<scp>SARS‐CoV</scp>‐2 vaccination in patients with autoimmune cytopenias: The experience of a reference center

Fattizzo, Bruno; Giannotta, Juri Alessandro; Cecchi, Nicola; Barcellini, Wilma

doi:10.1002/ajh.26345

Cited by 23 publications

(16 citation statements)

References 17 publications

(41 reference statements)

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“…Valuable and recent reviews in this area suggest the risk of relapse appears to vary in the region between 3.3% and 12% and this is important information when counselling and ensuring follow‐up of patients. 21 , 26 , 27 We note numerous similarities in this cohort to recent reports; of note a large proportion of patients appear to require treatment (93% in one cohort) and encouragingly response rates to treatments are high. 20 This cohort did not consist of patients who had undergone splenectomy; however, there is evidence this group has higher risk of relapse and warrants close monitoring post‐vaccination.…”

Section: Discussionsupporting

confidence: 77%

“…An incidence of ITP relapse of 6.6% and new ITP diagnosis of 1.4% was noted in this cohort following vaccination. Valuable and recent reviews in this area suggest the risk of relapse appears to vary in the region between 3.3% and 12% and this is important information when counselling and ensuring follow‐up of patients 21,26,27 . We note numerous similarities in this cohort to recent reports; of note a large proportion of patients appear to require treatment (93% in one cohort) and encouragingly response rates to treatments are high 20 .…”

Section: Discussionsupporting

confidence: 57%

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Real‐world, single‐center experience of SARS‐CoV‐2 vaccination in immune thrombocytopenia

Woolley

Tailor

Shah

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Immune thrombocytopenic purpura (ITP) relapse following vaccination remains poorly reported in the adult population.Objectives: This report details real world data from the largest single-center cohort of ITP relapse following severe acute respiratory syndrome (SARS-CoV-2) vaccination. Methods:The vaccination status of 294 patients under active follow-up was reviewed. A total of 17 patients were identified resulting in an incidence of ITP relapse following SARS-CoV-2 vaccination in this cohort of 6.6% and an incidence of newly diagnosed ITP following SARS-CoV-2 vaccination of 1.4%. Results: Patients were noted to develop marked deviation of platelet count from baseline following vaccination (P =< .0001). Fourteen patients had a prior diagnosis of ITP and median follow-up following diagnosis was 4 years (range 0-45 years). Days from vaccination to presentation ranged from 2-42 (median 14) and the follow-up period was 34 weeks. Fifteen patients (88%) presented with symptoms and all 17 patients developed symptoms during the follow-up period. Nine patients (53%) received a second dose of vaccine during the follow-up period with seven patients (78%) requiring therapeutic support to facilitate second vaccination. Decision to treat patients was multi-factorial and aimed at decreasing bleeding symptoms and obtaining a platelet count >30 × 10 9 /L. Sixteen patients (94%) required therapeutic intervention and at the end of the follow-up period, four patients (24%) remained unresponsive to treatment with a platelet count <30 × 10 9 /L. Conclusion: Vaccination of ITP patients continues to have important clinical benefit; however, recommendations for patients who relapse remain lacking. This report outlines the real-world patient outcomes in the era of widespread SARS-CoV-2 vaccination.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 57%

Real‐world, single‐center experience of SARS‐CoV‐2 vaccination in immune thrombocytopenia

Woolley

Tailor

Shah

et al. 2022

Journal of Thrombosis and Haemostasis

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“…molecular mimicry and aberrant over activation of humoral and cellular immunity) that may occur even after vaccination. 16 , 17 , 18 On the other hand, in our patient SARS‐CoV‐2 vaccine may have induced an immune activation that disclosed a latent autoimmunity. The presence of a PNH clone in our patient, as commonly observed in subjects with primary AA, favours the second pathogenic mechanism, although both hypotheses are not mutually exclusive.…”

mentioning

confidence: 66%

A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination

et al. 2021

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“…autoimmune hemolytic anemia AIHA, immune thrombocytopenia ITP, and autoimmune neutropenia AIN) and with bone marrow failure syndromes, including aplastic anemia (AA), low risk myelodysplastic syndromes (LR-MDS), and paroxysmal nocturnal hemoglobinuria (PNH). These conditions are rare and clinically heterogeneous, and several reports of disease exacerbations have been described both after COVID-19 infection and its vaccine 7 – 11 . More importantly, these diseases are mainly handled with immunosuppressive drugs, including steroids, the anti-CD20 monoclonal antibody rituximab, cytotoxic immunosuppressants such as cyclosporine A, anti-thymocyte globulin (in AA), and complement inhibitors that may hamper the response to vaccine.…”

Section: Introductionmentioning

confidence: 99%

Seroconversion to mRNA SARS-CoV-2 vaccines in patients with autoimmune cytopenias and bone marrow failures

Fattizzo

Bortolotti

Giannotta

et al. 2022

Sci Rep

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Data concerning the efficacy of SARS-CoV-2 vaccines in patients with non-oncological hematologic conditions are lacking. These include autoimmune cytopenias (autoimmune hemolytic anemia AIHA, immune thrombocytopenia ITP, and autoimmune neutropenia), and bone marrow failure syndromes (aplastic anemia, low risk myelodysplastic syndromes, and paroxysmal nocturnal hemoglobinuria). These conditions may relapse/reactivate after COVID-19 infection and vaccine. Moreover, they are mainly handled with immunosuppressive drugs that may hamper the response to vaccine. In this study, we prospectively evaluated the rate of seroconversion after mRNA SARS-CoV-2 vaccines in patients with autoimmune cytopenias or bone marrow failure syndrome after 2 ± 1 months from the last vaccine dose. Overall, 149 patients were tested and 135 (91%) seroconverted. The highest proportion of non-responders was observed in Evans syndrome (association of ITP and AIHA) and warm AIHA patients (p = 0.001), in those with lower levels of baseline serum IgG (p = 0.008), and in patients on active therapy with steroids (p = 0.03) who also had lower anti-Spike titers. The latter were inversely related with age, and a positively with lymphocyte counts. Additionally, patients who had received rituximab within 12 months from vaccination showed higher rates of non-response (p = 0.03) as compared to those treated before. Contrarily, cyclosporine alone, complement inhibitors, and bone marrow stimulating agents had no detrimental effect on seroconversion. These data suggest maintaining high vigilance and adherence to preventive/protective measures in this population since a proportion of cases may not respond or exhibit low anti-Spike titers.

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SARS‐CoV‐2 vaccination in patients with autoimmune cytopenias: The experience of a reference center

Cited by 23 publications

References 17 publications

Real‐world, single‐center experience of SARS‐CoV‐2 vaccination in immune thrombocytopenia

Real‐world, single‐center experience of SARS‐CoV‐2 vaccination in immune thrombocytopenia

A case of severe aplastic anaemia after SARS‐CoV‐2 vaccination

Seroconversion to mRNA SARS-CoV-2 vaccines in patients with autoimmune cytopenias and bone marrow failures

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