Enhancement of Omicron-specific immune responses following bivalent COVID-19 booster vaccination in patients with chronic lymphocytic leukaemia - Scorecard - MDSpire
Advertisement
Enhancement of Omicron-specific immune responses following bivalent COVID-19 booster vaccination in patients with chronic lymphocytic leukaemia
Clinical Scorecard: Improvement of Immune Responses to Omicron After Bivalent COVID-19 Booster in Chronic Lymphocytic Leukaemia Patients
At a Glance
Category
Detail
Condition
Chronic Lymphocytic Leukaemia (CLL) with immune suppression
Key Mechanisms
Bivalent mRNA vaccines induce humoral and cellular immune responses targeting ancestral and Omicron spike proteins
Target Population
Patients with CLL receiving multiple COVID-19 vaccine boosters
Care Setting
Outpatient vaccination and monitoring in immunocompromised patients
Key Highlights
87% of CLL patients showed measurable antibody response post-bivalent booster, with titres comparable to healthy controls.
Bivalent vaccine induced a preferential increase in antibody and cellular responses against Omicron BA.1 variant.
Neutralisation of recent Omicron subvariants (e.g., XBB) remained limited, indicating need for updated vaccines.
Guideline-Based Recommendations
Diagnosis
Assess SARS-CoV-2 antibody levels using validated platforms (e.g., Roche Elecsys) pre- and post-vaccination.
Evaluate cellular immunity via IFN-gamma ELISpot assays to complement humoral response assessment.
Management
Administer bivalent mRNA COVID-19 booster vaccines (Original/Omicron BA.1) to CLL patients, especially those with prior multiple vaccine doses.
Consider additional protective measures such as prophylactic antibody administration for patients lacking antibody responses, particularly those on BTK inhibitors or BCL2 inhibitors.
Monitoring & Follow-up
Monitor antibody titres and neutralisation capacity against circulating SARS-CoV-2 variants post-booster.
Evaluate cellular immune responses to assess vaccine-induced T-cell immunity.
Risks
Patients on Bruton tyrosine kinase inhibitors or BCL2 inhibitors may have suppressed humoral immunity and remain seronegative despite vaccination.
Limited neutralisation against emerging Omicron subvariants may increase risk of breakthrough infection.
Patient & Prescribing Data
84 CLL patients receiving 5th or 6th COVID-19 vaccine dose with bivalent mRNA vaccines
Bivalent boosters elicited antibody responses in 87% of patients, including those with pan-hypogammaglobulinaemia; however, a subset on immunosuppressive therapies remained seronegative.
Clinical Best Practices
Prioritize bivalent mRNA booster vaccination in immunosuppressed CLL patients to enhance Omicron-specific immunity.
Incorporate both humoral and cellular immunity assessments to fully evaluate vaccine response.
Provide additional prophylactic interventions for patients with inadequate antibody responses due to ongoing immunosuppressive treatments.
Update vaccine formulations to match circulating variants to improve neutralisation breadth.
by Thomas Roberts, Grace Uwenedi, Rachel Bruton, Graham McIlroy, Sarah Damery, Panagiota Sylla, Nicola Logan, Sam Scott, May Lau, Ahmed Elzaidi, Siobhan Plass, Soumyajit Mallick, Katie Spencer, Christine Stephens, Christopher Bentley, Guy Pratt, Jianmin Zuo, Shankara Paneesha, Brian Willett, Paul Moss, Helen Parry
Over the past 10 years, the treatment landscape and prognosis for Chronic Lymphocytic Leukemia (CLL) has dramatically improved, even among older adults.
