Humoral Immune Response in Hematooncological Patients and Health Care Workers Who Received SARS-CoV-2 Vaccinations

Abstract

IMPORTANCETo our knowledge, little is known about antibody development after SARS-CoV-2 vaccination in immunocompromised individuals, such as patients with cancer.OBJECTIVE To determine whether hematooncological patients develop anti-SARS-CoV-2 antibodies after vaccination. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included 2 independent cohorts of patients who were treated for hematological and solid malignant tumors between October 2020 and May 2021, comprising 901 samples from 595 patients and 58 health care workers (HCWs). Serum samples were collected from patients who were treated at an academic center and a community hospital in a rural area and a control group of HCWs, all of whom received SARS-CoV-2 vaccination. MAIN OUTCOMES AND MEASURESTotal anti-SARS-CoV-2 nucleocapsid (anti-NC) and antispike protein (anti-S) antibodies were measured retrospectively. RESULTS In total, 595 patients (320 women [53.8%] and 275 men [46.2%]; median [range] age, 67 [19-96] years) and 58 HCWs (40 women [69.0%] and 18 men [31.0%]; median [range] age, 42 [24-60] years) were included. Previous SARS-CoV-2 infection was documented in 43 of 595 (7.2%), while anti-NC antibodies that suggested previous infections were observed in 49 of 573 evaluable patients (8.6%). In both cohorts, anti-S antibody levels were higher in fully vaccinated patients compared with patients who received 1 dose. After the first vaccination, patients with hematological cancer who received B cell-targeting agents had lower anti-S levels (median, 1.6 AU/mL; range: 0-17 244 AU/mL) than patients who received other therapies (median, 191.6 AU/mL; range, 0-40 000; P < .001) or patients with solid tumors (median, 246.4 AU/mL; range, 0-40 000 AU/mL; P < .001). Anti-S levels after the first vaccination differed according to ongoing antineoplastic treatment modalities, with the lowest median levels in patients who received chemotherapy alone (157.7 AU/mL; range, 0-40 000 AU/mL) or in combination with immunotherapy (118.7 AU/mL; range, 14.1-38 727 AU/mL) and the highest levels in patients with no ongoing antineoplastic treatment (median, 634.3 AU/mL; range, 0-40 000 AU/mL; P = .01). Antibody levels after full immunization were higher in HCWs (median, 2500 U/mL; range, 485-2500 U/mL) than in patients with cancer (median, 117.0 U/mL; range, 0-2500 U/mL; P < .001). CONCLUSIONS AND RELEVANCEIn this cohort study of patients with hematooncological diseases and a control group of HCWs, anti-SARS-CoV-2 antibodies after vaccination could be detected in patients with cancer. Lower antibody levels compared with HCWs and differences in seroconversion in specific subgroups underscore the need for further studies on SARS-CoV-2 vaccination in patients with hematooncological disease.

Seroconversion rate after vaccination against COVID-19 in patients with cancer—a systematic review

“…28,29,40 Findings from prospective clinical trials with a longer follow-up will further elucidate how to tailor vaccination in special populations. [90][91][92][93] A major obstacle to achieve herd immunity is vaccine hesitancy. 94 In the specific population of PsC, vaccine acceptance is generally higher than in other patient populations.…”

“…FFP-2 masks), for at least 6-8 weeks after the first vaccine dose, and to not postpone the second dose, if possible. 48,92,93 In addition, households and other close contacts of immunocompromised patients should be vaccinated. 48,85…”

Short-term effectiveness of COVID-19 vaccines in immunocompromised patients: A systematic literature review and meta-analysis

“…Prior studies demonstrated chronic kidney disease patients undergoing hemodialysis have more IgG antibody levels after receiving COVID-19 vaccines than kidney transplant recipients ( 26 , 30 ). Also, a recent European cohort study of patients with hemato-oncological diseases and a control group of HCWs suggested that patients with cancer developed lower antibody, and those receiving chemotherapy and B cell-targeting agents showed a particularly impaired serological response ( 9 ). This could suggest that the immunosuppressant therapy may be a critical factor implicated in this lack of humoral response.…”

“…Other studies evaluated the humoral immune response among these patients ( 8 ). Studies suggested that immunocompromised patients who received COVID-19 vaccines might not develop high neutralizing antibody titers or be as protected against severe COVID-19 outcomes as are immunocompetent patients ( 9 , 10 ). Vaccine responsiveness in patients who were receiving an immunosuppressor drug therapy exhibited impaired serological immune responses ( 9 , 11 ).…”

“…Studies suggested that immunocompromised patients who received COVID-19 vaccines might not develop high neutralizing antibody titers or be as protected against severe COVID-19 outcomes as are immunocompetent patients ( 9 , 10 ). Vaccine responsiveness in patients who were receiving an immunosuppressor drug therapy exhibited impaired serological immune responses ( 9 , 11 ). Though there is growing evidence that VE and immune response among immunocompromised patients seem lower than in healthy people, limited data are available ( 4 , 6 , 8 ).…”