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  3. Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario.
 

Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario.

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BORIS DOI
10.48350/175196
Date of Publication
November 9, 2022
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Author
Krekeler, Carolin
Reitnauer, Lea
Bacher, Vera Ulrike
Universitätsklinik für Hämatologie und Hämatologisches Zentrallabor
Khandanpour, Cyrus
Steger, Leander
Boeckel, Göran Ramin
Klosner, Justine
Tepasse, Phil-Robin
Kemper, Marcel
Hennies, Marc Tim
Mesters, Rolf
Stelljes, Matthias
Schmitz, Norbert
Kerkhoff, Andrea
Schliemann, Christoph
Mikesch, Jan-Henrik
Schmidt, Nicole
Lenz, Georg
Bleckmann, Annalen
Shumilov, Evgenii
Subject(s)

600 - Technology::610...

Series
Cancers
ISSN or ISBN (if monograph)
2072-6694
Publisher
MDPI AG
Language
English
Publisher DOI
10.3390/cancers14225512
PubMed ID
36428605
Uncontrolled Keywords

COVID-19 booster vacc...

Description
BACKGROUND

Two-dose COVID-19 vaccination often results in poor humoral response rates in patients with hematologic malignancies (HMs); yet responses to COVID-19 booster vaccines and the risk of COVID-19 infection post-booster are mostly uncertain.

METHODS

We included 200 outpatients with HMs and predominantly lymphoid neoplasms (96%, 191/200) in our academic center and reported on the humoral responses, which were assessed by measurement of anti-spike IgG antibodies in peripheral blood as early as 14 days after mRNA-based prime-boost vaccination, as well as factors hampering booster efficacy. Previous basic (double) immunization was applied according to the local recommendations with mRNA- and/or vector-based vaccines. We also report on post-booster COVID-19 breakthrough infections that emerged in the Omicron era and the prophylaxis strategies that were applied to poor and non-responders to booster vaccines.

RESULTS

A total of 55% (110/200) of the patients achieved seroconversion (i.e., anti-spike protein IgG antibody titer > 100 AU/mL assessed in median 48 days after prime-boost vaccination) after prime-boost vaccination. Multivariable analyses revealed age, lymphocytopenia, ongoing treatment and prior anti-CD20 B-cell depletion to be independent predictors for booster failure. With each month between anti-CD20-mediated B-cell depletion and booster vaccination, the probability of seroconversion increased by approximately 4% (p < 0.001) and serum-antibody titer (S-AbT) levels increased by 90 AU/mL (p = 0.011). Notably, obinutuzumab treatment was associated with an 85% lower probability for seroconversion after prime-boost vaccination compared to rituximab (p = 0.002). Of poor or non-responders to prime-boost vaccination, 41% (47/114) underwent a second booster and 73% (83/114) underwent passive immunization. COVID-19 breakthrough infections were observed in 15% (29/200) of patients after prime-boost vaccination with predominantly mild courses (93%). Next to seroconversion, passive immunization was associated with a significantly lower risk of COVID-19 breakthrough infections after booster, even in vaccine non-responders (all p < 0.05). In a small proportion of analyzed patients with myeloid neoplasms (9/200), the seroconversion rate was higher compared to those with lymphoid ones (78% vs. 54%, accordingly), while the incidence rate of COVID-19 breakthrough infections was similar (22% vs. 14%, respectively). Following the low frequency of myeloid neoplasms in this study, the results may not be automatically applied to a larger cohort.

CONCLUSIONS

Patients with HMs are at a high risk of COVID-19 booster vaccine failure; yet COVID-19 breakthrough infections after prime-boost vaccination are predominantly mild. Booster failure can likely be overcome by passive immunization, thereby providing immune protection against COVID-19 and attenuating the severity of COVID-19 courses. Further sophistication of clinical algorithms for preventing post-vaccination COVID-19 breakthrough infections is urgently needed.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/115631
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