Tolerability of Coronavirus Disease 2019 Vaccines, BNT162b2 and mRNA-1273, in Patients With Thymic Epithelial Tumors

Abstract

Introduction Defects in immunological self-tolerance result in an increased risk for development of autoimmune paraneoplastic diseases (AD) and immune-mediated toxicity in response to immune stimulation in individuals with thymic epithelial tumors (TETs). We conducted a survey to evaluate the tolerability of Covid-19 messenger RNA (mRNA) vaccines in patients with TETs, including individuals with pre-existing AD. Methods After reviewing published data on adverse events (AEs) associated with the BNT162b2 (Pfizer, Inc., and BioNTech) and mRNA-1273 (ModernaTX, Inc.) mRNA vaccines, we designed and administered a questionnaire to participants at three timepoints: after each dose of vaccination and one month following the final dose. Questions related to AD and use of immunosuppressive drugs were included. Descriptive statistics were used to analyze data and results were compared with previously described results related to the BNT162b2 and mRNA-1273 vaccines. Results From February 26 th and June 1 st , 2021, we administered the survey to 54 participants (median age: 58 years; thymoma: 33; pre-existing AD: 19). Common AEs included injection-site pain, fatigue, and headaches. There were no vaccination-related hospitalizations or deaths. Autoimmune flares occurred in three (16%) patients after the first dose and three (17%) patients after the second dose. The majority of AD flares were mild and self-limited. One patient (2%) was diagnosed with a new AD following vaccination. Conclusions Tolerability of COVID-19 mRNA vaccines in patients with TETs is comparable to the general population. Most patients with pre-existing AD did not experience disease flares and the development of new AD was rare. Patients with TETs should be encouraged to get vaccinated against COVID-19 due to the documented benefits of vaccination and manageable risk profile.

Correspondence Regarding “Tolerability of Coronavirus Disease 2019 Vaccines BNT162b2 and mRNA-1273 in Patients With Thymic Epithelial Tumors”

“…However, the frequency of axillary lymphadenopathy after BNT162b2 vaccination was not stated by Ballman et al. 1 The frequency of axillary lymphadenopathy after BNT162b2 vaccination in patients with TETs remains unclear and is of high interest to clinicians.…”

“…The purpose of this letter is to provide additional context for the results of Ballman et al. 1 and their implications for the vaccination of patients with TETs.…”

“…In the Ballman et al. 1 study, one patient (1 of 29, 3.45%) with TET who received the mRNA-1273 vaccine experienced axillary lymphadenopathy, whereas 1956 participants (14.03%) in the clinical trials of this vaccine experienced axillary lymphadenopathy after a second dose. However, the frequency of axillary lymphadenopathy after BNT162b2 vaccination was not stated by Ballman et al.…”

“…We read the research article by Ballman et al. 1 recently published in JTO Clinical and Research Reports with great interest. The authors conducted a survey to evaluate the tolerability of two coronavirus disease 2019 (COVID-19) mRNA vaccines in patients with thymic epithelial tumors (TETs) and concluded that tolerability was comparable with that in the general population.…”

“…Therefore, some patients in the study by Ballman et al. 1 might have been treated with granulocyte colony stimulating factor. On the basis of these previous findings, details on concomitant treatments administered in this cohort would be highly informative.…”