Seroconversion and outcomes after initial and booster COVID‐19 vaccination in adults with hematologic malignancies

DOI record: { "DOI": "10.1002/cncr.34354", "ISSN": [ "0008-543X", "1097-0142" ], "URL": "http://dx.doi.org/10.1002/cncr.34354", "abstract": "<jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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 (<jats:italic>p</jats:italic> = .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 (<jats:italic>N</jats:italic> = 25) was diagnosed with a COVID‐19 infection.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Lay summary</jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID‐19) vaccination.</jats:p></jats:list-item>\n\n<jats:list-item><jats:p>In this single‐institution review, less than one half of the patients studied made detectable antibodies.</jats:p></jats:list-item>\n\n<jats:list-item><jats:p>For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination.</jats:p></jats:list-item>\n\n<jats:list-item><jats:p>By the end of February 2022, 33 of the original 378 patients had a documented COVID‐19 infection.</jats:p></jats:list-item>\n\n<jats:list-item><jats:p>The only deaths from COVID‐19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID‐19 infection.</jats:p></jats:list-item>\n</jats:list>\n</jats:p></jats:sec>", "alternative-id": [ "10.1002/cncr.34354" ], "assertion": [ { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Received", "name": "received", "order": 0, "value": "2022-03-25" }, { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Accepted", "name": "accepted", "order": 1, "value": "2022-05-25" }, { "group": { "label": "Publication History", "name": "publication_history" }, "label": "Published", "name": "published", "order": 2, "value": "2022-07-11" } ], "author": [ { "ORCID": "http://orcid.org/0000-0003-0102-6491", "affiliation": [ { "name": "Department of Medicine Alpert Medical School of Brown University Providence Rhode Island USA" }, { "name": "Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island USA" } ], "authenticated-orcid": false, "family": "Ollila", "given": "Thomas A.", "sequence": "first" }, { "affiliation": [ { "name": "Department of Medicine Alpert Medical School of Brown University Providence Rhode Island USA" } ], "family": "Masel", "given": "Rebecca H.", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine Alpert Medical School of Brown University Providence Rhode Island USA" }, { "name": "Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island USA" } ], "family": "Reagan", "given": "John L.", "sequence": "additional" }, { "affiliation": [ { "name": "Department of Medicine Alpert Medical School of Brown University Providence 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