%0 Journal Article
%T Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy.
%A Lim YJ
%A Ward V
%A Brown A
%A Phillips E
%A Kronsteiner B
%A Malone T
%A Jennings D
%A Healy S
%A Longet S
%A James T
%A Thomson P
%A Farrell L
%A Oates M
%A Jackson R
%A Morrison A
%A Burns M
%A Carroll M
%A Klenerman P
%A Turtle L
%A Naisbitt D
%A Rhodes M
%A Robinson K
%A Gatto S
%A Young M
%A Linton K
%A Eyre TA
%A Eyre DW
%A Dunachie S
%A Barnes E
%A Pettitt A
%J Br J Haematol
%V 205
%N 2
%D 2024 Aug 13
%M 38867615
%F 8.615
%R 10.1111/bjh.19562
%X Immune responses to primary COVID-19 vaccination were investigated in 58 patients with follicular lymphoma (FL) as part of the PETReA trial of frontline therapy (EudraCT 2016-004010-10). COVID-19 vaccines (BNT162b2 or ChAdOx1) were administered before, during or after cytoreductive treatment comprising rituximab (depletes B cells) and either bendamustine (depletes CD4+ T cells) or cyclophosphamide-based chemotherapy. Blood samples obtained after vaccine doses 1 and 2 (V1, V2) were analysed for antibodies and T cells reactive to the SARS-CoV-2 spike protein using the Abbott Architect and interferon-gamma ELISpot assays respectively. Compared to 149 healthy controls, patients with FL exhibited lower antibody but preserved T-cell responses. Within the FL cohort, multivariable analysis identified low pre-treatment serum IgA levels and V2 administration during induction or maintenance treatment as independent determinants of lower antibody and higher T-cell responses, and bendamustine and high/intermediate FLIPI-2 score as additional determinants of a lower antibody response. Several clinical scenarios were identified where dichotomous immune responses were estimated with >95% confidence based on combinations of predictive variables. In conclusion, the immunogenicity of COVID-19 vaccines in FL patients is influenced by multiple disease- and treatment-related factors, among which B-cell depletion showed differential effects on antibody and T-cell responses.