Seroconversion and outcomes after initial and booster COVID‐19 vaccination in adults with hematologic malignancies
MD Thomas A Ollila, MD Rebecca H Masel, MD John L Reagan, MD, PhD Shaolei Lu, Ralph D Rogers, BS, MT, ASCP Kimberly J Paiva, MPH, PA-C Rashida Taher, Ella Burguera‐couce, Adam S Zayac, NP Inna Yakirevich, MD Rabin Niroula, MD Peter Barth, MD Adam J Olszewski
Cancer, doi:10.1002/cncr.34354
BACKGROUND: Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease-19 (COVID-19) infection and reduced response to vaccination. METHODS: The authors retrospectively analyzed serologic responses to initial and booster COVID-19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID-19-related outcomes. RESULTS: Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B-cell-depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty-three patients (8.8%) developed a COVID-19 infection, and there were three COVID-19-related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID-19 infection, no patient with seroconversion died from COVID-19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID-19 infection. CONCLUSIONS: Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID-19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID-19 death in the otherwise high-risk population.
CONFLICT OF INTEREST Thomas A. Ollila reports a grant from the Rhode Island Foundation outside the submitted work. Peter Barth reports personal fees from Celgene and advisory board service at AbbVie, Janssen, and Sanofi-Aventis outside the submitted work. Adam J. Olszewski reports research funding from Genentech, TG Therapeutics, Celldex Pharmaceuticals, and Precision Bio; and grants from Acrotech Pharma, Adaptive Biotechnologies outside the submitted work. The remaining authors made no disclosures.
References
Abramson, Ghosh, Smith, ADCs, BiTEs, CARs, and small molecules: a new era of targeted therapy in non-Hodgkin lymphoma, ASCO Educ Book,
doi:10.1200/edbk_279043Anderson, Rouphael, Widge, Safety and immunogenicity of SARS-CoV-2 mRNA-1273 vaccine in older adults, N Engl J Med,
doi:10.1056/NEJMoa2028436Bedognetti, Zoppoli, Massucco, Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin's lymphoma patients treated with rituximabcontaining regimens, J Immunol,
doi:10.4049/jimmunol.1004095Branagan, Duffy, Gan, Tandem high-dose influenza vaccination is associated with more durable serologic immunity in patients with plasma cell dyscrasias, Blood Adv,
doi:10.1182/bloodadvances.2020003880Chung, Shah, Devlin, Disease-and therapy-specific impact on humoral immune responses to COVID-19 vaccination in hematologic malignancies, Blood Cancer Discov,
doi:10.1158/2643-3230.Bcd-21-0139Dahiya, Luetkens, Lutfi, Impaired immune response to COVID-19 vaccination in patients with B-cell malignancies after CD19 CAR T-cell therapy, Blood Adv,
doi:10.1182/bloodadvances.2021006112Gilbert, Montefiori, Mcdermott, Immune correlates analysis of the mRNA-1273 COVID-19 vaccine efficacy clinical trial, Science,
doi:10.1126/science.abm3425Greenberger, Saltzman, Senefeld, Johnson, Degennaro et al., Antibody response to SARS-CoV-2 vaccines in patients with hematologic malignancies, Cancer Cell,
doi:10.1016/j.ccell.2021.07.012Gurion, Rozovski, Itchaki, Humoral serologic response to the BNT162b2 vaccine is abrogated in lymphoma patients within the first 12 months following treatment with anti-CD2O antibodies, Haematologica,
doi:10.3324/haematol.2021.279216Herishanu, Rahav, Levi, Efficacy of a third BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL who failed standard 2-dose vaccination, Blood,
doi:10.1182/blood.2021014085Hueso, Pouderoux, Pere, Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19, Blood,
doi:10.1182/blood.2020008423Ollila, Butera, Egan, Vincristine sulfate liposome injection with bendamustine and rituximab as first-line therapy for B-cell lymphomas: a phase I study, Oncologist,
doi:10.1093/oncolo/oyab079Paiva, Grisson, Chan, Validation and performance comparison of three SARS-CoV-2 antibody assays, J Med Virol,
doi:10.1002/jmv.26341Ribas, Dhodapkar, Campbell, How to provide the needed protection from COVID-19 to patients with hematologic malignancies, Blood Cancer Discov,
doi:10.1158/2643-3230.Bcd-21-0166Sadoff, Gars, Shukarev, Interim results of a phase 1-2a trial of Ad26.COV2.S Covid-19 vaccine, N Engl J Med,
doi:10.1056/NEJMoa2034201Sadoff, Gray, Vandebosch, Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19, N Engl J Med,
doi:10.1056/NEJMoa2101544Saini, Tagliamento, Lambertini, Mortality in patients with cancer and coronavirus disease 2019: a systematic review and pooled analysis of 52 studies, Eur J Cancer
Sidler, Born, Schietzel, Trajectories of humoraland cellular immunity and responses to a third dose of mRNA vaccines against SARS-CoV-2 in patients with a history of anti-CD20 therapy, RMD Open,
doi:10.1136/rmdopen-2021-002166Teh, Coussement, Neoh, Immunogenicity of COVID-19 vaccines in patients with hematological malignancy: a systematic review and meta-analysis, Blood Adv,
doi:10.1182/bloodadvances.2021006333Walensky, Md, Mph, on Signing the Advisory Committee on Immunization Practices' Recommendation for an Additional Dose of an mRNA COVID-19 Vaccine in Moderately Cancer September 15, 2022 to Severely Immunocompromised People
