背景:慢性淋巴细胞白血病(CLL)和其他非霍奇金淋巴瘤(NHL)导致广泛的免疫抑制,赋予SARS-CoV-2发病率和死亡率更大的风险。我们的研究分析了这些癌症患者SARS-CoV-2疫苗接种的抗体(Ab)血清阳性。
方法:最终分析,240名患者参与其中,和血清阳性定义为阳性的总或尖峰蛋白Ab。
结果:CLL中血清阳性为50%,68%的WM,其余的NHL占70%。在所有癌症中,与辉瑞疫苗接种相比,Moderna疫苗接种导致更高的血清阳性(64%vs.49%;P=0.022),特别是CLL患者(59%vs.43%;P=0.029)。这种差异不能通过治疗状态或先前的抗CD20单克隆Ab治疗的差异来解释。在CLL患者中,与未接受治疗的患者相比,目前或之前的癌症治疗导致较低的血清阳性(36%vs.68%;P=.000019)。与辉瑞相比,接受布鲁顿酪氨酸激酶(BTK)抑制剂治疗的CLL患者在接受Moderna疫苗接种后具有更好的血清阳性(50%vs.23%;P=.015)。在所有癌症中,与超过一年相比,1年内的抗CD20药物导致较低的Ab反应(13%vs.40%;P=.022),加强疫苗接种后仍然存在差异。
结论:无痛性淋巴瘤患者的抗体反应低于一般人群。在有抗白血病药物治疗史或用辉瑞疫苗免疫的患者中发现较低的Ab血清阳性。该数据表明,Moderna疫苗接种可能会在惰性淋巴瘤患者中对SARS-CoV-2产生更大程度的免疫力。
Chronic lymphocytic leukemia (CLL) and other non-Hodgkin\'s lymphomas (NHLs) lead to broad immunosuppression, conferring a greater risk for morbidity and mortality from SARS-CoV-2. Our
study analyzed antibody (Ab) seropositivity from SARS-CoV-2 vaccination in patients with these cancers.
In the final analysis, 240 patients were involved, and seropositivity was defined as a positive total or spike protein Ab.
Seropositivity was 50% in CLL, 68% in WM, and 70% in the remaining NHLs. Moderna vaccination led to higher seropositivity compared to Pfizer vaccination across all cancers (64% vs. 49%; P = .022) and specifically CLL patients (59% vs. 43%; P = .029). This difference was not explainable by differences in treatment status or prior anti-CD20 monoclonal Ab therapy. In CLL patients, current or prior cancer therapy led to lower seropositivity compared to treatment-naïve patients (36% vs. 68%; P = .000019). CLL patients treated with Bruton\'s tyrosine kinase (BTK) inhibitors had better seropositivity after receiving the Moderna vaccination compared to Pfizer (50% vs. 23%; P = .015). Across all cancers, anti-CD20 agents within 1 year led to a lower Ab response compared to greater than one year (13% vs. 40%; P = .022), a difference which persisted after booster vaccination.
Antibody response is lower in patients with indolent lymphomas compared to the general population. Lower Ab seropositivity was found in patients with a history of anti-leukemic agent therapy or those immunized with Pfizer vaccine. This data suggests that Moderna vaccination may confer a greater degree of immunity against SARS-CoV-2 in patients with indolent lymphomas.