Certain patients with hematologic diseases have poor, no response to COVID-19 vaccination
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Nearly one in six patients with hematologic disorders had a negative COVID-19 vaccination-related antibody response, according to results of a prospective, observational single-center study presented at ASH Annual Meeting and Exposition.
Patients with myeloid neoplasms, lymphoid neoplasms and nonmalignant hematologic diseases were among those most likely to have a negative response after a second vaccination. However, all patients with chronic myeloid leukemia had a measurable immune response.
“Preventive vaccination in this patient cohort demonstrated reduced efficacy. Knowledge of influencing factors is limited,” Susanne Saussele, MD, professor at University Hospital Mannheim of Heidelberg University and head of the CML Excellence Center in Mannheim, Germany, told Healio. “The aim of our study was to evaluate vaccination-related antibody response to BNT162b2 (Pfizer/BioNTech), mRNA-1273 (Moderna) and ChADOx1 (AstraZeneca) in patients with hematologic diseases and identify factors influencing vaccination response.”
The analysis included 373 patients with hematologic diseases (median age, 64 years; 44% women) whose antibody levels were measures at least 14 days (median, 58) after a second COVID-19 vaccination. Among them, 338 (90.6%) had a malignant hematologic disease (myeloid neoplasms, n = 214; lymphoid neoplasms, n = 124) and 35 had a nonmalignant hematologic disease (autoimmune disease, n = 26; benign, n = 9). Additionally, 229 patients (70%) were on active therapy and 144 patients (44%) were previously treated or treatment-naive, researchers noted.
Most patients (n = 289) received the BNT162b2 mRNA vaccine, whereas 36 received mRNA-1273, 26 received ChADOx1 and 22 received ChADOx1 followed by BNT162b2.
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 antibody concentration of 0.8 U/mL or higher.
Researchers analyzed data for all patients without detection of an anti-N (nucleocapsid) SARS-CoV-2 antibody.
Results showed positive vaccination-related antibody response in 317 patients (85%), with a median level of 197 U/mL (range, 0.8-250), and negative response in 56 patients (15%). Most (70%) of those with a negative response had lymphoid neoplasms, 23% had myeloid neoplasms and 7% had nonmalignant hematologic disease. In addition, 39 patients in the negative cohort (70%) were treated on active therapy and 17 (30%) were previously treated or were treatment-naive.
Analyses also revealed among the 13 patients with myeloid neoplasms and a negative response, those with classical myeloproliferative neoplasm had the highest negative result for antibodies, followed by myelodysplastic syndrome. Additionally, all patients with CML had a measurable immune response.
Meanwhile, among patients with lymphoid neoplasms, those with low-grade non-Hodgkin lymphoma had the highest negative antibody result (45%), followed by high-grade non-Hodgkin lymphoma, (18%, predominately diffuse large B-cell lymphoma).
Only patients with autoimmune diseases had a negative result among those with nonmalignant hematologic diseases.
Treatment with ruxolitinib (Jakafi, Incyte), rituximab (Rituxan; Genentech, Biogen) and ibrutinib (Imbruvica; Pharmacyclics, Janssen) correlated with negative vaccination response, whereas younger age and CML were associated with positive response, researchers noted.
“In conclusion, a remarkable group of patients with hematologic diseases had no response after second COVID-19 vaccination,” Saussele told Healio. “We were able to identify additional therapies that correlated with negative response. The results serve as a guide for better protection and surveillance in this vulnerable patient cohort.”
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Rotterdam J, et al. Abstract 218. Presented at: ASH Annual Meeting and Exposition; Dec. 11-14, 2021; Atlanta.
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