Thus, protecting allo-HCT recipients with effective vaccination against SARS-CoV-2 is critical. Further, allo-HCT patients can experience prolonged COVID-19 infection due to their inability to clear the virus. Indeed, preliminary reports showed that mortality of allo-HCT patients diagnosed with COVID-19 range from 30 to 35% 30 days after diagnosis. As a consequence, infection of allo-HCT recipients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes severe forms of coronavirus disease 2019 (COVID-19) more frequently than in healthy individuals. This is due to defects in B-cell, T-cell, monocyte and dendritic cell compartments. Unfortunately, the procedure induces severe immunosuppression persisting several months to several years after transplantation, particularly in patients suffering from chronic graft-versus-host disease (GVHD). The study was registered at on 11 March 2021 (EudractCT # 2021-000673-83).Īllogeneic hematopoietic stem cell transplantation (allo-HCT) has remained the best treatment option for many patients with life-threatening hematological disorders such as acute myeloid leukemia. Immunological markers could help identify allo-HCT patients at risk of poor Ab response to mRNA vaccination. ConclusionsĬhronic GVHD and rituximab administration in allo-HCT recipients are associated with reduced Ab responses to BNT162b2 vaccination.
Ongoing moderate/severe chronic GVHD ( P 0.5, P < 0.01) and more weakly with the number of follicular helper T cells ( r = 0.4, P = 0.01). Further, 49% of allo-HCT patients versus 88% of healthy adults had detectable NT50 Ab at day 49 while allo-HCT recipients had significantly lower NT50 Ab titers than healthy adults ( P = 0.0004). Comparing anti-RBD Ab levels in allo-HCT recipients and healthy adults, we observed significantly lower anti-RBD Ab levels in allo-HCT recipients at days 21, 28 and 49. Among the 37 SARS-CoV-2 naive patients, 20 (54%) and 32 (86%) patients had detectable anti-RBD Ab 21 days and 49 days postvaccination. Three patients had detectable anti-RBD Ab before vaccination. Flow cytometry analysis of peripheral blood cells was performed before vaccination to identify potential predictors of Ab responses. Results observed in allo-HCT patients were compared to those obtained in 40 healthy adults naive of SARS-CoV-2 infection. Binding antibodies (Ab) to SARS-CoV-2 receptor binding domain (RBD) were assessed at days 0, 21, 28, and 49 while neutralizing Ab against SARS-CoV-2 wild type (NT50) were assessed at days 0 and 49. Methodsįorty allo-HCT recipients were included in a study of immunization with BNT162b2 mRNA vaccine at days 0 and 21. Factors affecting response to SARS-CoV-2 mRNA vaccine in allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients remain to be elucidated.
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