ABSTRACT
Introduction: The COVID-19 pandemic posed a major challenge in cancer care worldwide, which might have an impact on the management of hematologic malignancies. Aims: To compare the characteristics, management, and outcomes of diffuse large B-cell lymphoma (DLBCL) patients diagnosed during the first year of the COVID-19 pandemic compared to the previous year. Methods: This retrospective study compared DLBCL patients diagnosed from 1/3/2020 to 28/2/2021 and those diagnosed between 1/3/2019 and 28/2/2020 in two tertiary centers in Italy and Israel. Results: A total of 182 patients were diagnosed with DLBCL during the study period in both centers. More patients were diagnosed during the pandemic in both centers compared to the year before (60 vs. 29 and 54 vs. 39 in Italy and in Israel, respectively). Only in the Italian cohort was there a trend towards older age at diagnosis during the pandemic (68 vs. 61 years;P=0.13). The interval between the initiation of symptoms and diagnosis was longer during the pandemic for both cohorts. Five and four patients were diagnosed with COVID-19 during treatment in Italy and Israel, respectively. For both cohorts, there was no difference in dose density or intensity before or during the pandemic. Although in the Italian cohort there was a trend towards lower estimated 1-year PFS (73.7% vs. 89.7%;P=0.06) during the pandemic compared to the year before, there was no such difference in the Israeli cohort. In a univariate analysis for PFS in the Italian cohort, diagnosis during the pandemic was associated with 2.6-fold increased risk for progression (95% CI 0.9–7.2;P=0.07). In multivariate analysis, age was the only independent prognostic factor (HR 1.08, 95% CI 1.03–1.14;P<0.001). Conclusions: In both cohorts, patients' characteristics were comparable between the periods. Yet, more patients were diagnosed with DLBCL during the pandemic, and the interval between symptoms and diagnosis was longer compared to the year before. Still, there was no change in treatment in terms of dose density and intensity. The trend towards a shorter PFS during the outbreak in the Italian cohort can be explained by the older age of the patients treated during this period.
ABSTRACT
OBJECTIVES: To assess the humoral immune response to the BNT162b2 vaccine after allogeneic haematopoietic cell transplantation (HCT). METHODS: This is a prospective cohort study. The SARS-CoV-2 IgGII Quant (Abbott©) assay was performed 4-6 weeks after the second BNT162b2 vaccine for quantitative measurement of anti-spike antibodies. RESULTS: The cohort included 106 adult patients. Median time from HCT to vaccination was 42 (range 4-439) months. Overall, 15/106 (14%, 95% confidence interval (CI) 7-21%) were seronegative despite vaccination, 14/52 patients on immunosuppression (27%, 95%CI 19-35%) compared to only 1/54 patients off immunosuppression (1.8%, 95%CI 1-4%) (p 0.0002). The proportion of seronegative patients declined with time; it was 46% (6/13) during the first year, 12.5% (3/24) during the second year and 9% (6/69) beyond 2 years from transplant. Patients with acute graft-versus-host disease (GVHD) (odds ratio (OR) 3.3, 95%CI 0.97-11.1, p 0.06) and moderate to severe chronic GVHD (OR 5.9, 95%CI 1.2-29, p 0.03) were more likely to remain seronegative. Vaccination was well tolerated by most patients. However, 7% (7/106) reported that GVHD-related symptoms worsened within days following vaccination. CONCLUSION: A significant proportion of allogeneic HCT recipients receiving immunosuppression demonstrated an inadequate humoral response to the BNT162b2 vaccine. These patients should be recognized and instructed to take appropriate precautions. Recipients who were off immunosuppression had a humoral response that was comparable to that of the general population.