Spanish Society of Hematology and Hemotherapy expert consensus opinion for SARS-CoV-2 vaccination in onco-hematological patients

Abstract

In the midst of the COVID-19 pandemic, different vaccines in front of SARS-CoV-2 have been approved and administered in different vulnerable populations. As patients with cancer were excluded from pivotal trials of vaccination, little is known on their immunogenic response to these vaccines, particularly in patients with severely impaired immune system. In response to that uncertainty, the Spanish Society of Hematology and Hemotherapy launched an initiative aimed to provide recommendations for vaccination of the main hematological conditions. This document is based on the available information on COVID-19 outcomes, prior knowledge on vaccination in hematological patients, recent published data on serological response in oncohematological patients and expert opinions. New information about SARS-CoV-2 vaccination will be gathered in the near future, providing new scientific grounds to delineate the most adequate management of vaccination in patients with hematological diseases. The current limited data on SARS-CoV-2 vaccines in hematological patients represents a major limitation of this expert consensus opinion. In fact, the speed in which this field evolves may reduce their validity in the near future.

SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders

“…We assessed seropositivity using serological ELISA or chemiluminescence immunoassay following manufacturer instructions according to their availability at the microbiology services of each participating center. As recommended by the SEHH, in vaccinated individuals serological testing included the detection of IgG against both the nucleocapsid (N) and surface (S) proteins (anti-N and anti-S IgG, respectively) [ 7 ]. Of the 1394 patients included, 1244 (89%) received quantitative assessment, whereas the remainder was assessed through qualitative testing.…”

“…The coronavirus infectious disease 2019 (COVID-19) pandemic caused by the new coronavirus (SARS-CoV-2) can have a dreadful impact in hematological patients, with mortality rates exceeding 25% [ 1 – 6 ]. SARS-CoV-2 vaccination is expected to reduce the severity of COVID-19 in these immunocompromised patients [ 7 – 11 ]. Although the antibody response after full SARS-CoV-2 vaccination in hematological patients is of a lower magnitude than in the general population [ 12 – 18 ], a clinical benefit is still expected, as is the case with influenza vaccination in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients [ 19 ].…”

One-year breakthrough SARS-CoV-2 infection and correlates of protection in fully vaccinated hematological patients

“…14 Hematology Division, Hospital Universitario Infanta Leonor, Madrid, Spain. 15 Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 16 Hematology Division, Hospital de Fuenlabrada, Madrid, Spain.…”

Applicability of probabilistic graphical models for early detection of SARS-CoV-2 reactive antibodies after SARS-CoV-2 vaccination in hematological patients

“…Hematological patients have proven to be the most vulnerable population to coronavirus infectious disease 2019 (COVID-19) pandemic caused by the new zoonotic coronavirus (SARS-CoV-2) in terms of delayed treatments, deferral of cell therapy procedures and more importantly suffering a relevant mortality that exceeds 25% [1][2][3][4][5][6]. Although hematological patients have been inexplicably excluded from randomized SARS-CoV-2 vaccine trials, national and scientific societies have actively recommended on SARS-CoV-2 vaccination in order to lessen the severity of COVID-19 in these immunocompromised patients [7][8][9][10][11]. Initial reports on antibody response after full SARS-CoV-2 vaccination in hematological patients have confirmed the lower antibody response rates compared to the general population [12][13][14][15][16][17][18].…”