Responses to COVID-19 vaccination vary after treatment for lymphoid malignancies
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Patients with lymphoid malignancies who received anti-CD20 therapy within the previous year did not demonstrate antibody responses to the messenger RNA COVID-19 vaccines, according to study results published in Blood Advances.
“It has been observed that patients with lymphoid malignancies are at increased risk for COVID-19 and are at high risk for poor outcomes,” Jennifer L. Crombie, MD, oncologist and instructor in medicine at Dana-Farber Cancer Institute, told Healio. “Although vaccines have been shown to be effective in preventing or decreasing the severity of COVID-19, patients with lymphoma and chronic lymphocytic leukemia have not been included in vaccine trials. In this study, we aimed to evaluate antibody responses following vaccination with an mRNA COVID-19 vaccine in patients with lymphoma and CLL.”
The prospective study included 23 patients (median age, 69 years) undergoing various phases of treatment for lymphoid malignancies who received either the BNT162b2 (Pfizer; n = 16) or mRNA-1273 (Moderna; n = 7) vaccine.
Most patients (61%) had CLL and 39% had lymphoma, including diffuse large B-cell lymphoma (13%), mantle cell lymphoma (13%), follicular lymphoma (4%), marginal zone lymphoma (4%) and Hodgkin lymphoma (4%). Overall, 17 patients received prior treatment, including 15 treated with an anti-CD20 monoclonal antibody therapy (six within the previous year). Patients who underwent CAR T-cell therapy or autologous stem cell transplant received the vaccine at least 3 months after initiation of therapy.
Plasma samples were collected before the first vaccine dose, at the time of the second dose and 28 days later. Samples were analyzed for COVID-19 antibodies and results were compared with those of 23 otherwise healthy controls (median age, 24 years) with plasma samples collected at the same intervals.
Results showed none of the patients who underwent anti-CD20 therapy within the previous year produced antibodies to COVID-19 by day 28 after the second vaccine dose. Conversely, patients with lymphoma or CLL who had not undergone prior cancer therapy did develop antibodies, whereas those currently on therapy had more variable antibody responses.
“Although not surprising, one key finding was that patients who received anti-CD20 therapy within the past 12 months were not able to develop an antibody response to the vaccine,” Crombie said. “It was surprising, however, that responses were more variable following recent treatment with other therapies including CAR T-cell therapy, other chemotherapy regimens and targeted agents. Although responses can vary by treatment and disease, our data suggest that patients with lymphoid malignancies should continue to be cautious despite vaccination.”
Crombie and colleagues are conducting a follow-up study evaluating antibody response after vaccination, as well as booster doses in a larger cohort of patients with lymphoid malignancies.
“We are also looking into T-cell responses following vaccination in patients with lymphoid malignancies,” Crombie added.
For more information:
Jennifer L. Crombie, MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: jennifer_crombie@dfci.harvard.edu.
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