Patients with blood cancers show immune response to COVID-19 vaccine boosters
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Less than half of patients with hematologic malignances exhibited seroconversion after receiving their initial COVID-19 vaccine, research published in Cancer showed.
However, 56% of these nonresponders showed evidence of detectable COVID-19 antibodies after a booster.
Additionally, none of the patients in the study who were seronegative after a booster and subsequently received preexposure prophylaxis with tixagevimab plus cilgavimab (Evusheld, AstraZeneca) developed COVID-19.
Investigators said the results underscore the importance of booster shots and use of preventive monoclonal antibodies among this patient population at high risk for developing severe COVID-19.
Background
Several previous studies have shown patients with hematologic malignancies are less likely to produce an antibody response to initial COVID-19 vaccination, according to Thomas A. Ollila, MD, hematologist/oncologist with Lifespan Cancer Institute and assistant professor of medicine at Alpert Medical School of Brown University.
Motivation for this analysis came from patients, many of whom have asked whether they should receive boosters and what effect they may have, Ollila added.
“I always encourage my patients to receive a booster, and so we decided to check whether patients who did not mount an antibody response to initial vaccines would do so after receiving a booster,” he told Healio. “In addition, with the availability of prophylactic [monoclonal antibodies], we wanted to have an idea of how protected our patients could feel once they had received it. Many patients with lymphoma, even those now free of disease, were essentially isolating given the known increased risk for severe COVID-19, so as much information as we can give them regarding risk is helpful.”
Methodology
Ollila and colleagues conducted a retrospective study of 378 adults (median age, 69.7 years; range, 62.2-77.6) with hematologic malignancies who received initial and booster doses of one of three FDA-approved COVID-19 vaccines between February 2021 and February 2022. The study included patients with any type of lymphoid, myeloid or plasma cell malignancy.
Investigators used quantitative antibody testing to determine vaccine response and subsequently followed patients for COVID-19-related outcomes.
Key findings
Antibody analysis showed seroconversion in 181 patients (48%) after initial vaccination. Seroconversion was detected among 48 of 85 initial vaccine nonresponders (56%) after receiving a booster of a COVID-19 vaccine.
A total of 33 patients (8.8%) in the study group developed COVID-19 infection.
Three deaths attributed to COVID-19 occurred among study patients; however, none of the patients who developed antibodies after vaccine or booster doses died of subsequent COVID-19.
None of the 25 patients who received preexposure prophylactic tixagevimab plus cilgavimab developed subsequent COVID-19 infection.
Clinical implications
The study findings “speak to the importance of booster shots” and have helped guide more informed treatment-related discussions with patients, Ollila said.
“Both patients on and off treatment responded to boosters, so I no longer tell patients to wait a specified time after completion of therapy,” he told Healio.
“We also only noted deaths from COVID-19 in people who had undetectable antibodies,” Ollila added. “This does not mean that patients with detectable antibodies are not at risk, but it does provide some reassurance that they have a degree of protection, especially as they look to start living their lives again after the isolation of treatment during a pandemic.”
The results also help establish real-world evidence of Evusheld’s efficacy, at least for the initial omicron variant, Ollila said.
“Patients without detectable antibodies should know that they are at significantly increased risk for severe disease or death from COVID,” he said. “For those with undetectable or low antibodies, their providers should discuss prophylactic [monoclonal antibody] therapy, because it does appear effective in this population.”
For more information:
Thomas A. Ollila, MD, can be reached at Alpert Medical School of Brown University, Rhode Island Hospital, George Building, Suite 310, 593 Eddy St., Providence, RI 02903; email: thomas_ollila@brown.edu.
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Ollila TA, et al. Cancer. 2022;doi:10.1002/cncr.34354.
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