Hematological malignancies (HMs) have heterogeneous serological responses after vaccination due to disease or treatment. The aim of this real-world study was to analyze it after Pfizer-BioNT162b2 mRNA vaccination in 216 patients followed up for 1 year. The first 43 patients had an initial follow-up by a telemedicine (TM) system with no major events reported. The anti-spike IgG antibodies were checked 3–4 weeks post-first vaccination and every 3–4 months, by two standard bioassays and a rapid serological test (RST). Vaccine boosts were given when the level was <7 BAU/mL. Patients who did not seroconvert after 3–4 doses received tixagevimab/cilgavimab (TC). Fifteen results were discordant between two standard bioassays. Good agreement was observed between the standard and RST in 97 samples. After two doses, 68% were seroconverted (median = 59 BAU/mL) with a median of 162 BAU/mL and 9 BAU/mL, respectively, in untreated and treated patients (p < 0.001), particularly for patients receiving rituximab. Patients with gammaglobulin levels < 5 g/L had reduced seroconversion compared to higher levels (p = 0.019). The median levels were 228 BAU/mL post-second dose if seroconverted post-first and second, or if seroconverted only post-second dose. A total of 68% of post-second dose negative patients were post-third dose positive. A total of 16% received TC, six with non-severe symptomatic COVID-19 within 15–40 days. Personalized serological follow-up should apply particularly to patients with HMs.
Hematological malignancies patients (HM) have heterogeneous serological response after vaccination.
Real-world data.
216 patients with HM and 12 non-malignant hemopathies received BNT162b2 COVID-19 and monitored for >1 year. The first 43 patients had initial follow-up by telemedicine system (TM). Anti-Spike IgG antibodies were monitored 3-4 weeks post-1st vaccination and every 3-4 months, by 2 standard bioassays and a rapid serological test (RST). Vaccine boosts were given when the level was <7BAU/mL. Patients who did not seroconvert after 3-4 doses received tixagevimab/cilgavimab (TC).
Follow-up and results.
Tolerance using TM was good. 15 results were discordant between 2 standard bioassays. Good agreement was observed between standard and RST on 97 samples. After 2 doses, 68% were seroconverted (median 59 BAU/mL) with a median of 162 BAU/mL in untreated patients and 9 BAU/mL in treated patients (P<0.001), particularly for patients receiving rituximab. Patients with low levels of gammaglobulin levels (<5g/L) had reduced seroconversion (p=0.019). Median levels were 228 BAU/mL post-2nd dose if seroconverted post-1st and 2, if seronconverted only post-2nd. 68% of post-2nd negative patients were post-3rd positive. 16 pts received TC, 6 with non-severe symptomatic COVID-19 within 15-40 days.
Conclusion:
Personalized serological monitoring must be applicated particularly for HM patients.
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