Infectious Disease
Most patients with AML, myelodysplastic syndrome seropositive after two doses of COVID vaccine
December 12, 2021
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Jain AG et al. Abstract 278. Presented at: ASH Annual Meeting and Exposition; 11-14 December 2021; Atlanta.
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Jain does not report financial information. Please refer to the study for all relevant financial information from the other authors.
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A vast majority of patients with acute myeloid leukemia and myelodysplastic syndrome converted to seropositivity after two doses of COVID-19 vaccine, according to a study presented at the ASH annual meeting and exhibition.
The results of the single-site observational study – the largest to date among patients with AML and myelodysplastic syndrome with serial serological data after two vaccine doses – should be substantiated in a larger cohort, according to researchers. However, their data indicated that the Moderna vaccine appeared to produce a strong humoral response in these patient populations.
Data derived from Jain AG, et al. Abstract 278. Presented at: ASH Annual Meeting and Exposition; 11-14 December 2021; Atlanta.
“Patients with myeloid malignancies, including AML and myelodysplastic syndrome, are at high risk of severe SARS-CoV-2 infection, including death.” Akriti G. Jain, MD, Hematology and Oncology Fellow at the Moffitt Cancer Center and Research Institute and the University of South Florida, Healio said. “It is uncertain whether patients with AML and myelodysplastic syndrome, who often have a quantitative or qualitative deficiency in neutrophils and / or lymphocytes, will develop protective immunity from SARS-CoV-2 vaccines. Therefore, we conducted this study with the primary aim of improving the immune response and safety profile to the mRNA-1273. to describe [Moderna] Vaccine among a cohort of patients with AML and myelodysplastic syndrome. ”
The analysis included 46 patients (mean age at vaccination 68 years; range 37-85; 58.7% men; 95.7% white) with AML (n = 30) and myelodysplastic syndrome (n = 16) who were on Moffitt Cancer Center and Research were enrolled at the institute from January 12th to January 25th.
Akriti G. Jaina
Researchers gathered information about baseline characteristics, cancer diagnoses, treatments received, and disease status through chart reviews. The median time from diagnosis to the start of the vaccination series was 24.3 months (range 4.5-105) and 15 patients (32.6%) received active treatment for their disease during vaccination (13% with hypomethylating agents, 4, 3% with an erythroid ripening). 2.2% with immunomodulatory drugs and 13% with targeted therapy).
Most patients (87%) were in remission at the time of vaccination and more than two-thirds (69.6%) had undergone an allogeneic stem cell transplant.
Investigators took blood samples from patients before the first and second vaccine dose (days 1 and 29) and approximately 4 weeks after the second dose (day 57) for antibody analysis. They used a two-step enzyme-linked immunosorbent assay to assess serostatus, measure immunoglobulin G responses, and used Fisher’s exact test or the chi-square test to compare COVID-19 antibody positivity rates . In addition, they used the Kruskal-Wallis test to examine the association between COVID-19 antibody titers and patient characteristics, and a paired T-test to examine the differences in COVID-19 antibody titers from day one to after the first and second vaccination to analyze.
The results showed that of the total cohort, 69.6% of patients were seropositive on day 29 (after the first dose of vaccine) and 95.7% were seropositive on day 57 (after two doses of vaccine). Most patient characteristics – including age, gender, race, disease status, time to vaccination after disease diagnosis, therapy at time of vaccination, and whether on active treatment – did not significantly affect the seropositivity rate.
The researchers found significantly higher antibody titers after the second vaccine dose compared to the first dose (mean 3,806.5 vs. 315; P <0.0001) and reported that differences were noted between patient subgroups. The most common side effects after vaccination included mild pain at the injection site, tiredness, headache, and arm swelling.
“In this observational study, the vast majority of patients with AML and myelodysplastic syndrome converted to seropositivity after two doses of the vaccine. Most clinical and laboratory variables (including neutropenia and lymphopenia) did not affect the seropositivity rate, ”Jain told Healio. “More importantly, antibody titers rose dramatically after the second dose of vaccine, indicating the potential benefit of serial vaccination in poorly responding patients.”
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Douglas Tremblay, MD
This study is encouraging to clinicians and patients alike, as COVID-19 vaccination elicits a strong humoral immune response in patients with MDS and AML despite high rates of disease-related neutropenia and lymphopenia. In fact, almost all patients became seropositive after two doses.
While we have always encouraged our patients to get COVID-19 vaccination, this study provides further rationale and can help advise patients who are concerned about how their AML or MDS might affect antibody responses to vaccination.
Previous studies suggest that COVID-19 is disproportionately more severe in patients with MDS or AML. Results in the age of vaccination are less clear, so longer follow-up is important to see if the antibody response leads to an improvement in the severity of disease and death. In addition, the additional benefit of the booster must be examined from both a serological and a clinical point of view.
Douglas Tremblay, MD
Table Cancer Institute
Icahn School of Medicine on Mount Sinai
Disclosure: Tremblay does not report any relevant financial information.
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