ABSTRACT
Background: Recent studies reported low rates of seroconversion response to COVID-19 vaccination in patients (pts) with hematologic malignancies (HMs). Vaccine choice among the 3 FDA-authorized products (BNT162b2/Pfizer-BioNTech, mRNA-1273/Moderna, or Ad26.COV2.S/J&J), prior therapy, and disease-specific factors may affect seroconversion. Addressing these factors may improve seroconversion rates and identify pts at risk of severe COVID-19 infection despite vaccination. Methods: We conducted a retrospective study of adults with HMs vaccinated in our center between 2/2021 and 7/2021, excluding pts with prior COVID-19 infection. Seroconversion was assessed by the qualitative SARS-CoV-2 Total Antibody Test (IgG/IgM against Receptor Binding Domain [RBD], Wondfo USA, Willowbrook, IL). A subset of samples was tested by the semi-quantitative Abbott AdviseDx SARS-CoV-2 IgG II assay (IgG against RBD). For univariate associations (UVA) we used Fisher's exact test for categorical variables, and fractional polynomial fits for continuous variables to examine non-linearity. Multivariable analysis (MVA) used a robust Poisson model reporting risk ratio (RR) with 95% confidence intervals (CI). Results: Among 239 eligible pts, median age was 70 (range, 28-94), and 112 (47%) were female. HMs included aggressive B-cell lymphomas (n=74, 31%), indolent B-cell lymphomas (n=52, 22%), chronic lymphocytic leukemia (CLL, n=30, 13%), other lymphomas (n-19, 8%), plasma cell neoplasms (n=43, 18%), and myeloid cancers (n=21, 9%);140 pts (59%) received BNT162b2/Pfizer, 74 (31%) mRNA-1273/Moderna, and 23 (10%) Ad26.COV2.S/J&J vaccines (2 pts had undetermined vaccine type). HM was active in 100 pts (42%), whereas 108 (45%) pts were in remission after treatment, and 31 (13%) on watchful waiting (WW, never treated);141 (59%) had a prior exposure to an anti-B-cell monoclonal antibody, and 22 (9%) prior stem cell transplantation. Overall, 99 pts (41%;binomial 95% CI, 35-48%) showed post-vaccination seroconversion upon testing at median 10 weeks from first vaccine. Seroconversion was significantly less frequent among pts with lymphomas compared with plasma cell or myeloid neoplasms (overall P=.020;Fig A). It was also less frequent after prior anti-B-cell antibody exposure (29% vs 59%, P<.0001;Fig. B), and in those with active disease (28%, vs 49% for remission [P=.0027], vs 58% for WW [P=.0045];Fig. C). Furthermore, seroconversion was significantly more frequent after mRNA-1273/Moderna vaccine (57%) compared with BNT162b2/Pfizer (36%, P=.006) or Ad26.COV2.S/J&J (22%, P=.004;Fig. D). It was not associated with age (Fig. E), WBC (Fig. G), or time from vaccination (Fig. I), but was significantly higher with increased lymphocyte count (P<.0001;Fig F) and time elapsed from last chemotherapy (P=.0039;Fig. H). In a MVA (Fig. J), vaccination with mRNA-1273 remained significantly associated with higher rate of seroconversion compared with BNT162b2 (RR=0.59;95%CI, 0.44-0.79) or Ad26.COV2.S (RR=0.35;95%CI, 0.16-0.77). Higher seroconversion rate was also associated with remission (RR=1.98;95%CI, 1.42-2.76) or WW status (RR=1.72;95%CI 1.02-2.89) compared with active disease, and higher lymphocyte count. Exposure to anti-B-cell antibodies remained associated with lack of seroconversion (RR=0.66;95%CI, 0.44-0.99). Seroconversion was borderline less frequent in CLL than lymphomas, and higher with plasma cell or myeloid disorders. Results were similar in the subset of pts (n=191) with prior treatment, adjusting for time from last chemotherapy(data not shown). The anti-COVID-19 IgG titers on semiquantitative test (n=47, all after mRNA-based vaccines) were also lower in pts with active disease compared with those in remission (P=.065) or under WW (P=.028), and in those with prior anti-B-cell antibody (P=.0095). Conclusions: Pts with HMs demonstrate overall low rates of seroconversion after vaccination against COVID-19, particularly when they have active disease or are on/after B-cell depleting monoclonal antibody therapy. The mRNA vaccines (particularly mRNA- 273) appear to have elicited superior responses compared with the adenovirus-based product. Pts with active HMs or those within 2 years of last therapy should be particularly aware of the risk of infection despite vaccines and should be considered for strategies to enhance anti-COVID-19 immunity regardless of age. [Formula presented] Disclosures: Olszewski: TG Therapeutics: Research Funding;PrecisionBio: Research Funding;Celldex Therapeutics: Research Funding;Acrotech Pharma: Research Funding;Genentech, Inc.: Research Funding;Genmab: Research Funding.
ABSTRACT
Relevance. Based on the appeal of the Governor of the Murmansk region to the Operational Headquarters on preventing import and spread of a new coronavirus infection in Russia due to the aggravation of the epidemiological situation and in order to localize the spread of COVID-19, the Russian Emercom allocated forces and capabilities, including an airmobile hospital (AMH) and a temporary accommodation center, in the region. AMH was deployed at the industrial site of the Center for the construction of large-scale offshore facilities of NOVATEK-Murmansk LLC and subcontractors in Belokamenka village, where more than 10 thousand people worked and lived on a rotational basis. Intention. Summarize and analyze the experience of the AMH of Emercom of Russia under field conditions of an outbreak of the new coronavirus infection. Methodology. Daily reports on the activities of Emercom of Russia AMH were analyzed for the period from April 17, 2020 to June 12, 2020. Results and Discussion. Field camp deployment and functioning of Emercom of Russia AMH integrated into a regional medical and preventive institution are described. The data on admitted patients, scope and types of diagnostic tests are presented. It is shown that AMH as a separate outpatient diagnostic department of the Kolsky Central District Hospital should provide special and sanitary treatment, patient referrals and an algorithm of personnel activities, and also comply with anti- epidemic measures. During the period of AMH activities in the field, 1678 shift workers got medical advice, 3086 diagnostic studies were carried out for shift workers and employees of the Emercom of Russia. COVID-19 was detected in 500 persons, including 328 cases of mild disease, 98 cases of moderate severity, and 74 severe cases, without case fatalities. The outbreak and spread of the new coronavirus (COVID-19) infection as an emergency in the subject of Russia and at the large industrial and construction site were brought under control. Conclusion. This experience will help improve the activities of the Emercom of Russia AMH under field conditions. © 2020 Marine Biological Journal. All rights reserved.