Antibody Response Post-COVID-19 Vaccination in Patients With Chronic Myeloid Leukemia With Comparison Between Comirnaty and CoronaVac Vaccine

Abstract

Dear Editor, Chronic myeloid leukemia (CML) is a type of myeloproliferative neoplasm characterized by an oncogenic fusion gene, BCR-ABL1. Most CML patients present at chronic phase, ~90%, 1 when BCR-ABL1 tyrosine kinase inhibitor (TKI) is the recommended first-line treatment. Antibody response after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in CML patients is concerned due to probable CML-induced and/or TKI-induced immunosuppression. To our knowledge, two studies reported antibody response post-SARS-CoV-2 vaccine in CML patients. 2,3 A study reported anti-spike SARS-CoV-2 IgG (IgG-S) responses > 14 days after a dose of Comirnaty (Comirnaty or BNT162b2, Pfizer-BioNTech) (n = 1) or ChAdOx1 (ChAdOx1 nCoV-19 or AZD1222, AstraZeneca-Oxford) (n = 11) vaccine. 2 Seroconversion rate post-ChAdOx1 was lower than control group, 8/11 (73%) versus 58/63 (92%). 2 A study reported response 3 weeks (W) after a dose of Comirnaty (n = 16) using a different laboratory methodology. 3 As data are scarce and less so on CoronaVac (Sinovac) vaccine in CML patients, we conducted a longitudinal study on antibody progression post-SARS-CoV-2 vaccination in CML patients from southern Sarawak. We present the comparison of antibody response at 6 weeks (W6) and 16 weeks (W16) between Comirnaty and CoronaVac vaccine in the cohort.Titer of IgG-S was determined prior to vaccination (W0) and at 3 weeks (W3), 6 weeks (W6), 16 weeks (W16), 32 weeks (W32), and 52 weeks (W52) in reference to the first dose of vaccination. The second dose of vaccine was the same vaccine type as the first dose and it was scheduled at 3 weeks after the first dose for both vaccines. Vaccines were under Malaysia vaccination program and generally type of vaccine was not decided by patients.A total of 43 CML patients were enrolled from August 26, 2021, to November 30, 2021. Results presented were until December 9, 2021. At study entry, 23 (53%), 11 (26%), two (5%), one (2%), and two (5%) patients were on imatinib, nilotinib, dasatinib, bosutinib, and ponatinib, respectively; one (2%) patient on imatinib + peginterferon-α due to concomitant CML and essential thrombocythemia, and three (7%) patients were not on TKI as enrolled in Malaysia Stop TKI Trial (MSIT). 4 Most of them had completed second dose of vaccine during study entry.At W6, seroconversion rate post vaccination (IgG-S ≥ 50 AU/mL) was 42/43 (96.9%). The only nonseroconverted patient received ChAdOx1. Table 1 shows the comparison of IgG-S between Comirnaty and CoronaVac. After excluding patients with breakthrough COVID-19, median decline rate of IgG-S between W6 and W16 ([IgG-S W6 − IgG-S W16] / number of weeks between W6 and W16) was 165.2 (range = −155.8 to 334.0) and 67.8 (31.1 to 222.41) AU/ mL/week for Comirnaty (n = 6) and CoronaVac (n =7),

Anti-S Antibodies Against SARS-CoV-2 Infection Among Four Types of Vaccines in Malaysia

“…In one study done in Southern Sarawak (Malaysia) who received Pfizer, Sinovac, and AstraZeneca, the median of anti-S antibody levels was higher among Pfizer recipients too. 25 This is probably caused by several factors such as antigenic effects; the different mechanisms of action and ways of production are likely to introduce additional variation to the characteristics of immune responses and possible adverse reactions. In our study, only the Pfizer vaccine uses mRNA technology.…”