RESUMEN
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.
Asunto(s)
COVID-19 , Trasplante de Células Madre Hematopoyéticas , Vacuna BNT162 , Biomarcadores , Linfocitos T CD8-positivos , COVID-19/prevención & control , Vacunas contra la COVID-19 , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , ARN Mensajero , SARS-CoV-2 , VacunaciónRESUMEN
The impact of pre-transplant anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine in 20 recipients of allogeneic hematopoietic stem cell transplantation (Allo-HSCT) and/or their donors is reported here, showing that the persistence of anti-SARS-CoV-2 antibodies can be detected in almost all patients, whatever the type of vaccine used, and up to 9 months post transplant. Also, an anti-SARS-CoV-2 spike glycoprotein CD3+ T-cell response could be detected in six (35%) of 17 evaluable patients. This study provides a rationale to consider anti-SARS-CoV-2 vaccination of both recipients and donors before Allo-HSCT.
Asunto(s)
Vacuna BNT162/uso terapéutico , COVID-19/prevención & control , Adulto , Anciano , Aloinjertos , Anticuerpos Antivirales/inmunología , Formación de Anticuerpos , Vacuna BNT162/administración & dosificación , COVID-19/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos , Estudios Retrospectivos , SARS-CoV-2/inmunología , Trasplante de Células Madre , Trasplante Homólogo , Adulto JovenAsunto(s)
Anticuerpos Antivirales/biosíntesis , Vacuna BNT162/inmunología , COVID-19/prevención & control , Inmunoglobulina G/biosíntesis , Inmunoterapia Adoptiva , SARS-CoV-2/inmunología , Adulto , Anciano , Antígenos Virales/inmunología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Vacuna BNT162/efectos adversos , Productos Biológicos/uso terapéutico , Terapia Combinada , Femenino , Fiebre/etiología , Trasplante de Células Madre Hematopoyéticas , Humanos , Inmunización Secundaria , Huésped Inmunocomprometido , Inmunogenicidad Vacunal , Linfoma no Hodgkin/inmunología , Linfoma no Hodgkin/terapia , Masculino , Persona de Mediana Edad , Dolor/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Receptores de Antígenos de Linfocitos T/uso terapéutico , Receptores Quiméricos de Antígenos/uso terapéutico , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunación , Adulto JovenRESUMEN
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.