Abstract
Vaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. We prospectively quantified serum immunoglobulin G (IgG) antibodies to spike subunit 1 (S1) antigens during and after 2-dose mRNA-1273 (Spikevax/Moderna) vaccination in hematology patients. Obtaining S1 IgG ≥ 300 binding antibody units (BAUs)/mL was considered adequate as it represents the lower level of S1 IgG concentration obtained in healthy individuals, and it correlates with potent virus neutralization. Selected patients (n = 723) were severely immunocompromised owing to their disease or treatment thereof. Nevertheless, >50% of patients obtained S1 IgG ≥ 300 BAUs/mL after 2-dose mRNA-1273. All patients with sickle cell disease or chronic myeloid leukemia obtained adequate antibody concentrations. Around 70% of patients with chronic graft-versus-host disease (cGVHD), multiple myeloma, or untreated chronic lymphocytic leukemia (CLL) obtained S1 IgG ≥ 300 BAUs/mL. Ruxolitinib or hypomethylating therapy but not high-dose chemotherapy blunted responses in myeloid malignancies. Responses in patients with lymphoma, patients with CLL on ibrutinib, and chimeric antigen receptor T-cell recipients were low. The minimal time interval after autologous hematopoietic cell transplantation (HCT) to reach adequate concentrations was <2 months for multiple myeloma, 8 months for lymphoma, and 4 to 6 months after allogeneic HCT. Serum IgG4, absolute B- and natural killer-cell number, and number of immunosuppressants predicted S1 IgG ≥ 300 BAUs/mL. Hematology patients on chemotherapy, shortly after HCT, or with cGVHD should not be precluded from vaccination. This trial was registered at Netherlands Trial Register as #NL9553.
【초록키워드】 Treatment, IgG, vaccination, therapy, Trial, severe COVID-19, antibody, mRNA-1273, Antigen, Chemotherapy, serum, Multiple myeloma, Immunoglobulin, lymphoma, response, Patient, Virus neutralization, Immunocompromised, Allogeneic, CLL, hematology, T-cell, disease, patients, leukemia, chimeric antigen receptor, Immunosuppressant, Concentration, IgG4, high risk, cell transplantation, High-dose, subunit, Registered, hematological, Antibody concentrations, recipient, S1 IgG, benefit, Cell, autologous, myeloid malignancies, HCT, predicted, identify, Netherland, quantified, binding antibody unit, in healthy individuals, Obtaining, patients treated, precluded, 【제목키워드】 mRNA-1273, COVID-19 vaccination, Patient, Immunocompromised, Analysis,