (95% confidence interval [CI], 64.8-70.4%; I2 = 94%). Meta-regression analysis showed that patients with lymphoid malignancies, but not myeloid malignancies, had lower seroconversion rates than those with solid cancers (R2 = 0.52, P < 0.0001). Patients receiving chimeric antigen receptor T-cells (CART), B-cell targeted therapies or JAK inhibitors were associated with poor seroconversion (R2 = 0.39, P < 0.0001). The pooled NAb and CIR rates were 52.8% (95% CI; 45.8-59.7%, I2 = 87%) and 66.6% (95% CI, 57.1-74.9%; I2 = 86%), respectively. Approximately 20.9% (95% CI, 11.4-35.1%, I2 = 90%) of HM patients failed to elicit humoral and cellular immunity. Among non-seroconverted patients after primary vaccination, only 40.5% (95% CI, 33.0-48.4%; I2 = 87%) mounted seroconversion after the booster. In conclusion, HM patients, especially those with lymphoid malignancies and/or receiving CART, B-cell targeted therapies, or JAK inhibitors, showed poor SR after SARS-CoV-2 vaccination. A minority of patients attained seroconversion after booster vaccination. Strategies to improve immune response in these severely immunosuppressed patients are needed.
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Multiple COVID-19 vaccine doses in CLL and MBL improve immune responses with progressive and high seroconversion. Blood 2022; 140:2709-2721. [PMID: 36206503 PMCID: PMC9550283 DOI: 10.1182/blood.2022017814] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) or monoclonal B-lymphocytosis (MBL) have impaired response to COVID-19 vaccination. A total of 258 patients (215 with CLL and 43 with MBL) had antispike antibody levels evaluable for statistical analysis. The overall seroconversion rate in patients with CLL was 94.2% (antispike antibodies ≥50 AU/mL) and 100% in patients with MBL after multiple vaccine doses. After 3 doses (post-D3) in 167 patients with CLL, 73.7% were seropositive, 17.4% had antispike antibody levels between 50 and 999 AU/mL, and 56.3% had antispike antibody levels ≥1000 AU/mL, with a median rise from 144.6 to 1800.7 AU/mL. Of patients who were seronegative post-D2, 39.7% seroconverted post-D3. For those who then remained seronegative after their previous dose, seroconversion occurred in 40.6% post-D4, 46.2% post-D5, 16.7% post-D6, and 0% after D7 or D8. After seroconversion, most had a progressive increase in antispike antibody levels. Neutralization was associated with higher antispike antibody levels, more vaccine doses, and earlier severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants; neutralizing antibody against early clade D614G was detected in 65.3%, against Delta in 52.0%, and against Omicron in 36.5%. SARS-CoV-2-specific T-cell production of interferon γ and interleukin 2 occurred in 73.9% and 60.9%, respectively, of 23 patients tested. After multiple vaccine doses, by multivariate analysis, immunoglobulin M ≥0.53 g/L, immunoglobulin subclass G3 ≥0.22 g/L and absence of current CLL therapy were independent predictors of positive serological responses. Multiple sequential COVID-19 vaccination significantly increased seroconversion and antispike antibody levels in patients with CLL or MBL.
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34
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Dimou A. Areas of Uncertainty in SARS-CoV-2 Vaccination for Cancer Patients. Vaccines (Basel) 2022; 10:vaccines10122117. [PMID: 36560527 PMCID: PMC9784623 DOI: 10.3390/vaccines10122117] [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: 08/30/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Early in the COVID-19 pandemic, it was recognized that infection with SARS-CoV-2 is associated with increased morbidity and mortality in patients with cancer; therefore, preventive vaccination in cancer survivors is expected to be particularly impactful. Heterogeneity in how a neoplastic disease diagnosis and treatment interferes with humoral and cellular immunity, however, poses a number of challenges in vaccination strategies. Herein, the available literature on the effectiveness of COVID-19 vaccines among patients with cancer is critically appraised under the lens of anti-neoplastic treatment optimization. The objective of this review is to highlight areas of uncertainty, where more research could inform future SARS-CoV-2 immunization programs and maximize benefits in the high-risk cancer survivor population, and also minimize cancer treatment deviations from standard practices.
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Affiliation(s)
- Anastasios Dimou
- Division of Medical Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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35
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Kakkassery H, Carpenter E, Patten PEM, Irshad S. Immunogenicity of SARS-CoV-2 vaccines in patients with cancer. Trends Mol Med 2022; 28:1082-1099. [PMID: 35999131 PMCID: PMC9345889 DOI: 10.1016/j.molmed.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 01/21/2023]
Abstract
Transmission of the SARS-CoV-2 virus and its corresponding disease (COVID-19) has been shown to impose a higher burden on cancer patients than on the general population. Approved vaccines for use include new technology mRNA vaccines such as BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), and nonreplicating viral vector vaccines such as Ad26.COV2.S (Johnson & Johnson) and AZD1222 (AstraZeneca). Impaired or delayed humoral and diminished T-cell responses are evident in patients with cancer, especially in patients with haematological cancers or those under active chemotherapy. Herein we review the current data on vaccine immunogenicity in cancer patients, including recommendations for current practice and future research.
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Affiliation(s)
- Helen Kakkassery
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Esme Carpenter
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Piers E M Patten
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Department of Haematological Medicine, King's College Hospital, London, UK
| | - Sheeba Irshad
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK; Breast Cancer Now Research Unit, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
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36
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Della Pia A, Kim GY(G, Ip A, Ahn J, Liu Y, Kats S, Koropsak M, Lukasik B, Contractor A, Amin K, Ayyagari L, Zhao C, Gupta A, Batistick M, Leslie LA, Goy AH, Feldman TA. Anti-spike antibody response to the COVID vaccine in lymphoma patients. PLoS One 2022; 17:e0266584. [PMID: 36454941 PMCID: PMC9714943 DOI: 10.1371/journal.pone.0266584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Patients with hematologic malignancies have poor outcomes from COVID infection and are less likely to mount an antibody response after COVID infection. This is a retrospective study of adult lymphoma patients who received the COVID vaccine between 12/1/2020 and 11/30/2021. The primary endpoint was a positive anti-COVID spike protein antibody level following the primary COVID vaccination series. The primary vaccination series was defined as 2 doses of the COVID mRNA vaccines or 1 dose of the COVID adenovirus vaccine. Subgroups were compared using Fisher's exact test, and unadjusted and adjusted logistic regression models were used for univariate and multivariate analyses. A total of 243 patients were included in this study; 72 patients (30%) with indolent lymphomas; 56 patients (23%) with Burkitt's, diffuse large B-cell lymphoma (DLBCL), and primary mediastinal B-cell lymphoma (PMBL) combined; 55 patients (22%) with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL); 44 patients (18%) with Hodgkin and T-cell lymphomas (HL/TCL) combined; 12 patients (5%) with mantle cell lymphoma; and 4 patients (2%) with other lymphoma types. One-hundred fifty-eight patients (65%) developed anti-COVID spike protein antibodies after completing the primary COVID vaccination series. Thirty-eight of 46 (83%) patients who received an additional primary shot and had resultant levels produced anti-COVID spike protein antibodies. When compared to other lymphoma types, patients with CLL/SLL had a numerically lower seroconversion rate of 51% following the primary vaccination series whereas patients with HL/TCL appeared to have a robust antibody response with a seropositivity rate of 77% (p = 0.04). Lymphoma patients are capable of mounting a humoral response to the COVID vaccines. Further studies are required to confirm our findings, including whether T-cell immunity would be of clinical relevance in this patient population.
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Affiliation(s)
- Alexandra Della Pia
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Gee Youn (Geeny) Kim
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- Department of Pharmacy Practice, Ernest Mario School of Pharmacy at Rutgers University, Piscataway, NJ, United States of America
| | - Andrew Ip
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
- * E-mail:
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, United States of America
| | - Yanzhi Liu
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, United States of America
| | - Simone Kats
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Michael Koropsak
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | - Brittany Lukasik
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | | | - Krushna Amin
- Robert Wood Johnson University Hospital, New Brunswick, NJ, United States of America
| | | | - Charles Zhao
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
| | - Amolika Gupta
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
| | - Mark Batistick
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
| | - Lori A. Leslie
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
| | - Andre H. Goy
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
| | - Tatyana A. Feldman
- Division of Oncology, Hackensack University Medical Center, Hackensack, NJ, United States of America
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, United States of America
- Department of Oncology, Hackensack Meridian School of Medicine, Nutley, NJ, United States of America
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Sakai A, Morishita T, Suzumura K, Hanatate F, Yoshikawa T, Sasaki N, Lee S, Fujita K, Hara T, Araki H, Tagami A, Murayama M, Yamada R, Iwata A, Sobajima T, Kasahara Y, Matsuzawa Y, Takemura M, Yamamoto Y, Fujigaki H, Saito K, Tsurumi H, Matsunami H. The Trajectory of the COVID-19 Vaccine Antibody Titers Over Time and the Association of Mycophenolate Mofetil in Solid Organ Transplant Recipients. Transplant Proc 2022; 54:2638-2645. [PMID: 36372567 PMCID: PMC9537258 DOI: 10.1016/j.transproceed.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 01/07/2023]
Abstract
The COVID-19 vaccine will be safe and effective in solid organ transplant recipients (SOTs). However, the blunted antibody responses were also of concern. Few studies have reported prolonged serologic follow-up after 2 doses of BNT162b2 vaccine in SOTs. We performed a single-center, prospective observational study of 78 SOTs who received 2 doses of BNT162b2 vaccine. We identified the trajectory of antibody titers after vaccination among SOTs with or without mycophenolate mofetil (MMF) or withdrawn from MMF. We found low seroconversion rates (29/42: 69%) and low antibody titers in SOTs treated with MMF. An inverse linear relationship between neutralizing antibody titers and MMF concentration was confirmed in restricted cubic spline plots (P for effect < .01, P for nonlinearity = .08). For the trajectory of antibody responses, seroconversion and improved antibody titers were observed after withdrawal from MMF in SOTs who showed seronegative or low antibody titers at the first visit after 2 doses of vaccine (P for effect < .01, P for nonlinearity < .05, and P for interaction < .01). We identified increased B-cell counts after withdrawal from MMF (P < .01). The recovery of antibody responses was seen in SOTs withdrawn from MMF. The trajectories of antibody responses were modified by MMF administration.
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Affiliation(s)
- Akiyoshi Sakai
- Department of Clinical Laboratory, Matsunami General Hospital, Gifu, Japan
| | - Tetsuji Morishita
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan,Matsunami Research Park, Gifu, Japan,Address correspondence to Tetsuji Morishita, Vice Director of Internal Medicine, Matsunami General Hospital, 185-1 Dendai, Kasamatsu-cho, Hashima-gun, Gifu 501-6062, Japan
| | - Kaori Suzumura
- Department of Clinical Laboratory, Matsunami General Hospital, Gifu, Japan
| | - Fumika Hanatate
- Department of Breast Surgery, Matsunami General Hospital, Gifu, Japan
| | | | | | - Shin Lee
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Kei Fujita
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Takeshi Hara
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Hiroshi Araki
- Department of Gastroenterology, Matsunami General Hospital, Gifu, Japan
| | - Atsushi Tagami
- Department of Gastroenterology, Matsunami General Hospital, Gifu, Japan
| | - Masanori Murayama
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Rie Yamada
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Akira Iwata
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Takuya Sobajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yukiko Kasahara
- Department of Pediatrics, Matsunami General Hospital, Gifu, Japan
| | - Yoriko Matsuzawa
- Department of Pediatrics, Matsunami General Hospital, Gifu, Japan
| | - Masao Takemura
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake, Aichi, Japan
| | - Yasuko Yamamoto
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake, Aichi, Japan
| | - Hidetsugu Fujigaki
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake, Aichi, Japan
| | - Kuniaki Saito
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake, Aichi, Japan
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38
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Tang C, Shen Y, Soosapilla A, Mulligan SP. Monoclonal B-cell Lymphocytosis - a review of diagnostic criteria, biology, natural history, and clinical management. Leuk Lymphoma 2022; 63:2795-2806. [PMID: 35767361 DOI: 10.1080/10428194.2022.2092857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since first described almost two decades ago, there has been significant evolution in our definition and understanding of the biology and implications of monoclonal B-cell lymphocytosis (MBL). This review provides an overview of the definition, classification, biology, and natural history of MBL, mainly focused on the dominant CLL-like phenotype form of MBL. The increasingly recognized implications of MBL with respect to immune dysfunction are discussed, particularly in view of the COVID-19 pandemic, along with management recommendations for MBL in the clinic.
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Affiliation(s)
- Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Gosford Hospital, Gosford, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Yandong Shen
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia
| | - Stephen P Mulligan
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
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39
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Wang X, Sima L. Antibody response after vaccination against SARS-CoV-2 in adults with hematological malignancies: a systematic review and meta-analysis. J Infect 2022:S0163-4453(22)00674-0. [PMID: 36417984 PMCID: PMC9675635 DOI: 10.1016/j.jinf.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against coronavirus disease 2019 (COVID-19), especially in fragile patients. We aimed to systematically analyze the outcomes of patients with hematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (2 doses of mRNA or one dose of vector- based vaccines). We identified 49 studies comprising 11,086 individuals. Overall risk of bias was low. The pooled response for hematological malignancies was 64% (95% confidence interval [CI]: 59-69; I²=93%) versus 96% (95% CI: 92-97; I²=44%) for solid cancer and 98% (95% CI: 96-99; I²=55%) for healthy controls (P<0.001). Outcome was different across hematological malignancies (P<0.001). The pooled response was 50% (95% CI: 43-57; I²=84%) for chronic lymphocytic leukemia, 76% (95% CI: 67-83; I²=92%) for multiple myeloma, 83% (95% CI: 69-91; I²=85%) for myeloproliferative neoplasms, 91% (95% CI: 82-96; I²=12%) for Hodgkin lymphoma, and 58% (95% CI: 44-70; I²=84%) for aggressive and 61% (95% CI: 48-72; I²=85%) for indolent non-Hodgkin lymphoma. The pooled response for allogeneic and autologous hematopoietic cell transplantation was 82% and 83%, respectively. Being in remission and prior COVID-19 showed significantly higher responses. Low pooled response was identified for active treatment (35%), anti-CD20 therapy ≤1 year (15%), Bruton kinase inhibition (23%), venetoclax (26%), ruxolitinib (42%), and chimeric antigen receptor T-cell therapy (42%). Studies on timing, value of boosters, and long-term efficacy are needed. This study is registered with PROSPERO (clinicaltrials gov. Identifier: CRD42021279051).
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - Laozei Sima
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
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40
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Krekeler C, Reitnauer L, Bacher U, Khandanpour C, Steger L, Boeckel GR, Klosner J, Tepasse PR, Kemper M, Hennies MT, Mesters R, Stelljes M, Schmitz N, Kerkhoff A, Schliemann C, Mikesch JH, Schmidt N, Lenz G, Bleckmann A, Shumilov E. Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario. Cancers (Basel) 2022; 14:cancers14225512. [PMID: 36428605 PMCID: PMC9688056 DOI: 10.3390/cancers14225512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Two-dose COVID-19 vaccination often results in poor humoral response rates in patients with hematologic malignancies (HMs); yet responses to COVID-19 booster vaccines and the risk of COVID-19 infection post-booster are mostly uncertain. Methods: We included 200 outpatients with HMs and predominantly lymphoid neoplasms (96%, 191/200) in our academic center and reported on the humoral responses, which were assessed by measurement of anti-spike IgG antibodies in peripheral blood as early as 14 days after mRNA-based prime-boost vaccination, as well as factors hampering booster efficacy. Previous basic (double) immunization was applied according to the local recommendations with mRNA- and/or vector-based vaccines. We also report on post-booster COVID-19 breakthrough infections that emerged in the Omicron era and the prophylaxis strategies that were applied to poor and non-responders to booster vaccines. Results: A total of 55% (110/200) of the patients achieved seroconversion (i.e., anti-spike protein IgG antibody titer > 100 AU/mL assessed in median 48 days after prime-boost vaccination) after prime-boost vaccination. Multivariable analyses revealed age, lymphocytopenia, ongoing treatment and prior anti-CD20 B-cell depletion to be independent predictors for booster failure. With each month between anti-CD20-mediated B-cell depletion and booster vaccination, the probability of seroconversion increased by approximately 4% (p < 0.001) and serum−antibody titer (S-AbT) levels increased by 90 AU/mL (p = 0.011). Notably, obinutuzumab treatment was associated with an 85% lower probability for seroconversion after prime-boost vaccination compared to rituximab (p = 0.002). Of poor or non-responders to prime-boost vaccination, 41% (47/114) underwent a second booster and 73% (83/114) underwent passive immunization. COVID-19 breakthrough infections were observed in 15% (29/200) of patients after prime-boost vaccination with predominantly mild courses (93%). Next to seroconversion, passive immunization was associated with a significantly lower risk of COVID-19 breakthrough infections after booster, even in vaccine non-responders (all p < 0.05). In a small proportion of analyzed patients with myeloid neoplasms (9/200), the seroconversion rate was higher compared to those with lymphoid ones (78% vs. 54%, accordingly), while the incidence rate of COVID-19 breakthrough infections was similar (22% vs. 14%, respectively). Following the low frequency of myeloid neoplasms in this study, the results may not be automatically applied to a larger cohort. Conclusions: Patients with HMs are at a high risk of COVID-19 booster vaccine failure; yet COVID-19 breakthrough infections after prime-boost vaccination are predominantly mild. Booster failure can likely be overcome by passive immunization, thereby providing immune protection against COVID-19 and attenuating the severity of COVID-19 courses. Further sophistication of clinical algorithms for preventing post-vaccination COVID-19 breakthrough infections is urgently needed.
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Affiliation(s)
- Carolin Krekeler
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
- Correspondence:
| | - Lea Reitnauer
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Ulrike Bacher
- Central Hematology Laboratory, Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Cyrus Khandanpour
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
- Department for Hematology and Oncology, University Hospital Schleswig-Holstein, 23564 Luebeck, Germany
| | - Leander Steger
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Göran Ramin Boeckel
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Muenster, Germany
- Department of Medicine D for Nephrology and Rheumatology, University Hospital Münster, 48149 Muenster, Germany
| | - Justine Klosner
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Muenster, Germany
| | - Marcel Kemper
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Marc Tim Hennies
- Institute of Virology, University Hospital Münster, 48149 Muenster, Germany
| | - Rolf Mesters
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Matthias Stelljes
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Norbert Schmitz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Nicole Schmidt
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), 37077 Goettingen, Germany
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
| | - Evgenii Shumilov
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Muenster, Germany
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Seganfredo FB, Dias AR, Santos PR, Rebelo M, João C, Mendes D, Carmo E. Successful treatment of persistent and severe SARS‐CoV‐2 infection in a high‐risk chronic lymphocytic leukemia patient using Ronapreve™ antibodies. Clin Case Rep 2022; 10:e6548. [PMID: 36408087 PMCID: PMC9666912 DOI: 10.1002/ccr3.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with lymphoproliferative diseases are at an increased risk of an incomplete immune response following vaccination or SARS‐CoV‐2 infection and might develop persistent viral infection and severe COVID‐19 disease. We present a case of successful treatment of persistent and mechanical‐ventilation‐requiring SARS‐CoV‐2 infection in a del17+ CLL patient using exogenous antibodies. Patients with chronic lymphocytic leukemia (CLL) might have an incomplete immune response following vaccination or SARS‐CoV‐2 infection. There is therapeutic potential of monoclonal antibodies in persistent and severe COVID‐19, mirrored in a CLL patient.
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Affiliation(s)
- Fernanda Braga Seganfredo
- Haematology Department Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) Lisbon Portugal
| | - Ana Raquel Dias
- Haematology Department Hospital do Divino Espírito Santo de Ponta Delgada Ponta Delgada Portugal
| | - Pedro R. Santos
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Marta Rebelo
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Cristina João
- Haematology Department Fundação Champalimaud Lisbon Portugal
| | - Dina Mendes
- Pharmaceutical Department Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
| | - Eduarda Carmo
- Intensive Care Unit Centro Hospitalar Lisboa Ocidental – Hospital Egas Moniz Lisbon Portugal
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Wang H, Guo H, Yang J, Liu Y, Liu X, Zhang Q, Zhou K. Bruton tyrosine kinase inhibitors in B-cell lymphoma: beyond the antitumour effect. Exp Hematol Oncol 2022; 11:60. [PMID: 36138486 PMCID: PMC9493169 DOI: 10.1186/s40164-022-00315-9] [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: 06/22/2022] [Accepted: 09/11/2022] [Indexed: 01/08/2023] Open
Abstract
Targeting B-cell receptor signalling using Bruton tyrosine kinase (BTK) inhibitors (BTKis) has become a highly successful treatment modality for B-cell malignancies, especially for chronic lymphocytic leukaemia. However, long-term administration of BTKis can be complicated by adverse on- and/or off-target effects in particular cell types. BTK is widely expressed in cells of haematopoietic origin, which are pivotal components of the tumour microenvironment. BTKis, thus, show broad immunomodulatory effects on various non-B immune cell subsets by inhibiting specific immune receptors, including T-cell receptor and Toll-like receptors. Furthermore, due to the off-target inhibition of other kinases, such as IL-2-inducible T-cell kinase, epidermal growth factor receptor, and the TEC and SRC family kinases, BTKis have additional distinct effects on T cells, natural killer cells, platelets, cardiomyocytes, and other cell types. Such mechanisms of action might contribute to the exceptionally high clinical efficacy as well as the unique profiles of adverse effects, including infections, bleeding, and atrial fibrillation, observed during BTKi administration. However, the immune defects and related infections caused by BTKis have not received sufficient attention in clinical studies till date. The broad involvement of BTK in immunological pathways provides a rationale to combine BTKis with specific immunotherapies, such as immune checkpoint inhibitor or chimeric antigen receptor-T-cell therapy, for the treatment of relapsed or refractory diseases. This review discusses and summarises the above-mentioned issues as a reference for clinicians and researchers.
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Affiliation(s)
- Haoran Wang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Hao Guo
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Jingyi Yang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Yanyan Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Xingchen Liu
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Qing Zhang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China
| | - Keshu Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, 450003, China.
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Lee HK, Hoechstetter MA, Buchner M, Pham TT, Huh JW, Müller K, Zange S, von Buttlar H, Girl P, Wölfel R, Brandmeier L, Pfeuffer L, Furth PA, Wendtner CM, Hennighausen L. Comprehensive analysis of immune responses in CLL patients after heterologous COVID-19 vaccination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.09.21.22280205. [PMID: 36172132 PMCID: PMC9516861 DOI: 10.1101/2022.09.21.22280205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Patients with chronic lymphocytic leukemia (CLL) treated with B-cell pathway inhibitors and anti-CD20 antibodies exhibit low humoral response rate (RR) following SARS-CoV-2 vaccination. To investigate the relationship between the initial transcriptional response to vaccination with ensuing B and T cell immune responses, we performed a comprehensive immune transcriptome analysis flanked by antibody and T cell assays in peripheral blood prospectively collected from 15 CLL/SLL patients vaccinated with heterologous BNT162b2/ChAdOx1 with follow up at a single institution. The two-dose antibody RR was 40% increasing to 53% after booster. Patients on BTKi, venetoclax ± anti-CD20 antibody within 12 months of vaccination responded less well than those under BTKi alone. The two-dose T cell RR was 80% increasing to 93% after booster. Transcriptome studies revealed that seven patients showed interferon-mediated signaling activation within 2 days and one at 7 days after vaccination. Increasing counts of COVID-19 specific IGHV genes correlated with B-cell reconstitution and improved humoral RR. T cell responses in CLL patients appeared after vaccination regardless of treatment status. A higher humoral RR was associated with BTKi treatment and B-cell reconstitution. Boosting was particularly effective when intrinsic immune status was improved by CLL-treatment.
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Affiliation(s)
- Hye Kyung Lee
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Manuela A. Hoechstetter
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Maike Buchner
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany.,TranslaTUM - Central Institute for Translational Cancer Research, Technische Universität München, 81675 Munich, Germany
| | - Trang Thu Pham
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Katharina Müller
- Bundeswehr Institute of Microbiology, Munich, Germany,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Sabine Zange
- Bundeswehr Institute of Microbiology, Munich, Germany,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Heiner von Buttlar
- Bundeswehr Institute of Microbiology, Munich, Germany,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Philipp Girl
- Bundeswehr Institute of Microbiology, Munich, Germany,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Roman Wölfel
- Bundeswehr Institute of Microbiology, Munich, Germany,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Lisa Brandmeier
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Pfeuffer
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany
| | - Priscilla A. Furth
- Departments of Oncology & Medicine, Georgetown University, Washington, DC, USA
| | - Clemens-Martin Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Lothar Hennighausen
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Noori M, Azizi S, Abbasi Varaki F, Nejadghaderi SA, Bashash D. A systematic review and meta-analysis of immune response against first and second doses of SARS-CoV-2 vaccines in adult patients with hematological malignancies. Int Immunopharmacol 2022; 110:109046. [PMID: 35843148 PMCID: PMC9273573 DOI: 10.1016/j.intimp.2022.109046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cancer patients particularly those with hematological malignancies are at higher risk of affecting by severe coronavirus disease 2019 (COVID-19). Due to the immunocompromised nature of the disease and the immunosuppressive treatments, they are more likely to develop less antibody protection; therefore, we aimed to evaluate the immunogenicity of COVID-19 vaccines in patients with hematological malignancies. METHODS A comprehensive systematic search was conducted in PubMed, Scopus, and Web of Science databases, as well as Google scholar search engine as of December 10, 2021. Our primary outcomes of interest comprised of estimating the antibody seropositive rate following COVID-19 vaccination in patients with hematological malignancies and to compare it with those who were affected by solid tumors or healthy subjects. The secondary outcomes were to assess the vaccine's immunogenicity based on different treatments, status of the disease, and type of vaccine. After the two-step screening, the data were extracted and the summary measures were calculated using a random-effect model. RESULTS A total of 82 articles recording 13,804 patients with a diagnosis of malignancy were included in the present review. The seropositive rates in patients with hematological malignancies after first and second vaccine doses were 30.0% (95% confidence interval (95%CI): 11.9-52.0) and 62.3% (95%CI 56.0-68.5), respectively. These patients were less likely to develop antibody response as compared to cases with solid tumors (RR 0.73, 95%CI 0.67-0.79) and healthy subjects (RR 0.62, 95%CI 0.54-0.71) following complete immunization. Chronic lymphocytic leukemia (CLL) patients had the lowest response rate among all subtypes of hematological malignancies (first dose: 22.0%, 95%CI 13.5-31.8 and second dose: 47.8%, 95%CI 41.2-54.4). Besides, anti-CD20 therapies (5.7%, 95%CI 2.0-10.6) and bruton's tyrosine kinase inhibitors (26.8%, 95%CI 16.9-37.8) represented the lowest seropositiveness post first and second doses, respectively. Notably, patients who were in active status of disease showed lower antibody detection rate compared to those on remission status (RR 0.87, 95%CI 0.76-0.99). Furthermore, lower rate of seropositivity was found in patients received BNT162.b2 compared to ones who received mRNA-1273 (RR 0.89, 95%CI 0.79-0.99). CONCLUSION Our findings highlight the substantially low rate of seroprotection in patients with hematological malignancies with a wide range of rates among disease subgroups and different treatments; further highlighting the fact that booster doses might be acquired for these patients to improve immunity against SARS-CoV-2.
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Affiliation(s)
- Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Azizi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farhan Abbasi Varaki
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Sisteré-Oró M, Andrade N, Wortmann DD, Du J, Garcia-Giralt N, González-Cao M, Güerri-Fernández R, Meyerhans A. Anti-SARS-COV-2 specific immunity in HIV immunological non-responders after mRNA-based COVID-19 vaccination. Front Immunol 2022; 13:994173. [PMID: 36091014 PMCID: PMC9459333 DOI: 10.3389/fimmu.2022.994173] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 02/05/2023] Open
Abstract
Individuals infected with the human immunodeficiency virus type 1 (HIV-1) belong to the group of people most vulnerable to SARS-CoV-2 infections and the associated disease COVID-19. Here we describe SARS-CoV-2-specific antibody and cellular immune responses in a small cohort of immunological non-responder HIV-1 patients (HIV-INRs) after receiving the COVID-19 mRNA-based BioNTech/Pfizer vaccine. Compared to the control group of vaccinated healthy individuals that all developed a virus-specific immune response, 5 of 10 vaccinated HIV-1 patients showed insufficient immune responses. The lack of response was not directly correlated with patients CD4 cell counts. Three of the five non-responders that agreed to receive a booster vaccination subsequently generated a virus-specific response. Thus, even HIV-INRs can be efficiently vaccinated against COVID-19 but may require a follow-up by virus-specific immune monitoring to guarantee clinical vaccine benefits.
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Affiliation(s)
- Marta Sisteré-Oró
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Naina Andrade
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Diana D.J. Wortmann
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Juan Du
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
| | - Natalia Garcia-Giralt
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
| | - María González-Cao
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Robert Güerri-Fernández
- Infectious Diseases Unit, Hospital del Mar, Institute of Medical Research (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades infecciosas, CIBERINFEC Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Robert Güerri-Fernández, ; Andreas Meyerhans,
| | - Andreas Meyerhans
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- *Correspondence: Robert Güerri-Fernández, ; Andreas Meyerhans,
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Sherman AC, Crombie JL, Cheng CA, Desjardins M, Zhou G, Ometoruwa O, Rooks R, Senussi Y, McDonough M, Guerrero LI, Kupelian J, Doss-Gollin S, Smolen KK, van Haren SD, Armand P, Levy O, Walt DR, Baden LR, Issa NC. Immunogenicity of a three-dose primary series of mRNA COVID-19 vaccines in patients with lymphoid malignancies. Open Forum Infect Dis 2022; 9:ofac417. [PMID: 36043177 PMCID: PMC9384786 DOI: 10.1093/ofid/ofac417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with lymphoid malignancies are at risk for poor COVID-19 related outcomes and have reduced vaccine-induced immune responses. Currently a three-dose primary regimen of mRNA vaccines is recommended in the U.S. for immunocompromised hosts.
Methods
A prospective cohort study of healthy adults (n = 27) and patients with lymphoid malignancies (n = 94) was conducted, with longitudinal follow-up through completion of a two or three-dose primary mRNA COVID vaccine series, respectively. Humoral responses were assessed in all participants, and cellular immunity in a subset of participants.
Results
The rate of seroconversion (68.1% v. 100%) and the magnitude of peak anti-S IgG titer (median anti-S IgG 32.4, IQR 0.48-75.0 v. 72.6, IQR 51.1-100.1; p = 0.0202) were both significantly lower in patients with lymphoid malignancies as compared to the healthy cohort. However, peak titers of patients with lymphoid malignancies who responded to vaccination were similar to healthy cohort titers (median anti-S IgG 64.3, IQR 23.7 - 161.5, p = 0.7424). The third dose seroconverted 7/41 (17.1%) patients who were seronegative after the first two doses. Although most patients with lymphoid malignancies produced vaccine-induced T-cell responses in the subset studied, B-cell frequencies were low with minimal memory cell formation.
Conclusions
A three-dose primary mRNA series enhanced anti-S IgG responses to titers equivalent to healthy adults in patients with lymphoid malignancies who were seropositive after the first two doses and seroconverted 17.1% who were seronegative after the first two doses. T-cell responses were present, raising the possibility that the vaccines may confer some cell-based protection even if not measurable by anti-S IgG.
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Affiliation(s)
- Amy C Sherman
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Jennifer L Crombie
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Chi An Cheng
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | - Michaël Desjardins
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Division of Infectious Diseases, Centre Hospitalier de l’Université de Montréal , Montreal, Qc , Canada
| | - Guohai Zhou
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Omolola Ometoruwa
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Rebecca Rooks
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Yasmeen Senussi
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | | | | | - John Kupelian
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
| | - Simon Doss-Gollin
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
| | - Kinga K Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Simon D van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Philippe Armand
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
- Broad Institute of MIT & Harvard , Cambridge, 02142, MA USA
| | - David R Walt
- Harvard Medical School , Boston, MA, 02115 , USA
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University , Boston, MA, 02115 , USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
| | - Nicolas C Issa
- Division of Infectious Diseases, Brigham and Women’s Hospital , Boston, MA, 02115 , USA
- Dana-Farber Cancer Institute , Boston, MA, 02115 , USA
- Harvard Medical School , Boston, MA, 02115 , USA
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Ito Y, Honda A, Kurokawa M. COVID-19 mRNA Vaccine in Patients With Lymphoid Malignancy or Anti-CD20 Antibody Therapy: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e691-e707. [PMID: 35459624 PMCID: PMC8958822 DOI: 10.1016/j.clml.2022.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 04/09/2023]
Abstract
BACKGROUND The humoral response to vaccination in individuals with lymphoid malignancies or those undergoing anti-CD20 antibody therapy is impaired, but details of the response to mRNA vaccines to protect against COVID-19 remain unclear. This systematic review and meta-analysis aimed to characterize the response to COVID-19 mRNA vaccines in patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy. MATERIALS AND METHODS A literature search retrieved 52 relevant articles, and random-effect models were used to analyze humoral and cellular responses. RESULTS Lymphoid malignancies and anti-CD20 antibody therapy for non-malignancies were significantly associated with lower seropositivity rates (risk ratio 0.60 [95% CI 0.53-0.69]; risk ratio 0.45 [95% CI 0.39-0.52], respectively). Some subtypes (chronic lymphocytic leukemia, treatment-naïve chronic lymphocytic leukemia, myeloma, and non-Hodgkin's lymphoma) exhibited impaired humoral response. Anti-CD20 antibody therapy within 6 months of vaccination decreased humoral response; moreover, therapy > 12 months before vaccination still impaired the humoral response. However, anti-CD20 antibody therapy in non-malignant patients did not attenuate T cell responses. CONCLUSION These data suggest that patients with lymphoid malignancies or those undergoing anti-CD20 antibody therapy experience an impaired humoral response, but cellular response can be detected independent of anti-CD20 antibody therapy. Studies with long-term follow-up of vaccine effectiveness are warranted (PROSPERO registration number: CRD42021265780).
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Affiliation(s)
- Yusuke Ito
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Akira Honda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Galitzia A, Barabino L, Murru R, Caocci G, Greco M, Angioni G, Mulas O, Oppi S, Massidda S, Costa A, La Nasa G. Patients with Chronic Lymphocytic Leukemia Have a Very High Risk of Ineffective Response to the BNT162b2 Vaccine. Vaccines (Basel) 2022; 10:vaccines10071162. [PMID: 35891328 PMCID: PMC9317769 DOI: 10.3390/vaccines10071162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with CLL have high rates of either severe disease or death from COVID-19 and a low response rate after COVID-19 vaccination has been reported. We conducted a single-center study with the main objective to evaluate the immunogenicity of the BNT1162b2 mRNA vaccines in 42 patients affected by CLL with the assessment of antibody response after the second and the third dose. After the second dose of vaccine, 13 patients (30%) showed an antibody response. The presence of hypogammaglobulinemia and the use of steroids or IVIG were the main factors associated with poor response. After the third dose, 5/27 (18%) patients showed an antibody response while in non-responders to the second dose, only 1 patient (4%) showed an elicitation of the immune response by the third dose, with no statistically significant difference. Our data, despite the small size of our cohort, demonstrate that patients with CLL have a low rate of effective response to the BNT162b2 vaccine. However, the effective role of a subsequent dose is still unclear, highlighting the need for alternative methods of immunization in this particularly fragile group of patients.
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Affiliation(s)
- Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Correspondence: (A.G.); (G.C.)
| | - Luca Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
| | - Roberta Murru
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
- Correspondence: (A.G.); (G.C.)
| | - Marianna Greco
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Giancarlo Angioni
- Laboratory of Clinical Chemical Analysis and Microbiology, ARNAS G. Brotzu, 09134 Cagliari, Italy;
| | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Sara Oppi
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Stefania Massidda
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
| | - Alessandro Costa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy; (L.B.); (O.M.); (A.C.); (G.L.N.)
- Hematology and Transplant Centre, Ospedale Oncologico Armando Businco, ARNAS G. Brotzu, 09121 Cagliari, Italy; (R.M.); (M.G.); (S.O.); (S.M.)
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Sisteré-Oró M, Wortmann DDJ, Andrade N, Aguilar A, Mayo de las Casas C, Casabal FG, Torres S, Bona Salinas E, Raventos Soler L, Arcas A, Esparre C, Garcia B, Valarezo J, Rosell R, Güerri-Fernandez R, Gonzalez-Cao M, Meyerhans A. Brief Research Report: Anti-SARS-CoV-2 Immunity in Long Lasting Responders to Cancer Immunotherapy Through mRNA-Based COVID-19 Vaccination. Front Immunol 2022; 13:908108. [PMID: 35911701 PMCID: PMC9330498 DOI: 10.3389/fimmu.2022.908108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/01/2022] [Indexed: 01/14/2023] Open
Abstract
Cancer patients (CPs) have been identified as particularly vulnerable to SARS-CoV-2 infection, and therefore are a priority group for receiving COVID-19 vaccination. From the patients with advanced solid tumors, about 20% respond very efficiently to immunotherapy with anti-PD1/PD-L1 antibodies and achieve long lasting cancer responses. It is unclear whether an efficient cancer-specific immune response may also correlate with an efficient response upon COVID-19 vaccination. Here, we explored the antiviral immune response to the mRNA-based COVID-19 vaccine BNT162b2 in a group of 11 long-lasting cancer immunotherapy responders. We analysed the development of SARS-CoV-2-specific IgG serum antibodies, virus neutralizing capacities and T cell responses. Control groups included patients treated with adjuvant cancer immunotherapy (IMT, cohort B), CPs not treated with immunotherapy (no-IMT, cohort C) and healthy controls (cohort A). The median ELISA IgG titers significantly increased after the prime-boost COVID vaccine regimen in all cohorts (Cohort A: pre-vaccine = 900 (100-2700), 3 weeks (w) post-boost = 24300 (2700-72900); Cohort B: pre-vaccine = 300 (100-2700), 3 w post-boost = 8100 (300-72900); Cohort C: pre-vaccine = 500 (100-2700), 3 w post-boost = 24300 (300-72900)). However, at the 3 w post-prime time-point, only the healthy control group showed a statistically significant increase in antibody levels (Cohort A = 8100 (900-8100); Cohort B = 900 (300-8100); Cohort C = 900 (300-8100)) (P < 0.05). Strikingly, while all healthy controls generated high-level antibody responses after the complete prime-boost regimen (Cohort A = 15/15 (100%), not all CPs behaved alike [Cohort B= 12/14 (84'6%); Cohort C= 5/6 (83%)]. Their responses, including those of the long-lasting immunotherapy responders, were more variable (Cohort A: 3 w post-boost (median nAb titers = 95.32 (84.09-96.93), median Spike-specific IFN-γ response = 64 (24-150); Cohort B: 3 w post-boost (median nAb titers = 85.62 (8.22-97.19), median Spike-specific IFN-γ response (28 (1-372); Cohort C: 3 w post-boost (median nAb titers = 95.87 (11.8-97.3), median Spike-specific IFN-γ response = 67 (20-84)). Two long-lasting cancer responders did not respond properly to the prime-boost vaccination and did not generate S-specific IgGs, neutralizing antibodies or virus-specific T cells, although their cancer immune control persisted for years. Thus, although mRNA-based vaccines can induce both antibody and T cell responses in CPs, the immune response to COVID vaccination is independent of the capacity to develop an efficient anti-cancer immune response to anti PD-1/PD-L1 antibodies.
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Affiliation(s)
- Marta Sisteré-Oró
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Diana D. J. Wortmann
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Naína Andrade
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Andres Aguilar
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Clara Mayo de las Casas
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
- Laboratorio Oncología, Hospital Universitario Dexeus, Pangaea Oncology Lab, Barcelona, Spain
| | | | - Susana Torres
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Eduardo Bona Salinas
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Laura Raventos Soler
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Andrea Arcas
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Carlos Esparre
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
| | - Beatriz Garcia
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
- Laboratorio Oncología, Hospital Universitario Dexeus, Pangaea Oncology Lab, Barcelona, Spain
| | - Joselyn Valarezo
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
- Laboratorio Oncología, Hospital Universitario Dexeus, Pangaea Oncology Lab, Barcelona, Spain
| | - Rafael Rosell
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
- Laboratorio Oncología, Hospital Universitario Dexeus, Pangaea Oncology Lab, Barcelona, Spain
- Laboratorio Oncología, Germans Trias i Pujol Health Science Insitute and Hospital (IGTP), Badalona, Spain
| | | | - Maria Gonzalez-Cao
- Instituto Oncologico Dr Rosell, Hospital Quiron-Dexeus Barcelona, Barcelona, Spain
- *Correspondence: Maria Gonzalez-Cao, ; Andreas Meyerhans,
| | - Andreas Meyerhans
- Infection Biology Laboratory, Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA) Pg. Lluiís Companys 23, Barcelona, Spain
- *Correspondence: Maria Gonzalez-Cao, ; Andreas Meyerhans,
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50
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Applicability of probabilistic graphical models for early detection of SARS-CoV-2 reactive antibodies after SARS-CoV-2 vaccination in hematological patients. Ann Hematol 2022; 101:2053-2067. [PMID: 35780254 DOI: 10.1007/s00277-022-04906-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Prior studies of antibody response after full SARS-CoV-2 vaccination in hematological patients have confirmed lower antibody levels compared to the general population. Serological response in hematological patients varies widely according to the disease type and its status, and the treatment given and its timing with respect to vaccination. Through probabilistic machine learning graphical models, we estimated the conditional probabilities of having detectable anti-SARS-CoV-2 antibodies at 3-6 weeks after SARS-CoV-2 vaccination in a large cohort of patients with several hematological diseases (n= 1166). Most patients received mRNA-based vaccines (97%), mainly Moderna® mRNA-1273 (74%) followed by Pfizer-BioNTech® BNT162b2 (23%). The overall antibody detection rate at 3 to 6 weeks after full vaccination for the entire cohort was 79%. Variables such as type of disease, timing of anti-CD20 monoclonal antibody therapy, age, corticosteroids therapy, vaccine type, disease status, or prior infection with SARS-CoV-2 are among the most relevant conditions influencing SARS-CoV-2-IgG-reactive antibody detection. A lower probability of having detectable antibodies was observed in patients with B-cell non-Hodgkin's lymphoma treated with anti-CD20 monoclonal antibodies within 6 months before vaccination (29.32%), whereas the highest probability was observed in younger patients with chronic myeloproliferative neoplasms (99.53%). The Moderna® mRNA-1273 compound provided higher probabilities of antibody detection in all scenarios. This study depicts conditional probabilities of having detectable antibodies in the whole cohort and in specific scenarios such as B cell NHL, CLL, MM, and cMPN that may impact humoral responses. These results could be useful to focus on additional preventive and/or monitoring interventions in these highly immunosuppressed hematological patients.
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