ABSTRACT
OBJECTIVE: To evaluate the magnitude of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with cancer receiving active therapies. PATIENTS AND METHODS: Patients 18 years or older in whom SARS-CoV-2 spike antibody (anti-S Ab) levels were measured after 2 doses of SARS-CoV-2 mRNA vaccines were included. Patients with prior coronavirus disease 2019 (COVID-19) infection or receiving other immunosuppressive therapy were excluded. RESULTS: Among 201 patients who met the criteria, 61 were immunocompetent, 91 had a hematologic malignancy, and 49 had a solid malignancy while receiving treatments associated with cytopenia, including chemotherapy or cyclin-dependent kinase 4 and 6 inhibitors. A significantly greater proportion of immunocompetent patients (96.7% [59 of 61]) had anti-S Ab titers of 500 U/mL or greater compared to patients with hematologic (7.7% [7 of 91) and solid (55.1% [27 of 49]) malignancy (P<.001). Despite 2 doses of SARS-CoV-2 mRNA vaccines, 52.7% of patients with hematologic malignancy (48 of 91) and 8.2% of those with solid malignancy (4 of 49) receiving cytopenic therapy had no seroconversion (spike antibody titers <0.8 U/mL). Two patients subsequently had development of breakthrough COVID-19 infection after full vaccination. CONCLUSION: A substantial proportion of patients with hematologic and solid malignancies receiving chemotherapies and CDK4/6i had poor humoral responses after SARS-CoV-2 mRNA vaccination. Our study adds to a growing body of literature suggesting that immunosuppressed patients have a suboptimal humoral response to COVID-19 vaccination. Our study also underscores the importance of assessing antibody response after COVID-19 vaccines in these vulnerable patients.
ABSTRACT
A 55-year-old asymptomatic woman with newly diagnosed, locally advanced breast cancer undergoing routine staging with 2-deoxy-2[18F]fluoro-d-glucose positron emission tomography/computed tomography was found to have multiple hypermetabolic pulmonary nodules on imaging that were concerning for metastatic disease. However, further workup with dedicated chest computed tomography imaging demonstrated multiple bilateral, peripheral nodular lesions with peripheral ground-glass opacity, predominantly in the lower lung zone, that were suspicious for coronavirus disease 2019. The patient ultimately was diagnosed with coronavirus disease 2019 based on detection of viral ribonucleic acid via polymerase chain reaction. Follow-up chest computed tomography scan obtained after 27 days showed complete resolution of the lung lesions. In the setting of a global pandemic, a high index of suspicion for coronavirus disease 2019 in cancer patients is warranted, not only to enable early identification and treatment of a potentially aggressive infection but also to prevent misdiagnosis of metastatic disease.