Prospective longitudinal study of kinetics of humoral response to one, two, or three doses of SARS-CoV-2 vaccine in hematopoietic cell transplant recipients - Scorecard - MDSpire
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Prospective longitudinal study of kinetics of humoral response to one, two, or three doses of SARS-CoV-2 vaccine in hematopoietic cell transplant recipients
Clinical Scorecard: Longitudinal Analysis of Humoral Immune Response Following One, Two, or Three Doses of SARS-CoV-2 Vaccine in Recipients of Hematopoietic Cell Transplants
At a Glance
Category
Detail
Condition
COVID-19 in recipients of hematopoietic cell transplant (HCT)
Key Mechanisms
Measurement of anti-spike protein receptor binding domain (anti-S RBD) antibodies and neutralizing antibody (NAb) activity as surrogates of vaccine effectiveness
Target Population
Adult recipients (≥18 years) of autologous or allogeneic hematopoietic cell transplants
Care Setting
Oncology and transplant outpatient and clinical research settings
Key Highlights
Anti-S RBD antibody titers and neutralization percentages increase significantly after second and third doses of SARS-CoV-2 vaccines in HCT recipients.
Younger age (≤50 years), autologous HCT, longer time (>12 months) from transplant to vaccination, and absence of immunosuppressive therapy are associated with higher antibody titers.
Third vaccine dose induces a 36-fold increase in anti-S RBD titers compared to one month after the primary vaccination series.
Guideline-Based Recommendations
Diagnosis
Use serologic assays measuring anti-S RBD antibodies and surrogate virus neutralization tests (SVNT) to assess humoral response post-vaccination in HCT recipients.
Management
Administer SARS-CoV-2 vaccination series including booster (third) dose to HCT recipients to enhance and sustain humoral immunity.
Consider timing of vaccination relative to transplant date, ideally >12 months post-transplant for improved antibody response.
Monitor and adjust immunosuppressive therapy when possible to optimize vaccine response.
Monitoring & Follow-up
Perform longitudinal antibody testing at baseline, before second dose, and at 1, 3, and 6 months post-second dose, and 1 month post-third dose to evaluate durability of humoral response.
Risks
HCT recipients on immunosuppressive therapy have reduced antibody responses and may remain at higher risk for severe COVID-19 despite vaccination.
Patient & Prescribing Data
126 adult HCT recipients (79% allogeneic, 21% autologous), median age 59.5 years
mRNA vaccines (Pfizer, Moderna) elicit higher initial antibody titers compared to J&J vaccine; immunosuppressive therapy during vaccination correlates with lower antibody titers; third dose significantly boosts humoral immunity.
Clinical Best Practices
Schedule SARS-CoV-2 vaccination at least 12 months post-transplant when feasible to maximize antibody response.
Administer a third (booster) dose to HCT recipients to substantially increase antibody titers and neutralization capacity.
Monitor antibody levels longitudinally to assess vaccine-induced immunity and guide clinical decisions.
Recognize that patients on immunosuppressive therapy may require additional protective measures due to attenuated vaccine response.
by Qamar J. Khan, Cory R. Bivona, Ben Liu, Maggie Nelson, Grace A. Martin, Muhammad Umair Mushtaq, Priyanka Sharma, Natalie R. Streeter, Marc Hoffmann, Gary C. Doolittle, Cuncong Zhong, Laura Mitchell, Kevin H. Li, Ziyan Y. Pessetto, Arnab Ghosh, Harsh B. Pathak, Jun Zhang, Andrew K. Godwin, Joseph P. McGuirk
