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Editorials
responses is not as robust and reproducible as serological responses, T-cell responses should be evaluated in treat- ment-naïve NHL/CLL patients as well as among those receiving BTK inhibitors, BCL2 inhibitors, chemotherapy and/or anti-CD20 to establish whether it could provide additional protection.
Overall, the findings raise questions about the manage- ment of patients with NHL/CLL during this COVID-19 era, for whom there are currently no consensual guide- lines. It is time to consider adapting our therapeutic strategies in these patients. First, in any non-critical clini- cal situation, SARS-CoV-2 vaccination should be pro- posed before the onset of treatments with BTK inhibitors, BCL2 inhibitors or anti-CD20. Secondly, to prevent pro- longed COVID-19 and lack of vaccination efficacy, avoid- ing or delaying the administration of anti-CD20 may be considered in patients with indolent NHL/CLL with low tumor burden and mild symptoms or cytopenia, for whom delaying the initiation of the treatment will not place the patient at risk. Furthermore, consideration should be given to not re-administering anti-CD20 in patients with NHL in the relapse/refractory setting when other reasonable options are available. Moreover, as already adopted in many centers, avoidance or suspen- sion of maintenance therapy with anti-CD20 in patients with indolent B-cell lymphoma in complete remission to allow their vaccination should also be recommended. This decision should not preclude a patient from receiv- ing the most efficacious treatment strategy and requires consideration of the disease characteristics and the patient's history.
Lastly, systematic vaccination of the patients’ relatives and close associates and hospital workers should also benefit the patients directly. Other vaccination strategies should also be explored in these patients such as the effect of a third vaccine dose in nonresponding patients or in those with a low serological response. This approach is currently recommended in some countries, for example France, although its efficacy has not yet been demonstrated. Additional large studies are required to address the question of vaccination in cancer patients, such as that supported by the “COVID-19 and Cancer Global Taskforce”10 and, more specifically, among vacci- nated NHL/CLL patients, to specify the level of cellular protection against infection and to determine the risk of clinical COVID-19 and its severity. Meanwhile, individ-
uals with NHL/CLL should receive the COVID-19 vac- cine, be informed that they are unlikely to be protected and continue social distancing and adhere to other proven mitigation strategies such as mask wearing. Finally, these findings should contribute to the produc- tion of guidelines for the management of NHL/CLL patients during the COVID-19 pandemic, an essential step towards improving the efficiency of vaccination in this setting.
Disclosures
CB reports research funding from Roche and non-financial support from Takeda and Roche outside the submitted work.
Acknowledgments
The author thanks Rémy Duléry and Sylvain Lamure for their collaboration on COVID-19 in lymphoma patients.
References
1. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584 (7821):430-436.
2. Scarfo L, Chatzikonstantinou T, Rigolin GM, et al. COVID-19 sever- ity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus. Leukemia. 2020;34(9):2354-2363.
3. Duléry R, Lamure S, Delord M, et al. Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy. Am J Hematol. 2021;96(8):934-944.
4. Mato AR, Roeker LE, Lamanna N, et al. Outcomes of COVID-19 in patients with CLL: a multicenter international experience. Blood. 2020;136(10):1134-1143.
5.Herishanu Y, Avivi A, Aharon A, et al. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood. 2021;137(23):3165-3173.
6.Benjamini O, Rokach L, Itchaki G, et al. Safety and efficacy of BNT162b mRNA COVID-19 vaccine in patients with chronic lym- phocytic leukemia. Haematologica. 2022;107(3):625-634.
7. Gurion R, Rozovski U, Itchaki G, et al. Humoral serological response to the BNT162b2 vaccine is abrogated in lymphoma patients within the first 12 months following treatment with anti-CD2O antibodies. Haematologica. 2022;107(3):715-720.
8. Durali D, de Goër de Herve M-G, Gasnault J, Taoufik Y. B cells and progressive multifocal leukoencephalopathy: search for the missing link. Front Immunol. 2015;6:241.
9.Sahin U, Muik A, Derhovanessian E, et al. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. Nature. 2020;586(7830):594-599.
10. Yusuf A, Sarfati D, Booth CM, et al. COVID-19 and Cancer Global Taskforce. Cancer and COVID-19 vaccines: a complex global pic- ture. Lancet Oncol. 2021;22(6):749-751.
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