Новая Коронавирусная Инфекция COVID-19 И Состояние Гуморального Иммунного Ответа У Пациентов С Гематологическими Злокачественными Опухолями

Abstract

AIM. To study the baseline condition of the humoral component in the adaptive immune system and its changes in patients with hematologic malignancies who received the standard chemotherapy with and without monoclonal antibodies (mAb) after a COVID-19 infection. MATERIALS & METHODS. The study enrolled 51 patients with hematologic malignancies (AL, NHL, cHL, MM, CMPN). They were treated at the NN Burdenko Main Military Clinical Hospital. Patients were aged 24–84 years (median 50.6 years); there were 14 women and 37 men. The control group consisted of 16 healthy medical professionals working at the hospital who had had COVID-19. The main group included a subgroup of patients (n = 21) treated with mAb chemotherapy. In all patients, blood serum was tested for anti-SARS-CoV-2 antibodies of different classes. RESULTS. Significant differences were identified while assessing the level of IgG antibodies to SARS-CoV-2 S1-protein in lymphoma and multiple myeloma patients (median 431 BAU/mL vs. 667 BAU/mL; p < 0.05) as well as in patients with lymphomas and chronic myeloproliferative neoplasms (median 431 BAU/mL vs. 705 BAU/mL; p < 0.05). The juxtaposition of the control (n = 16) and main (n = 51) groups showed that their median levels of anti-SARS-CoV-2 IgG antibodies did not differ and accounted for 15.7 units. In the groups of patients with (n = 21) and without (n = 30) mAb chemotherapy, by the semi-quantitative method, the median levels of IgM/IgG antibodies to the S1-protein receptor-binding domain and SARS-CoV-2 nucleocapsid proteins accounted for 10.1 units vs. 16.1 units (p < 0.05). In the same groups of patients, the quantitative method yielded the median levels of anti-SARS-CoV-2 S1-protein IgG antibodies of 433 BAU/mL and 595 BAU/mL, respectively (p < 0.05). CONCLUSION. Patients with hematologic malignancies show a decline in the levels of anti-SARS-CoV-2 S-protein IgG antibodies. Non-recipients of mAb chemotherapy have a higher level of anti-SARS-CoV-2 IgG antibodies. Patients with an indication for mAb chemotherapy (rituximab and obinutuzumab) need to be protected from COVID-19 by means of epidemiological preventive measures. One of them is anti-SARS-CoV-2 vaccination prior to mAb chemotherapy onset or post-exposure prophylaxis with recombinant humanized IgG mAbs tixagevimab + cilgavimab.