SARS-CoV-2 m-RNA Vaccine Response in Immunocompromised Patients: A Monocentric Study Comparing Cancer, People Living with HIV, Hematopoietic Stem Cell Transplant Patients and Lung Transplant Recipients

Risk of Severe COVID-19 in Four Immunocompromised Populations: A French Expert Perspective

Immunocompromised patients are disproportionately impacted by severe disease, hospitalization, and mortality associated with coronavirus disease 2019 (COVID-19). To optimize the management of these patients in clinical practice, we convened an expert panel to review current evidence on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine responses and severe COVID-19 in immunocompromised populations. We identified four main immunocompromised groups-solid organ transplant recipients, patients receiving allogeneic hematopoietic stem cell transplantation or chimeric antigen receptor (CAR) T cell therapy, patients treated for hematologic malignancies, and patients treated for inflammatory diseases-who mount suboptimal humoral responses to SARS-CoV-2 vaccination and are at increased risk of severe COVID-19-related outcomes. A wide range of risk factors were associated with reduced vaccine responses and/or poor outcomes, most commonly older age, comorbidities, and the type and number of immunosuppressive therapies. We believe that early identification and close monitoring of these at-risk patients, plus regular booster vaccinations, prophylactic monoclonal antibody therapy, non-pharmacologic prevention measures, prompt antiviral treatment, and other risk mitigation strategies, are critical to protect against SARS-CoV-2 infection and severe COVID-19.

Immunogenicity and Predictive Factors Associated with Poor Response after Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in Lung Transplant Patients

Lung transplant patients are more likely to develop severe coronavirus disease 2019 (COVID-19) compared with the general population and should be vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, previous studies have reported reduced vaccination immunogenicity in lung transplantation patients. We aimed to investigate the serological response and associated factors after SARS-CoV-2 vaccination in this population. Lung transplant patients without a history of contracting coronavirus disease who had received a second or higher dose of SARS-CoV-2 vaccination were enrolled. The anti-SARS-Cov-2 spike and neutralizing antibody levels were measured in blood samples. Firth's logistic regression analysis was performed to assess the factors associated with non-response after vaccination. Forty-six lung transplant patients were enrolled, of which sixteen (34.8%) showed a serological response to vaccination. All patients who received anti-SARS-CoV-2 vaccination before transplantation (n = 5) exhibited a serological response. No significant difference was observed in anti-SARS-CoV-2 S antibody or neutralization titers based on the number and timing of vaccination. Firth's logistic regression showed an association between lower hemoglobin levels (odds ratio, 0.59; confidence interval, 0.35-0.92; p = 0.017) and non-response to SARS-CoV-2 vaccination. Lung transplant patients showed poor serologic responses after SARS-CoV-2 vaccination in this pilot study; anemia may be associated with this poor response.