Infectious Disease

Certain patients with haematological disorders have a poor response to the COVID-19 vaccination

December 11, 2021

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Rotterdam J. et al. Abstract 218. Presented at: ASH Annual Meeting and Exposition; 11-14 December 2021; Atlanta.

Disclosure:
Saussele reports research grants and / or fees from Bristol Myers Squibb, Incyte, Novartis, Pfizer and Roche. Please refer to the study for all relevant financial information from the other authors.

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Almost every sixth patient with hematologic disease had a negative COVID-19 vaccination related to the antibody response, according to the results of a prospective, observational study at a single center presented at the ASH annual meeting and exhibition.

Patients with myeloid neoplasms, lymphoid neoplasms, and non-malignant haematological disorders were among those who were most likely to have a negative reaction after a second vaccination. However, all patients with chronic myeloid leukemia had a measurable immune response.

Antibody response to COVID-19 vaccine.

Data derived from Rotterdam J, et al. Abstract 218. Presented at: ASH Annual Meeting and Exposition; 11-14 December 2021; Atlanta.

“The preventive vaccination in this patient cohort showed a reduced effectiveness. The knowledge about influencing factors is limited “, Susanne Saussele, MD, Professor at the Mannheim University Hospital of Heidelberg University and Head of the CML Center of Excellence in Mannheim, Germany, opposite Healio. “The aim of our study was to evaluate the vaccine-related antibody response to BNT162b2 (Pfizer / BioNTech), mRNA-1273 (Moderna) and ChADOx1 (AstraZeneca) in patients with haematological diseases and to identify factors that influence the vaccination response.”

Susanne Saussele, MD

Susanne Saussele

The analysis comprised 373 patients with haematological diseases (mean age 64 years; 44% women), whose antibody levels were measured at least 14 days (median 58) after a second COVID-19 vaccination. Of them, 338 (90.6%) had a malignant haematological disease (myeloid neoplasms, n = 214; lymphoid neoplasms, n = 124) and 35 had a non-malignant haematological disease (autoimmune disease, n = 26; benign, n = 9). In addition, 229 patients (70%) received active therapy and 144 patients (44%) had previously been treated or treatment-naïve, the researchers found.

Most patients (n = 289) received the BNT162b2 mRNA vaccine, while 36 received mRNA-1273, 26 ChADOx1, and 22 ChADOx1 followed by BNT162b2.

The researchers used an electrochemiluminescent assay to quantify antibodies, pan-immunoglobulin (including IgG) against the receptor binding domain of the SARS-CoV-2 spike protein. They defined positive response as an antibody concentration of 0.8 U / ml or higher.

The researchers analyzed the data of all patients without detecting an anti-N (nucleocapsid) SARS-CoV-2 antibody.

The results showed a positive vaccination reaction with a median of 197 U / ml (range 0.8-250) in 317 patients (85%) and a negative reaction in 56 patients (15%). Most (70%) of the patients with negative responses had lymphoid neoplasms, 23% had myeloid neoplasms, and 7% had non-malignant haematological disease. In addition, 39 patients of the negative cohort (70%) were treated with active therapy and 17 (30%) were pretreated or were treatment-naive.

Analyzes also showed that among the 13 patients with myeloid neoplasms and negative response, those with classic myeloproliferative neoplasms had the highest negative result for antibodies, followed by myelodysplastic syndrome. In addition, all patients with CML had a measurable immune response.

Among patients with lymphoid neoplasia, those with low-grade non-Hodgkin lymphoma had the highest negative antibody result (45%), followed by high-grade non-Hodgkin lymphoma (18%, mostly diffuse large B-cell lymphoma). .

Only patients with autoimmune diseases had a negative result among those with non-malignant haematological diseases.

Treatment with ruxolitinib (Jakafi, Incyte), rituximab (Rituxan; Genentech, Biogen), and ibrutinib (Imbruvica; Pharmacyclics, Janssen) correlated with a negative vaccine response, while younger age and CML were associated with a positive response, the researchers found.

“In summary, a notable group of patients with haematological disorders showed no response after the second COVID-19 vaccination,” Saussele told Healio. “We were able to identify additional therapies that correlated with negative responses. The results serve as a guide for better protection and better monitoring of this vulnerable group of patients. ”

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ASH annual conference and exhibition

ASH annual conference and exhibition

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