Humoral Responses After SARS-CoV-2 mRNA Vaccination and Breakthrough Infection in Cancer Patients.
Humoral Responses After SARS-CoV-2 mRNA Vaccination and Breakthrough Infection in Cancer Patients.
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DOI：
10.1016/j.mayocpiqo.2021.12.004
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发表时间：
2022-04
期刊：
影响因子：
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通讯作者：
Knutson KL
中科院分区：
文献类型：
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作者：
Chumsri S;Advani PP;Pai TS;Li Z;Mummareddy A;Acampora M;Reynolds GA;Wylie N;Boyle AW;Lou Y;Mody K;Moreno-Aspitia A;Swift MD;Virk A;Bharucha AE;Marquez CP;Patel TC;Gores GJ;Knutson KL
评价接受积极治疗的癌症患者对严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）信使RNA（mRNA）疫苗的体液反应程度。纳入了18岁或以上的患者，其中在2剂SARS-CoV-2 mRNA疫苗后测量了SARS-CoV-2刺突抗体（抗S Ab）水平。排除了既往感染2019冠状病毒病（COVID-19）或接受其他免疫抑制治疗的患者。在201例符合标准的患者中，61例具有免疫功能，91例患有血液学恶性肿瘤，49例患有实体恶性肿瘤，同时接受与血细胞减少相关的治疗，包括化疗或细胞周期蛋白依赖性激酶4和6抑制剂。与血液系统恶性肿瘤患者（7.7% [7/91]）和实体恶性肿瘤患者（55.1% [27/49]）相比，免疫功能正常患者（96.7% [59/61]）抗S Ab滴度≥ 500 U/mL的比例显著更高（P<.001）。尽管接种了2剂SARS-CoV-2 mRNA疫苗，但接受血细胞减少治疗的52.7%的恶性血液病患者（48/91）和8.2%的恶性实体瘤患者（4/49）未发生血清转换（峰值抗体滴度<0.8 U/mL）。两名患者随后在全面接种疫苗后发生了突破性COVID-19感染。接受化疗和CDK 4/6 i的血液和实体恶性肿瘤患者中，相当一部分在SARS-CoV-2 mRNA疫苗接种后体液应答较差。我们的研究增加了越来越多的文献，表明免疫抑制患者对COVID-19疫苗接种的体液反应不佳。我们的研究还强调了评估这些脆弱患者接种COVID-19疫苗后抗体反应的重要性。
To evaluate the magnitude of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with cancer receiving active therapies. Patients 18 years or older in whom SARS-CoV-2 spike antibody (anti-S Ab) levels were measured after 2 doses of SARS-CoV-2 mRNA vaccines were included. Patients with prior coronavirus disease 2019 (COVID-19) infection or receiving other immunosuppressive therapy were excluded. Among 201 patients who met the criteria, 61 were immunocompetent, 91 had a hematologic malignancy, and 49 had a solid malignancy while receiving treatments associated with cytopenia, including chemotherapy or cyclin-dependent kinase 4 and 6 inhibitors. A significantly greater proportion of immunocompetent patients (96.7% [59 of 61]) had anti-S Ab titers of 500 U/mL or greater compared to patients with hematologic (7.7% [7 of 91) and solid (55.1% [27 of 49]) malignancy (P<.001). Despite 2 doses of SARS-CoV-2 mRNA vaccines, 52.7% of patients with hematologic malignancy (48 of 91) and 8.2% of those with solid malignancy (4 of 49) receiving cytopenic therapy had no seroconversion (spike antibody titers <0.8 U/mL). Two patients subsequently had development of breakthrough COVID-19 infection after full vaccination. A substantial proportion of patients with hematologic and solid malignancies receiving chemotherapies and CDK4/6i had poor humoral responses after SARS-CoV-2 mRNA vaccination. Our study adds to a growing body of literature suggesting that immunosuppressed patients have a suboptimal humoral response to COVID-19 vaccination. Our study also underscores the importance of assessing antibody response after COVID-19 vaccines in these vulnerable patients.