BNT162b2 COVID-19 vaccine is significantly less effective in patients with hematologic malignancies
BNT162b2 COVID-19 vaccine is significantly less effective in patients with hematologic malignancies
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DOI：
10.1002/ajh.26284
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发表时间：
2021-07-14
影响因子：
12.8
通讯作者：
Koren-Michowitz, Maya
中科院分区：
文献类型：
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作者：
Herzog Tzarfati, Katrin;Gutwein, Odit;Koren-Michowitz, Maya
恶性血液病患者发生严重COVID-19感染的风险增加。接种COVID-19疫苗对这些患者尤为重要，但他们在接种疫苗后是否会产生免疫反应尚不清楚。我们研究了该人群对BNT 162 b2疫苗的血清学应答。与对照组（99%; p < 0.001）相比，接种疫苗后血清学阳性的患者比例（75%）较低，患者中位（四分位距[IQR]）抗体滴度较低（分别为90 [12.4-185.5]和173 [133-232] Au/ml; p < 0.001）。年龄较大、乳酸脱氢酶水平较高和治疗线数量与血清阳性可能性和抗体滴度较低相关，而绝对淋巴细胞计数、球蛋白水平和末次治疗至接种的时间与血清阳性可能性和抗体滴度较高相关。慢性淋巴细胞白血病患者血清阳性率最低，其次为惰性淋巴瘤。近期接受化学免疫疗法、抗CD 20抗体、BCL 2、BTK或JAK 2抑制剂治疗的患者血清阳性反应显著较少，且中位数（IQR）抗体滴度较低（分别为29%，1.9 [1.9-12] Au/ml; 0%，1.9 [1.9-1.9] Au/ml; 25%，1.9 [1.9-25] Au/ml; 40%，1.9 [1.9-92.8] Au/ml;和42%，10.9 [5.7-66.4] Au/ml; p < 0.001）。血液恶性肿瘤患者对BNT 162 b2疫苗的血清学反应受到相当大的损害，他们可能仍然存在严重COVID-19感染和死亡的风险。
Patients with hematologic malignancies have an increased risk of severe COVID-19 infection. Vaccination against COVID-19 is especially important in these patients, but whether they develop an immune response following vaccination is unknown. We studied serologic responses to the BNT162b2 vaccine in this population. A lower proportion of patients were seropositive following vaccination (75%) than in a comparison group (99%; p < 0.001), and median (interquartile range [IQR]) antibody titers in patients were lower (90 [12.4-185.5] and 173 [133-232] AU/ml, respectively; p < 0.001). Older age, higher lactate dehydrogenase, and number of treatment lines correlated with lower seropositivity likelihood and antibody titers, while absolute lymphocyte count, globulin level, and time from last treatment to vaccination correlated with higher seropositivity likelihood and antibody titers. Chronic lymphocytic leukemia patients had the lowest seropositivity rate followed by indolent lymphoma. Patients recently treated with chemo-immunotherapy, anti-CD20 antibodies, BCL2, BTK or JAK2 inhibitors had significantly less seropositive responses and lower median (IQR) antibody titers (29%, 1.9 [1.9-12] AU/ml; 0%, 1.9 [1.9-1.9] AU/ml; 25%, 1.9 [1.9-25] AU/ml; 40%, 1.9 [1.9-92.8] AU/ml; and 42%, 10.9 [5.7-66.4] AU/ml, respectively; p < 0.001). Serological response to BNT162b2 vaccine in patients with hematologic malignancies is considerably impaired, and they could remain at risk for severe COVID-19 infection and death.