Immunogenicity of anti-SARS-CoV-2 Comirnaty vaccine in patients with lymphomas and myeloma who underwent autologous stem cell transplantation - Scorecard - MDSpire
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Immunogenicity of anti-SARS-CoV-2 Comirnaty vaccine in patients with lymphomas and myeloma who underwent autologous stem cell transplantation
87% of patients developed a humoral immune response after two doses of Comirnaty vaccine, with median antibody titer of 747 BAU/ml.
Vaccination failure was significantly associated with being on active therapy at time of vaccination and not having ASCT as last treatment.
Seronegative patients showed significantly lower spike-specific CD8+IFNγ+ and CD4+ T-cell responses compared to seropositive patients.
Guideline-Based Recommendations
Diagnosis
Evaluate humoral immunity using anti-SARS-CoV-2 S1/S2 IgG test with cutoff >33.8 BAU/ml for positivity.
Assess cell-mediated immunity in seronegative patients using FACS and ELISpot assays for spike-specific T-cell responses.
Management
Prioritize mRNA vaccination (Comirnaty) for patients with hematological malignancies, including those post-ASCT.
Consider timing of vaccination relative to ASCT and ongoing therapy; vaccination at least 6 months post-ASCT is common but earlier vaccination can still elicit response.
Monitor patients on active therapy closely as they have higher risk of vaccination failure.
Monitoring & Follow-up
Measure antibody titers approximately 4 weeks after completion of vaccination regimen.
Perform cellular immunity assays in seronegative patients to evaluate T-cell response.
Regular follow-up to detect post-vaccination COVID-19 cases.
Risks
Reduced vaccine immunogenicity in patients on active hematological malignancy therapy.
Potential for lower cellular immune response in seronegative patients.
Patient & Prescribing Data
64 adult patients with hematological malignancies post-ASCT receiving Comirnaty vaccine
High seroconversion rate (87%) overall; vaccination failure more frequent in patients on active therapy and those without ASCT as last treatment; antibody titers correlated positively with absolute lymphocyte count.
Clinical Best Practices
Administer mRNA SARS-CoV-2 vaccines to patients with hematological malignancies including post-ASCT patients.
Schedule vaccination considering timing of ASCT and current therapy status to optimize immune response.
Use both humoral and cellular immunity assays to comprehensively assess vaccine response, especially in seronegative patients.
Maintain vigilant follow-up for COVID-19 infection post-vaccination in this high-risk population.
by Marco Salvini, Fabrizio Maggi, Camilla Damonte, Lorenzo Mortara, Antonino Bruno, Barbara Mora, Marco Brociner, Roberta Mattarucchi, Alessia Ingrassia, Davide Sirocchi, Benedetta Bianchi, Stefania Agnoli, Matteo Gallazzi, Michele Merli, Andrea Ferrario, Raffaella Bombelli, Daniela Barraco, Andreina Baj, Lorenza Bertù, Paolo A. Grossi, Francesco Passamonti
