{Reference Type}: Journal Article
{Title}: Immunogenicity of COVID-19 vaccines in patients with follicular lymphoma receiving frontline chemoimmunotherapy.
{Author}: Lim YJ;Ward V;Brown A;Phillips E;Kronsteiner B;Malone T;Jennings D;Healy S;Longet S;James T;Thomson P;Farrell L;Oates M;Jackson R;Morrison A;Burns M;Carroll M;Klenerman P;Turtle L;Naisbitt D;Rhodes M;Robinson K;Gatto S;Young M;Linton K;Eyre TA;Eyre DW;Dunachie S;Barnes E;Pettitt A;
{Journal}: Br J Haematol
{Volume}: 205
{Issue}: 2
{Year}: 2024 Aug 13
{Factor}: 8.615
{DOI}: 10.1111/bjh.19562
{Abstract}: 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.