Abstract
Little is known about the immune response to SARS-CoV-2 vaccination in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, several studies have reported that adequate protection could be provided to this population. The purpose of this study was to evaluate which factors can predict the efficacy of SARS-CoV-2 vaccination in these specifically immunosuppressed patients. Specific anti-Spike (S) antibody responses were assessed in a cohort of 117 allo-HSCT recipients after 2 injections of BNT162b2 mRNA SARS-CoV-2 vaccine (V1 and V2). Factors considered liable to influence the antibody response and analyzed in this series were the interval between allo-HSCT and V1, donor source, recipient and donor age, current immunosuppressive/chemotherapy (I/C) treatment, and levels of CD4 + and CD8 + T cells, B cells, and natural killer cells at the time of V1. Overall, the S-antibody response rate, evaluated at a median of 35 days after V2, was 82.9% for the entire cohort, with 71 patients (61%) reaching the highest titer. In univariate analysis, a lower pre-V1 median total lymphocyte count, lower CD4 + T cell and B cell counts, ongoing I/C treatment, and a haploidentical donor were characteristic of nonhumoral responders. However, multiparameter analysis showed that B cell aplasia was the sole factor predicting the absence of a specific immune response (odds ratio, 0.01; 95% confidence interval, 0.00 to 0.10; P < 10 -3 ). Indeed, the rate of humoral response was 9.1% in patients with B cell aplasia versus 95.9% in patients with a B cell count >0 (P < 10 -9 ). These results advocate for the administration of anti-SARS-CoV-2 vaccination in allo-HSCT recipients as early as peripheral B cell levels can be detected, and also suggest the need for close monitoring of B-cell reconstitution after Allo-HSCT.
Keywords: Allogeneic; B cell; BNT162b2; COVID-19; Immune status; Lymphopenia; SARS-CoV-2 mRNA; Vaccine.
【저자키워드】 COVID-19, lymphopenia, B cell, vaccine., BNT162b2, Allogeneic, Immune status, SARS-CoV-2 mRNA, 【초록키워드】 Treatment, SARS-CoV-2, Efficacy, immune response, T cells, Antibody Response, B cells, CD4, CD8, SARS-CoV-2 vaccine, lymphopenia, B cell, BNT162b2, Lymphocyte count, lymphocyte, Cohort, T cell, Antibody responses, Humoral response, mRNA, Patient, age, Allogeneic, Natural killer cells, Hematopoietic stem cell, characteristic, predict, SARS-CoV-2 vaccination, immunosuppressed patients, anti-SARS-CoV-2 vaccination, Donor, B-cell, Immune status, natural killer cell, administration, Analysis, Odds ratio, Immunosuppressed, humoral, HSCT, Stem cell transplantation, stem cell, response rate, Factor, 95% confidence interval, recipients, entire cohort, injection, responders, allogeneic hematopoietic stem cell transplantation, Univariate analysis, close monitoring, recipient, Specific, aplasia, allo-HSCT, highest, analyzed, evaluate, reported, evaluated, provided, median, absence, the antibody response, of BNT162b2, were assessed, 【제목키워드】 SARS-CoV-2, response, BNT162b2 mRNA, transplantation, MOST, hematopoietic, STEM, Poor,