ABSTRACT
Little is known about the immune response to SARS-CoV-2 vaccination in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, several studies have reported that adequate protection could be provided to this population. The purpose of this study was to evaluate which factors can predict the efficacy of SARS-CoV-2 vaccination in these specifically immunosuppressed patients. Specific anti-Spike (S) antibody responses were assessed in a cohort of 117 allo-HSCT recipients after 2 injections of BNT162b2 mRNA SARS-CoV-2 vaccine (V1 and V2). Factors considered liable to influence the antibody response and analyzed in this series were the interval between allo-HSCT and V1, donor source, recipient and donor age, current immunosuppressive/chemotherapy (I/C) treatment, and levels of CD4+and CD8+ T cells, B cells, and natural killer cells at the time of V1. Overall, the S-antibody response rate, evaluated at a median of 35 days after V2, was 82.9% for the entire cohort, with 71 patients (61%) reaching the highest titer. In univariate analysis, a lower pre-V1 median total lymphocyte count, lower CD4+ T cell and B cell counts, ongoing I/C treatment, and a haploidentical donor were characteristic of nonhumoral responders. However, multiparameter analysis showed that B cell aplasia was the sole factor predicting the absence of a specific immune response (odds ratio, 0.01; 95% confidence interval, 0.00 to 0.10; P < 10-3). Indeed, the rate of humoral response was 9.1% in patients with B cell aplasia versus 95.9% in patients with a B cell count >0 (P < 10-9). These results advocate for the administration of anti-SARS-CoV-2 vaccination in allo-HSCT recipients as early as peripheral B cell levels can be detected, and also suggest the need for close monitoring of B-cell reconstitution after Allo-HSCT.
Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , BNT162 Vaccine , Biomarkers , CD8-Positive T-Lymphocytes , COVID-19/prevention & control , COVID-19 Vaccines , Hematopoietic Stem Cell Transplantation/methods , Humans , RNA, Messenger , SARS-CoV-2 , VaccinationSubject(s)
BNT162 Vaccine/therapeutic use , COVID-19/prevention & control , Adult , Aged , Allografts , Antibodies, Viral/immunology , Antibody Formation , BNT162 Vaccine/administration & dosage , COVID-19/immunology , Female , Humans , Male , Middle Aged , Organ Transplantation , Retrospective Studies , SARS-CoV-2/immunology , Stem Cell Transplantation , Transplantation, Homologous , Young AdultSubject(s)
Antibodies, Viral/biosynthesis , BNT162 Vaccine/immunology , COVID-19/prevention & control , Immunoglobulin G/biosynthesis , Immunotherapy, Adoptive , SARS-CoV-2/immunology , Adult , Aged , Antigens, Viral/immunology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , BNT162 Vaccine/adverse effects , Biological Products/therapeutic use , Combined Modality Therapy , Female , Fever/etiology , Hematopoietic Stem Cell Transplantation , Humans , Immunization, Secondary , Immunocompromised Host , Immunogenicity, Vaccine , Lymphoma, Non-Hodgkin/immunology , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Pain/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Receptors, Antigen, T-Cell/therapeutic use , Receptors, Chimeric Antigen/therapeutic use , Spike Glycoprotein, Coronavirus/immunology , Vaccination , Young AdultABSTRACT
This was a monocentric prospective study testing the efficacy and safety of a first injection of BNT162b2 (Pfizer-BioNTech) in 112 Allo-HSCT patients. Antibody response to SARS-CoV-2 spike protein receptor-binding domain was tested at the time of the second injection (Roche Elecsys). The study also included a non-randomized control arm of 26 healthy controls. This study shows that a first dose of SARS-CoV-2 messenger RNA vaccine is safe and provides a 55% rate of seroconversion in allotransplanted patients compared to 100% for the controls (p < 0.001). Factors influencing the absence of response in patients were recent transplantation (<2 years), lymphopenia (<1 × 109/L) and immunosuppressive treatment or chemotherapy at the time of vaccination.