How to Provide the Needed Protection from COVID-19 to Patients with Hematologic Malignancies

Ribas, Antoni; Dhodapkar, Madhav V.; Campbell, Katie M.; Davies, Faith E.; Gore, Steven D.; Levy, Ronald; Greenberger, Lee M.

doi:10.1158/2643-3230.bcd-21-0166

Cited by 24 publications

(27 citation statements)

References 38 publications

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“…Such conclusions include the number of vaccine doses needed, the optimal time between doses, the identification of at-risk patients after vaccination and strategies for additional protection of at-risk patients beyond vaccination — aspects that are especially relevant for patients with haematological malignancies. From these studies, recommendations regarding the management of vaccination in patients with cancer can be deduced 9 , 223 but many open questions remain. Vaccine responses in paediatric patients with cancer have not been investigated and should be the focus of future studies.…”

Section: Future Directionsmentioning

confidence: 99%

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

et al. 2022

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Patients with cancer have a higher risk of severe coronavirus disease (COVID-19) and associated mortality than the general population. Owing to this increased risk, patients with cancer have been prioritized for COVID-19 vaccination globally, for both primary and booster vaccinations. However, given that these patients were not included in the pivotal clinical trials, considerable uncertainty remains regarding vaccine efficacy, and the extent of humoral and cellular immune responses in these patients, as well as the risks of vaccine-related adverse events. In this Review, we summarize the current knowledge generated in studies conducted since COVID-19 vaccines first became available. We also highlight critical points that might affect vaccine efficacy in patients with cancer in the future.

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Section: Future Directionsmentioning

confidence: 99%

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

et al. 2022

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“…Patients with NHL and chronic lymphocytic leukemia (CLL) experience poor prognosis of COVID-19, with 30-day mortality reaching ∼35% in unvaccinated patients [ 23 , 24 ]. Seropositivity rates following 2 doses of BNT162b2 among lymphoma patients are reported at ∼50% [ 25 , 26 , 27 ], and among CLL patients at ∼40%–45% [ 27 , 28 , 29 , 30 ]. Several predictors of seronegativity are described in the literature.…”

Section: Lymphoproliferative Disorders − Chronic Lymphocytic Leukemia...mentioning

confidence: 99%

Vaccination for SARS-CoV-2 in Hematological Patients

Riccardi¹,

Falcone²,

Yahav³

2022

Acta Haematol

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Patients with specific hematological malignancies (HM) are at increased risk for severe disease and death from infection with SARS-CoV-2. In healthy subjects, vaccination against SARS-CoV-2 has been demonstrated to be highly effective in disease prevention, however immunocompromised patients were largely excluded from vaccine randomized controlled trials. In this review, we overview available non-randomized studies addressing effectiveness and safety of several COVID-19 vaccines in patients with HM. Overall, COVID-19 vaccines are safe in patients with HM, with adverse events similar to those in the general population. Though serology testing is not recommended as a test to evaluate vaccine effectiveness, a correlation between higher antibody levels and protection against infection has been reported. Studies evaluating humoral response to COVID-19 vaccine in HM patients demonstrate low immunogenicity, mainly in patients with lymphoproliferative disorders, as well as with certain drugs, including mainly anti-CD20 antibodies, Bruton tyrosine kinase inhibitors, and also roxulitinib ruxolitinib and venetoclax. Seropositivity rates of patients with non-Hodgkin lymphoma and chronic lymphocytic leukemia following mRNA vaccination reach 40-50%. T-cell responses to vaccination are also impaired among these patients. Better humoral response rates are reported in multiple myeloma patients and hematopoietic stem cell transplant, reaching ~75-80%, but not in patients following chimeric antigen receptor T-cell therapy. Patients with chronic myeloid leukemia and myeloproliferative diseases have high response rate to vaccination. Third mRNA vaccine dose is currently recommended to all HM patients. Alternative approaches for vaccination and prevention in patients unable to mount an immune response following full vaccination are provided in the review.

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“…However, the ability of mRNA-based SARS-CoV-2 vaccines to immunize primary or treatment-induced immunocompromised individuals has recently been questioned (Collier et al, 2021). In particular, patients with inflammatory bowel disease under infliximab treatment (Kennedy et al, 2021), patients who have received an allogeneic stem cell transplantation (Lafarge et al, 2022), cancer patients (Chung et al, 2021;Ribas et al, 2021;Zeng et al, 2021;Greenberger et al, 2021aGreenberger et al, , 2021bThakkar et al, 2021aThakkar et al, , 2021b, methotrexate treatment (Mahil et al, 2021), kidney transplant or hemodialysis (Bachelet et al, 2021;Danthu et al, 2021), or multiple sclerosis (Apostolidis et al, 2021) have all demonstrated a reduced ability to mount an immune response, potentially adversely affecting protection offered by vaccines. However, studies in which a comprehensive comparative analysis of both humoral and cellular immune responses after a third dose of vaccine is lacking.…”

Section: Introductionmentioning

confidence: 99%

mRNA COVID-19 vaccine booster fosters B- and T-cell responses in immunocompromised patients

et al. 2022

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SARS-CoV-2 vaccination has proven effective in inducing an immune response in healthy individuals and is progressively us allowing to overcome the pandemic. Recent evidence has shown that response to vaccination in some vulnerable patients may be diminished, and it has been proposed a booster dose. We tested the kinetic of development of serum antibodies to the SARS-CoV-2 Spike protein, their neutralizing capacity, the CD4 and CD8 IFN-γ T-cell response in 328 subjects, including 131 immunocompromised individuals (cancer, rheumatologic, and hemodialysis patients), 160 health-care workers (HCW) and 37 subjects older than 75 yr, after vaccination with two or three doses of mRNA vaccines. We stratified the patients according to the type of treatment. We found that immunocompromised patients, depending on the type of treatment, poorly respond to SARS-CoV-2 mRNA vaccines. However, an additional booster dose of vaccine induced a good immune response in almost all of the patients except those receiving anti-CD20 antibody. Similarly to HCW, previously infected and vaccinated immunocompromised individuals demonstrate a stronger SARS-CoV-2–specific immune response than those who are vaccinated without prior infection.

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How to Provide the Needed Protection from COVID-19 to Patients with Hematologic Malignancies

Cited by 24 publications

References 38 publications

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

COVID-19 vaccines in patients with cancer: immunogenicity, efficacy and safety

Vaccination for SARS-CoV-2 in Hematological Patients

mRNA COVID-19 vaccine booster fosters B- and T-cell responses in immunocompromised patients

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