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Question 1 of 1
For patients with lymphoid malignancies who failed to respond to two previous COVID-19 vaccine doses, which of these factors is associated with increased likelihood of seropositivity following a third COVID-19 vaccine dose?
A
B
C
D
The immunosuppressive effect of active treatment and disease in patients with lymphoid malignancies has proven to impair immune response to the first two doses of SARS-CoV-2 vaccination.1,2 It is of value to determine whether a booster vaccination can improve antibody responses and whether certain subgroups of patients may benefit more than others from a third vaccine dose. Additionally, T-cell-mediated responses, even in the absence of seroconversion, may also infer an advantage to receiving a booster vaccine.2 We have previously summarized an evaluation of these responses following a second vaccine dose.
Here, we provide a summary of two papers investigating humoral and T-cell-mediated responses in patients with lymphoid malignancies receiving a third BNT162b2 vaccine dose. 1,2
A retrospective study (NCT04746092) published by Avivi et al. in the British Journal of Hematology observed the seroconversion rate of anti-SARS-CoV-2 spike antibodies in 44 patients with B-cell non-Hodgkin lymphoma (B-NHL) receiving a BNT162b2 booster vaccine who failed to respond to two previous doses of SARS-CoV-2 vaccination.
Baseline characteristics are summarized in Table 1.
Table 1. Baseline patient characteristics*
B-NHL, B-cell non-Hodgkin lymphoma; CR, complete remission; DLBCL, diffuse large B-cell lymphoma; IQR, interquartile range; PD, progressive disease; PR, partial response; SD, stable disease. |
|
Characteristic |
N = 44 |
---|---|
Median age, years (IQR) |
66 (55–73) |
Subtype, % |
|
DLBCL |
36.4 |
Other B-NHL† |
63.6 |
Disease status |
|
CR |
84 |
PR |
4.5 |
SD |
7 |
PD |
4.5 |
Treated with anti-CD20 mAbs, % |
95.5 |
Current maintenance therapy, % |
46 |
Median absolute lymphocyte count, × 103/µL (IQR) |
1.2 (0.7–1.5) |
≤6 months from previous anti-CD20 mAb, % |
45.2 |
Figure 1. Seropositivity rates according to time from previous anti-CD20 treatment and type of B-NHL*
B-NHL, B-cell non-Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma; mAB, monoclonal antibody.
*Adapted from Avivi, et al.1
In summary, this study demonstrated a high prevalence of seroconversion following a third SARS-CoV-2 vaccine dose in patients with B-NHL who failed to respond the first two doses, particularly for patients harboring aggressive B-NHL and those whose anti-CD20 mAb treatment ceased ≥6 months before vaccination.
Study limitations included the small cohort number, alonger period of time from the previous vaccine booster compared to similar studies, and the absence of T-cell-mediated immune response evaluation.
An observational study on the effect of a third BNT162b2 vaccine dose on SARS-CoV-2 anti-spike (anti-S) antibody (Ab) production, neutralizing capacity, and T-cell-mediated responses was recently published by Re et al. in Nature Communications. This study included patients with chronic lymphocytic leukemia (CLL), B-NHL, and multiple myeloma (MM) with poor or no response to their first two vaccine doses.2
Patient characteristics are summarized in Table 2.
Table 2. Patient characteristics*
Abs, antibodies; anti-S, anti-spike; CLL, chronic lymphocytic leukemia; mAb, monoclonal antibody; MM, multiple myeloma; NHL, non-Hodgkin Lymphoma. |
|
Characteristic |
N = 43 |
---|---|
No anti-S Abs before booster dose, % |
41.8 |
Median Ab titer in patients with Abs before booster dose, U/ml (range) |
87.1 (1.2–693) |
Median age, years (range) |
77 (37–92) |
Type of lymphoid malignancy, n |
|
MM |
16 |
NHL |
14 |
CLL |
13 |
In summary, a third dose of the BNT162b2 vaccine was beneficial for patients who had previous anti-S Ab responses, who had improved median Ab titer. This effect was greater in patients with MM compared to those with CLL or NHL. A considerable number of these patients without a humoral response were positive for T-cell-mediated responses after the booster vaccine.
Overall, these two studies support the use of a third vaccine dose in patients with lymphoid malignancies. Some selective factors, including shorter time from previous anti-CD20 treatment and active maintenance therapy in patients with B-NHL impaired seroconversion. However, T-cell-mediated immune activity may still provide important protection and was improved with a booster vaccine.
Your opinion matters
In your current clinical practice, how likely would you be to recommend a booster COVID-19 vaccine for your patients with lymphoid malignancies who have failed to respond to two previous COVID-19 vaccine doses?
References