Infectious Disease

Stem cell transplant recipients respond well to COVID-19 vaccination, study results

09/22/2021

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LeBourgeois does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors. Hill reports that he has received grants and personal fees from Gilead Sciences; Amplyx personal fees; Allovir grants and fees; personal fees from Allogene Therapeutics, CSL Behring, CRISPR Therapeutics, Octapharma, and Optum Health; Takeda grants and personal fees; and grants from Karius.

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Hematopoietic stem cell recipients responded well to the Pfizer-BioNTech COVID-19 vaccine in a single center study, with 83% showing an antibody response after two doses, researchers reported on JAMA Network Open.

For your studies, Amandine LeBourgeois, MD, a doctor in the hematology department of Nantes University Hospital in Nantes, France, and colleagues recruited 121 hematopoietic stem cell transplant (HSCT) recipients with no clinical history of COVID-19 and no active graft-versus-host disease more than 3 months after the transplant .

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The vaccination took place from January 20th to August 17th. The researchers tested the antibody responses twice at the time of the second dose and then 1 month later. They considered titers greater than or equal to 0.8 U / ml to be positive, with the highest value greater than 250 U / ml.

Of the 121 patients enrolled, they had asymptomatic COVID-19 and were excluded from the study. The 117 remaining patients had an average age of 57 years (interquartile range [IQR] = 20-75 years) and 60% were male (n = 70). The median time between vaccination doses was 22 days (IQR = 16-37 days).

At the time of the second dose, 54% of the patients (n = 63) had a positive anti-spike antibody response, reported LeBourgeois and colleagues. IgG titers among those with responses were 15.8 U / ml and ranged from 0.9 U / ml to greater than 250 U / ml, they said. Four patients (3%) exceeded the 250 U / ml value.

The next antibody test took place a median 35 days (IQR = 18-77 days) after the second dose and was positive in 97 patients (83%). Of the 97 patients, 72 (62%) achieved the highest antibody titre.

According to the researcher, the lack of an antibody response was linked to haplo grafts, HSCT procedures done last year, lymphopenia, and recent immunosuppressive treatment or chemotherapy at the time of vaccination.

“This is much higher than the 54% seroconversion rate reported after two doses in solid organ transplant recipients, and compares well with data obtained in patients treated for solid tumors who have a response rate of 95% after the second dose, ”the authors wrote. “However, this humoral response is only a marker of immunity, and allogeneic HSCT recipients will likely have differences in T-cell reactivity that should be investigated.”

In a related editorial Joshua A. Hill, MD, a doctor in the vaccines and infectious diseases division at the Fred Hutchinson Cancer Research Center in Seattle, said the available data shows that giving COVID-19 vaccines should be a priority after allogeneic HSCT recipients. However, vaccines are only one aspect of a broader strategy.

“Patients who are in the first year after HCT or who remain immunosuppressed in some other way should initially regard SARS-CoV-2 as a serious threat despite vaccination and follow familiar behaviors: avoid high-risk exposure, mask, hand hygiene and ensure that their close contacts are vaccinated, ”wrote Hill. “Strategies for better protection [HSCT] SARS-CoV-2 infection recipients remain a high priority for the medical community. “

References:

LeBourgeois A, et al. JAMA network open. 2021; doi: 10.1001 / jamanetworkopen.2021.26344.

HillJA et al. JAMA network open. 2021; doi: 10.1001 / jamanetworkopen.2021.27454.

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