Viral Immunity and Vaccines in Hematologic Malignancies: Implications for COVID-19

Dhodapkar, Madhav V.; Dhodapkar, Kavita M.; Ahmed, Rafi

doi:10.1158/2643-3230.bcd-20-0177

Cited by 22 publications

(15 citation statements)

References 15 publications

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“…Hematologic malignancies are associated with immune dysfunction with alterations in both innate and adaptive immunity [ 64 ]. Cytopenia, B/plasma cells reduction, hypogammaglobulinemia, and anti-cancer therapy are among the underlying cause of immunodeficiency in these patients [ 65 ]; thus, a lower vaccine efficacy might be observed consequently, which is consistent with our findings of the lower immunogenicity of mRNA vaccines in patients with hematologic malignancies.…”

Section: Discussionsupporting

confidence: 88%

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

et al. 2022

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Background Immunocompromised (IC) patients are at higher risk of severe SARS-CoV-2 infection, morbidity, and mortality compared to the general population. They should be prioritized for primary prevention through vaccination. This study aimed to evaluate the efficacy of COVID-19 mRNA vaccines in IC patients through a systematic review and meta-analysis approach. Method PubMed-MEDLINE, Scopus, and Web of Science were searched for original articles reporting the immunogenicity of two doses of mRNA COVID-19 vaccines in adult patients with IC condition between June 1, 2020 and September 1, 2021. Meta-analysis was performed using either random or fixed effect according to the heterogeneity of the studies. Subgroup analysis was performed to identify potential sources of heterogeneity. Results A total of 26 studies on 3207 IC patients and 1726 healthy individuals were included. The risk of seroconversion in IC patients was 48% lower than those in controls (RR = 0.52 [0.42, 0.65]). IC patients with autoimmune conditions were 54%, and patients with malignancy were 42% more likely to have positive seroconversion than transplant recipients (P < 0.01). Subgroup meta-analysis based on the type of malignancy, revealed significantly higher proportion of positive seroconversion in solid organ compared to hematologic malignancies (RR = 0.88 [0.85, 0.92] vs. 0.61 [0.44, 0.86], P = 0.03). Subgroup meta-analysis based on type of transplantation (kidney vs. others) showed no statistically significant between-group difference of seroconversion (P = 0.55). Conclusions IC patients, especially transplant recipients, developed lower immunogenicity with two-dose of COVID-19 mRNA vaccines. Among patients with IC, those with autoimmune conditions and solid organ malignancies are mostly benefited from COVID-19 vaccination. Findings from this meta-analysis could aid healthcare policymakers in making decisions regarding the importance of the booster dose or more strict personal protections in the IC patients.

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Section: Discussionsupporting

confidence: 88%

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

et al. 2022

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“…This may reflect the enrollment being skewed to patients who had been previously successfully treated for acute leukemia and low enrollment of patients on active chemotherapy, and the use of non-B cell toxic therapies for the treatment of patients with CML, MDS and AML. Experience with similar low seroconversion rates in patients with hematologic malignancies when receiving vaccinations for other viral infections, in particular when on certain therapies (26), has led to the testing of higher doses of the vaccine, different formulations, and repeated rounds of immunization (27,28). During the COVID-19 pandemic, some patients without seroconversion after receiving the full initial vaccination have received subsequent immunizations (sometimes referred to as boosters, but may not be the adequate term for persons who did not respond to the first set of vaccination).…”

Section: Main Textmentioning

confidence: 99%

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

Ribas

Dhodapkar

Campbell

et al. 2021

Blood Cancer Discovery

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Summary: Patients with hematologic malignancies are particularly vulnerable to COVID-19 infections, and upon a pooled data analysis of 24 publications, there is evidence that they have suboptimal antibody responses to COVID-19 vaccination and boosters. To provide them the needed additional protection from COVID-19, it is imperative to achieve a 100% full immunization rate in health care workers and adult caretakers, and to foster research to test higher doses and repeated rounds of COVID-19 vaccines and the use of passive immune prophylaxis and therapy.

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“…MGUS is known to be a condition that can decrease antibody response to infections and vaccination [6,15]. People with MGUS may have impaired anti-viral antibody response and a lower SARS-CoV-2 specific IgG as compared to the general population [6].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic coronavirus disease followed by symptomatic reinfection in a patient with monoclonal gammopathy of undetermined significance: A case report

Narayanan¹

2021

IJCR

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Coronavirus disease (COVID-19) pandemic has been present for over a year and has been seen to behave unpredictably in different people especially those with other underlying health conditions. Monoclonal Gammopathy of Undetermined Significance (MGUS) is a rare condition that can alter immune responses. There are few case reports of COVID in people with MGUS and most of these are in elderly people often with associated comorbidities. The mutual impact of COVID and MGUS in younger people (<50 years) has been far less explored, and therefore, this case report would add to such data. Although there is no conclusive evidence to suggest that MGUS increases predisposition or significantly impacts the clinical course and outcomes of COVID-19, it can have some bearing on serological assessment in both COVID infected or vaccinated individuals.

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Viral Immunity and Vaccines in Hematologic Malignancies: Implications for COVID-19

Cited by 22 publications

References 15 publications

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

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

Asymptomatic coronavirus disease followed by symptomatic reinfection in a patient with monoclonal gammopathy of undetermined significance: A case report

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