<scp>COVID</scp>‐19 vaccination in haematology patients: an Australian and New Zealand consensus position statement

McCaughan, Georgia; Ciaccio, Pietro R Di; Ananda‐Rajah, Michelle; Gilroy, Nicole; MacIntyre, Raina; Teh, Benjamin W; Weinkove, Robert; Curnow, Jennifer; Szer, Jeffrey; Enjeti, Anoop K; Ross, David M.; Mulligan, Stephen P.; Trotman, Judith; Dickinson, Michael; Quach, Hang; Choi, Philip; Polizzotto, Mark N.; Tam, Constantine S.; Ho, P. Joy; Ku, Matthew; Gregory, Gareth P.; Gangatharan, Shane; Hapgood, Greg; Cochrane, Tara; Cheah, Chan Yoon; Gibbs, Simon; Wei, Andrew H.; Johnston, Anna; Greenwood, Matthew; Prince, H. Miles; Latimer, Maya; Berkahn, Leanne; Wight, Joel; Armytage, Tasman; Hamad, Nada

doi:10.1111/imj.15247

Cited by 13 publications

(15 citation statements)

References 36 publications

(79 reference statements)

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“…The diagnoses of CLL and MBL were according to International Workshop on Chronic Lymphocytic Leukaemia (iwCLL) guidelines 23 . Vaccination occurred through the Australian Government program (http://www.health.gov.au) with Vaxzevria [AstraZeneca (AZ), Macquarie Park, Sydney, Australia], Comirnaty (Pfizer, Sydney, Australia) and Spikevax (Moderna, Cambridge, MA, USA) 24 . All patients and all 25 healthy donors (20 laboratory staff and five CLL patient relatives) provided informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…23 Vaccination occurred through the Australian Government program (www.health.gov.au) with Vaxzevria [AstraZeneca (AZ), Macquarie Park, Sydney, Australia], Comirnaty (Pfizer, Sydney, Australia) and Spikevax (Moderna, Cambridge, MA, USA). 24 All patients and all 25 healthy donors (20 laboratory staff and five CLL patient relatives) provided informed consent. Blood samples were taken pre vaccination, then following vaccination doses 1 (D1) and 2 (D2) ~2-4 weeks following each dose.…”

Section: Ater I a L S A N D M Ethodsmentioning

confidence: 99%

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COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

Shen

Freeman

Holland³

et al. 2022

Br J Haematol

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Summary Chronic lymphocytic leukaemia (CLL) is associated with immunocompromise and high risk of severe COVID‐19 disease and mortality. Monoclonal B‐cell lymphocytosis (MBL) patients also have immune impairment. We evaluated humoural and cellular immune responses in 181 patients with CLL (160) and MBL (21) to correlate failed seroconversion [<50 AU/ml SARS‐CoV‐2 II IgG assay, antibody to spike protein; Abbott Diagnostics)] following each of two vaccine doses with clinical and laboratory parameters. Following first and second doses, 79.2% then 45% of CLL, and 50% then 9.5% of MBL patients respectively remained seronegative. There was significant association between post dose two antibody level with pre‐vaccination reduced IgM (p < 0.0001), IgG2 (p < 0.035), and IgG3 (p < 0.046), and CLL therapy within 12 months (p < 0.001) in univariate analysis. By multivariate analysis, reduced IgM (p < 0.0002) and active therapy (p < 0.0002) retained significance. Anti‐spike protein levels varied widely and were lower in CLL than MBL patients, and both lower than in normal donors. Neutralisation activity showed anti‐spike levels <1000 AU/ml were usually negative for both an early viral clade and the contemporary Delta variant and 72.9% of CLL and 53.3% of MBL failed to reach levels ≥1000 AU/ml. In a representative sample, ~80% had normal T‐cell responses. Failed seroconversion occurred in 36.6% of treatment‐naïve patients, in 78.1% on therapy, and in 85.7% on ibrutinib.

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Section: Methodsmentioning

confidence: 99%

Section: Ater I a L S A N D M Ethodsmentioning

confidence: 99%

COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

Shen

Freeman

Holland³

et al. 2022

Br J Haematol

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“… 8 National and international healthcare institutions adapted guidelines regarding priority vaccination against COVID‐19 in this vulnerable patient population. 9 , 10 , 11 , 12 , 13 , 14…”

Section: Impact Of Covid‐19 Pandemic On Patients With Chronic Lymphocytic Leukemiamentioning

confidence: 99%

Reasons and consequences of COVID‐19 vaccine failure in patients with chronic lymphocytic leukemia

Morawska

2021

European J of Haematology

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People with hematologic malignancies are at a high risk of morbidity and mortality from COVID‐19. The response to vaccination is highly limited in patients with chronic lymphocytic leukemia. Less than half of the patients develop antibody response, suggesting that they remain at risk of SARS‐CoV‐2 infection even after the vaccination. Reasons for inadequate response to COVID‐19 vaccination in chronic lymphocytic leukemia are multifactorial and attributed to disease‐related immune dysregulation and patient‐ and therapy‐related factors. The negative predictors of response to vaccination include hypogammaglobulinemia, advanced age, current active treatment, and past treatment anti‐CD20 monoclonal antibodies. Despite using booster doses and heterologous immunization to improve humoral and cellular immunity, some patients with chronic lymphocytic leukemia will fail to respond. Active treatment at the time of vaccination and a recent history of anti‐CD20 monoclonal antibodies use are the strongest predictors of the non‐response. Current data support informing patients with chronic lymphocytic leukemia and other hematologic malignancies about the risk of infection regardless of vaccination. These individuals and members of their households should continue extreme preventive actions despite relaxed local regulations. Other emerging non‐vaccine preventive strategies include passive and post‐exposure prevention with monoclonal antibodies.

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“…109 The Australian and New Zealand guidelines stated that patients with hematological malignancies and some benign hematological illnesses should have accelerated access to COVID-19 vaccinations. 110 French oncology societies (GCO, TNCD, UNICANCER) recommends that patients with cancer who are undergoing treatment or who had therapy less than three years ago should be vaccinated, as well as their families. 111…”

Section: Cancer Patientsmentioning

confidence: 99%

Safety and efficacy of COVID-19 Vaccines in special populations

Alattas

Ibrahim

Ali

et al. 2022

J. Contemp. Med. Sci.

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Coronavirus disease 2019 (COVID-19), is a pandemic that resulted in extreme human and economic losses. A higher incidence of morbidity and mortality to COVID-19 was demonstrated in a special population. Factors that impact the disease severity include old age, obesity, pregnancy, diabetes mellitus, cancer, and immunosuppressive drugs. Fortunately, several COVID-19 vaccines were developed such as Pfizer-BioNTech, Moderna, Oxford-AstraZeneca, and Johnson & Johnson among others. These vaccines have shown good efficacy and safety profiles in the general population, but serious rare adverse effects were reported related to specific vaccines. Several studies are undergoing to test the efficacy in special populations. Reduced efficacy or delayed immunological response to COVID-19 vaccines were suggested for patients with autoimmune disorders or organ transplant patients, especially those receiving certain medications such as rituximab. There is a concern about organ rejection in organ transplant patients. Despite these facts, there is an agreement among health care providers to consider prioritization of the above-mentioned groups for receiving vaccinations with the same precautions followed for the general population. It is recommended to ongoing studies determine the efficacy and safety of COVID-19 vaccines in patients with comorbidities based on clinical data.

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COVID‐19 vaccination in haematology patients: an Australian and New Zealand consensus position statement

Cited by 13 publications

References 36 publications

COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

COVID‐19 vaccine failure in chronic lymphocytic leukaemia and monoclonal B‐lymphocytosis; humoural and cellular immunity

Reasons and consequences of COVID‐19 vaccine failure in patients with chronic lymphocytic leukemia

Safety and efficacy of COVID-19 Vaccines in special populations

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