SARS-CoV-2-reactive antibody waning, booster effect and breakthrough SARS-CoV-2 infection in hematopoietic stem cell transplant and cell therapy recipients at one year after vaccination - Scorecard - MDSpire

SARS-CoV-2-reactive antibody waning, booster effect and breakthrough SARS-CoV-2 infection in hematopoietic stem cell transplant and cell therapy recipients at one year after vaccination

  • By

  • José Luis Piñana

  • Rodrigo Martino

  • Lourdes Vazquez

  • Lucia López-Corral

  • Ariadna Pérez

  • Pedro Chorão

  • Alejandro Avendaño-Pita

  • María-Jesús Pascual

  • Andrés Sánchez-Salinas

  • Gabriela Sanz-Linares

  • María T. Olave

  • Ignacio Arroyo

  • Mar Tormo

  • Lucia Villalon

  • Venancio Conesa-Garcia

  • Beatriz Gago

  • María-José Terol

  • Marta Villalba

  • Valentín Garcia-Gutierrez

  • Almudena Cabero

  • José Ángel Hernández-Rivas

  • Elena Ferrer

  • Irene García-Cadenas

  • Anabel Teruel

  • David Navarro

  • Ángel Cedillo

  • Anna Sureda

  • Carlos Solano

  • February 28, 2023

  • 0 min

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Clinical Scorecard: Decline of SARS-CoV-2 Antibodies, Impact of Boosters, and Incidence of Breakthrough Infections in Recipients of Hematopoietic Stem Cell Transplantation and Cell Therapies One Year Post-Vaccination

At a Glance

CategoryDetail
ConditionCOVID-19 in recipients of hematopoietic stem cell transplantation (HSCT) and cell therapies
Key MechanismsWaning of SARS-CoV-2 spike-reactive antibody titers post-vaccination; reduced vaccine efficacy against variants of concern; booster doses increase antibody titers
Target PopulationRecipients of autologous HSCT (ASCT), allogeneic HSCT (allo-HSCT), and chimeric antigen receptor T-cell (CAR-T) therapy
Care SettingHematology and transplant centers managing immunocompromised patients

Key Highlights

  • Recipients of HSCT and CAR-T therapy have high COVID-19 mortality (>18%) during early pandemic waves.
  • mRNA vaccines induce SARS-CoV-2 spike-reactive antibodies but titers decline over time in these patients.
  • Booster doses increase antibody titers and may mitigate reduced vaccine efficacy against emerging variants.

Guideline-Based Recommendations

Diagnosis

  • Use serological testing for SARS-CoV-2 spike (S) and nucleocapsid (N) IgG antibodies to assess vaccination response and prior infection.
  • Define seropositivity as antibody titers above assay detection limits standardized to WHO BAU/mL.

Management

  • Administer full primary vaccination (two doses for mRNA vaccines) followed by booster doses in HSCT and CAR-T recipients.
  • Consider additional vaccine booster doses and/or pre-exposure prophylaxis with monoclonal antibodies for immunocompromised patients.

Monitoring & Follow-up

  • Monitor SARS-CoV-2 spike-reactive antibody titers at 3–6 weeks, 3 months, 6 months, and 12 months post-vaccination.
  • Identify poor responders as patients with antibody titers <250 BAU/mL at 3–6 weeks post-primary vaccination.

Risks

  • Immunocompromised patients have lower antibody titers and higher risk of breakthrough SARS-CoV-2 infection.
  • Emergence of variants of concern (e.g., Omicron) reduces vaccine efficacy, necessitating booster doses.

Patient & Prescribing Data

572 recipients of ASCT, allo-HSCT, and CAR-T therapy fully vaccinated against SARS-CoV-2

Booster doses increase SARS-CoV-2 spike antibody titers and may reduce incidence and severity of breakthrough infections in this vulnerable population.

Clinical Best Practices

  • Obtain informed consent and follow ethical guidelines for patient monitoring and data collection.
  • Use standardized serological assays normalized to WHO standards for antibody quantification.
  • Incorporate epidemiological data on circulating variants to interpret breakthrough infection risk.
  • Maintain prospective monitoring of antibody kinetics and breakthrough infections to guide vaccination strategies.

References

Original Source(s)

SARS-CoV-2-reactive antibody waning, booster effect and breakthrough SARS-CoV-2 infection in hematopoietic stem cell transplant and cell therapy recipients at one year after vaccination

  • by José Luis Piñana, Rodrigo Martino, Lourdes Vazquez, Lucia López-Corral, Ariadna Pérez, Pedro Chorão, Alejandro Avendaño-Pita, María-Jesús Pascual, Andrés Sánchez-Salinas, Gabriela Sanz-Linares, María T. Olave, Ignacio Arroyo, Mar Tormo, Lucia Villalon, Venancio Conesa-Garcia, Beatriz Gago, María-José Terol, Marta Villalba, Valentín Garcia-Gutierrez, Almudena Cabero, José Ángel Hernández-Rivas, Elena Ferrer, Irene García-Cadenas, Anabel Teruel, David Navarro, Ángel Cedillo, Anna Sureda, Carlos Solano

  • February 28, 2023

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