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Non-Hodgkin Lymphoma
Humoral serological response to the BNT162b2 vaccine is abrogated in lymphoma patients within the first 12 months following treatment with anti-CD2O antibodies
Ronit Gurion,1,2 Uri Rozovski,1,2 Gilad Itchaki,1,2 Anat Gafter-Gvili,1,2,3 Chiya Leibovitch,1,2 Pia Raanani,1,2 Haim Ben-Zvi,4 Moran Szwarcwort,5 Mor Taylor-Abigadol,6 Eldad J. Dann,6,7 Nurit Horesh,6 Tsofia Inbar,6 Inna Tzoran,6,7 Noa Lavi,6,7 Riva Fineman,6 Shimrit Ringelstein-Harlev6,7# and Netanel A. Horowitz6,7#
1Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva; 2Sackler School of Medicine, Tel Aviv University, Tel Aviv; 3Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva; 4Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach Tikva; 5Virology Laboratory, Rambam Health Care Campus, Haifa; 6Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa and 7The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
#SR-H and NAH contributed equally as co-senior authors.
ABSTRACT
Patients with lymphoma, especially those treated with anti-CD20 monoclonal antibodies, suffer high COVID-19-associated morbidi- ty and mortality. The goal of this study was to assess the ability of lymphoma patients to generate a sufficient humoral response after two injections of BNT162b2 Pfizer vaccine and to identify factors influencing the response. Antibody titers were measured with the SARS-CoV-2 IgG II Quant (Abbott©) assay in blood samples drawn from lymphoma patients 4±2 weeks after the second dose of vaccine. The cutoff for a positive response was set at 50 AU/mL. Positive serological responses were observed in 51% of the 162 patients enrolled in this cross-sectional study. In a multivariate analysis, an interval of <12 months between the last anti-CD20 monoclonal antibody dose and the second vaccine dose (odds ratio=31.3 [95% confidence interval: 8.4-116.9], P<0.001) and pres- ence of active lymphoma (odds ratio=4.2 (95% confidence interval: 2.1- 8.2), P=0.006) were identified as negative response predictors. The rate of seropositivity increased from 3% in patients vaccinated within 45 days after the last monoclonal antibody administration to 80% in patients vaccinated >1 year after this therapy. The latter percentage was equal to that of patients never exposed to monoclonal antibodies. In con- clusion, lymphoma patients, especially those recently treated with anti- CD20 monoclonal antibodies, fail to develop sufficient humoral response to BNT162b2 vaccine. While a serological response is not the only predictor of immunity, its low level could make this population more vulnerable to COVID-19, which implies the need for a different vaccination schedule for such patients.
Introduction
The global pandemic of coronavirus disease 2019 (COVID-19) had resulted in about 3.85 million deaths world-wide as of June 2021, with the estimated fatality rate among infected patients being between 1.5% and 2.1%.1 Emerging data demonstrate higher mortality rates among certain high-risk populations with significant co-mor- bidities, such as organ transplant recipients2 and cancer patients.3-5 There is evidence showing that patients with hematologic malignancies are the most vulnerable cancer population,3-7 with a higher risk of hospitalization and mortality following exposure to the virus.7 Estimated odds ratios (OR) for mortality are reported to vary between
Ferrata Storti Foundation
Haematologica 2022 Volume 107(3):715-720
Correspondence:
NETANEL A. HOROWITZ
n_horowitz@rambam.health.gov.il
Received: May 12, 2021. Accepted: June 22, 2021 Pre-published: July 29, 2021.
https://doi.org/10.3324/haematol.2021.279216 ©2022 Ferrata Storti Foundation
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