Article ; Online: Seroconversion and outcomes after initial and booster COVID-19 vaccination in adults with hematologic malignancies.
2022 Volume 128, Issue 18, Page(s) 3319–3329
Abstract: Background: Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease-19 (COVID-19) infection and reduced response to vaccination.: Methods! ...
Abstract | Background: Patients with hematologic malignancies have impaired humoral immunity secondary to their malignancy and its treatment, placing them at risk of severe coronavirus disease-19 (COVID-19) infection and reduced response to vaccination. Methods: The authors retrospectively analyzed serologic responses to initial and booster COVID-19 vaccination in 378 patients with hematologic malignancy and subsequently tracked COVID-19-related outcomes. Results: Seroconversion occurred in 181 patients (48%) after initial vaccination; patients who had active malignancy or those who were recently treated with a B-cell-depleting monoclonal antibody had the lowest rates of seroconversion. For initial nonresponders to vaccination, seroconversion after a booster dose occurred in 48 of 85 patients (56%). The seroconversion rate after the booster was similar for patients on (53%) and off (58%) active therapy (p = .82). Thirty-three patients (8.8%) developed a COVID-19 infection, and there were three COVID-19-related deaths (0.8%). Although no significant association was observed between postvaccination seroconversion and the incidence of COVID-19 infection, no patient with seroconversion died from COVID-19, and no patient who received tixagevimab/cilgavimab (N = 25) was diagnosed with a COVID-19 infection. Conclusions: Booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course regardless of the specific vaccine or on/off treatment status at the time of revaccination. Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID-19 infection, the authors' experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab in case of lack of seroconversion, effectively eliminated the risk of COVID-19 death in the otherwise high-risk population. Lay summary: Patients with hematologic malignancy, especially lymphoma, have an impaired response to coronavirus disease 2019 (COVID-19) vaccination. In this single-institution review, less than one half of the patients studied made detectable antibodies. For those who did not make detectable antibodies after initial vaccination, over one half (65%) were able to produce antibodies after booster vaccination. By the end of February 2022, 33 of the original 378 patients had a documented COVID-19 infection. The only deaths from COVID-19 were in those who had undetectable antibodies, and no patient who received prophylactic antibody therapy developed a COVID-19 infection. |
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MeSH term(s) | Adult ; Antibodies, Monoclonal ; Antibodies, Viral ; COVID-19 ; COVID-19 Vaccines ; Hematologic Neoplasms ; Hepatitis B Vaccines ; Humans ; Retrospective Studies ; Seroconversion ; Vaccination |
Chemical Substances | Antibodies, Monoclonal ; Antibodies, Viral ; COVID-19 Vaccines ; Hepatitis B Vaccines ; tixagevimab ; cilgavimab (1KUR4BN70F) |
Language | English |
Publishing date | 2022-07-11 |
Publishing country | United States |
Document type | Journal Article |
ZDB-ID | 1429-1 |
ISSN | 1097-0142 ; 0008-543X ; 1934-662X |
ISSN (online) | 1097-0142 |
ISSN | 0008-543X ; 1934-662X |
DOI | 10.1002/cncr.34354 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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