Patterns of seroconversion for SARS-CoV-2 IgG in patients with malignant disease and association with anticancer therapy

Krauthammer

et al. 2021

Preprint

Purpose: Vaccine-associated hypermetabolic lymphadenopathy (VAHL) is frequently observed on [18F]FDG PET-CT following BNT162b2 administration. Recent data suggest a prominent B-cell germinal-center (GC) response elicited by mRNA vaccines in draining lymph nodes. Thus, in this study we aimed to explore the correlation between VAHL and humoral immunity as reflected by post-vaccination serologic testing, and by comparing the incidence of VAHL between lymphoma patients treated recently with B-cell depleting therapy and those that did not. Methods: A total of 137 patients with hematologic malignancy that had post-vaccination [18F]FDG PET-CT were included (All-PET group), 86 received both vaccine doses before imaging (PET-2 group). Their VAHL status and grade on imaging were recorded. Among 102 lymphoma patients, 34 (33.3%) were treated during the year prior vaccination with anti-CD20 antibody containing therapy. A subgroup of 54 patients also underwent serologic testing 2-3 weeks after the booster dose, and their anti-spike titers were recorded and graded as well.Results: The overall incidence of VAHL in patients with hematologic malignancy was 31.4%. The 34 lymphoma patients treated during the year prior vaccination with anti-CD20 antibody containing therapy had significantly lower rates of VAHL comparted to all other lymphoma patients (8.8% versus 41.2% in all-PET patients, Pv < 0.01). VAHL rates were 10% in patients with negative serology, 31.3% in patients with low anti-spike titers and 72.2% in patients with high anti-spike titers. The positive predictive values of VAHL were 90% and 93.3% in all-PET and PET-2 patients, respectively. A positive statistically significant correlation was found between VAHL and serology ranks in All-PET patients (rs = 0.530, Pv < 0.001), and stronger correlation was found in PET-2 patients (rs = 0.642, Pv < 0.001).Conclusion: VAHL on [18F]FDG PET-CT of patients with hematologic malignancy may reflect GC B-cell proliferation and an effective humoral response elicited by BNT162b2 vaccine.

Section: Introductionmentioning

confidence: 99%

Correlation Between BNT162b2 mRNA Covid-19 Vaccine-associated Hypermetabolic Lymphadenopathy and Humoral Immunity in Patients With Hematologic Malignancy

Krauthammer

et al. 2021

Preprint

“…Notably the anti-S IgG seroconversion rates were lower or less pronounced in patients with a hematological conditions, in particular in patients treated with highly immune suppressive therapy, such as stem cell transplantation, anti-CD20 therapy or chimeric antigen receptor (CAR)-T cell therapy. 12 Small cohort studies have reported low seroconversion rates following a single dose of mRNA vaccination in the UK and France and seropositivity rates in patients with CLL and multiple myeloma. 13,14 Within our cohort of 131 patients, the overall seropositivity rate was 81% after the rst dose and up to 94% at 4 weeks after the second dose.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of SARS-CoV-2 mRNA Vaccines in Patients with Cancer: Findings from an International Collaborative Cohort Study

Addeo

Shah²,

Bordry

et al. 2021

SSRN Journal

Patients with cancer experience higher burden of SARS-CoV-2 infection, disease severity, complications, and mortality, compared to the general population. SARS-CoV-2 mRNA vaccines have shown to be highly effective in clinical trials; however, few data are available on the e cacy of SARS-CoV-2 vaccines in patients with cancer. Using a prospective cohort study design, we assessed the seroconversion rates and anti-SARS-CoV-2 S antibody titers following the 1st and 2nd dose of BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines in patients with cancer at centers in U.S. and Europe from January 2021 to April 2021. Among 131 patients included in the immunogenicity analysis, most (94%) developed antibody levels; however, 6% showed no seroconversion after completing the mRNA vaccination series. No differences in seroconversion rates were observed between BNT162b2 and mRNA-1273 vaccine groups. Patients with solid tumors (98%) were much more likely to seroconvert and develop higher antibody titers than those with hematological malignancy (77%). Although seroconversion rates were consistently high in patients receiving different types of anti-cancer therapy except anti-CD-20 antibody; the antibody titers were much lower in patients who received cytotoxic chemotherapy, immunotherapy, or monoclonal antibody compared to those on clinical surveillance or receiving endocrine therapy within six months prior to vaccination. None of the patients on anti-CD-20 antibody therapy developed an antibody response, even after receiving 2 doses of the vaccines. After correlating with cell-mediated immunity in a subset of patients at high-risk for antibody non-response, we propose exploring the addition of a second booster, or convalescent plasma therapy, or postpone vaccination until after completion of their speci c anti-cancer treatment. Although encouraging results, we suggest high-risk vaccinated patients with cancer to continue taking safety precautions until their immune response is con rmed at 4 weeks after 2nd dose of mRNA vaccines. We also highly encourage all eligible individuals in the general population to get vaccinated to ensure the protection of the most vulnerable groups, such as those with cancer.

Seminars in Nuclear Medicine

“…The amount of virus is higher in people who develop severe or critical illness ( 55 , 56 ). In few severely immunocompromised patients, especially haematological patients with B-cell defect due to the underlying disease or treatment with anti-CD20 antibody, active viral replication can be detected weeks to months after symptom onset ( 57 , 58 ). The same patient population has an increased risk of severe COVID-19.…”

Section: Oseltamivir Is Given On Suspicion Of Influenzamentioning

confidence: 99%

“…Patients after a severe case of COVID-19 should be evaluated individually in regard to the duration of isolation. Immunosuppressed individuals, in particular patients with impaired B-cell function ( 57 , 58 , 62 ), may excrete contagious virus for a prolonged time periode, hence ceasing isolation may require expert consultation. Patients can be discharged with or without isolation after recovery of acute symptoms.…”

Section: Dischargementioning

confidence: 99%

Clinical Management of COVID-19 Patients – An Update

Mølhave

Agergaard

Wejse

2022

SARS-CoV-2 virus may cause COVID-19 disease, which causes mild-to-moderate disease in 80% of laboratory-confirmed cases have and could be community-managed. A considerable age-dependent mortality is seen among elderly and other at-risk populations but among young and healthy individuals it is < 0.5%. Long term health issues has been reported following severe COVID-19 requiring hospitalization as well as after cases of mild COVID-19 without hospitalization. Upon receiving COVID-19 suspected patients at hospitals, patients should be isolated and PPE should be worn by all health staff when in contact with the patients. Additionally, patients are tested for the presence of SARS-CoV-2 RNA by PCR, and blood samples are drawn. Imaging is not pivotal for the diagnosis, but chest X-ray is a relevant examination for all and is used to determine severity and treatment need Abnormal findings on CT scans are found in most patients, most frequently peripheral ground-glass opacity and bilateral patchy shadowing are present. Patients are, according to their needs and risks, treated with oxygen therapy, anticoagulation therapy, steroids, antivirals, or even immunosuppressive drugs. Convalescent plasma therapy and monoclonal antibodies have a limited role in the treatment, mostly in severely immunocompromised patients.