Production of anti-spike antibodies in response to COVID vaccine in lymphoma patients

  1. Alexandra Della Pia
  2. Gee Youn (Geeny) Kim
  3. Andrew Ip
  4. Jaeil Ahn
  5. Yanzhi Liu
  6. Simone Kats
  7. Michael Koropsak
  8. Brittany Lukasik
  9. Anamta Contractor
  10. Krushna Amin
  11. Lakshmi Ayyagari
  12. Charles Zhao
  13. Amolika Gupta
  14. Mark Batistick
  15. Lori A. Leslie
  16. Andre Goy
  17. Tatyana Feldman

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Abstract

Patients with hematologic malignancies have poor outcomes from COVID infection and are less likely to mount an antibody response after COVID infection. There is limited data on the efficacy of the COVID vaccines in lymphoma patients, and to suggest the optimal timing of vaccination to elicit immunity in patients receiving immunochemotherapy. This is a retrospective study of adult lymphoma patients who received the COVID vaccine between 12/1/2020 and 11/30/2021. The primary endpoint was a positive anti-COVID spike protein antibody titer following the primary COVID vaccination series. The primary series was defined as 2 doses of the COVID mRNA vaccines or 1 dose of the COVID adenovirus vaccine. Subgroups were compared using Fisher’s exact test, and unadjusted and adjusted logistic regression models were used for univariate (UVA) and multivariate (MVA) analyses. A total of 243 patients were included in this study; 72 patients (30%) with indolent lymphomas; 56 patients (23%) with Burkitt’s, diffuse large B-cell lymphoma (DLBCL), and primary mediastinal B-cell lymphoma (PMBL) combined; 55 patients (22%) with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL); and 44 patients (18%) with Hodgkin and T-cell lymphomas (HL/TCL) combined. One-hundred fifty-eight patients (65%) developed anti-COVID spike protein antibodies after completing the primary COVID vaccination series. Thirty-eight of 46 (83%) patients who received an additional primary shot and had resultant levels produced anti-COVID spike protein antibodies. When compared to other lymphoma types, patients with CLL/SLL had a numerically lower seroconversion rate of 51% following the primary series whereas patients with HL/TCL appeared to have a robust antibody response with a seropositivity rate of 77% (p=0.04). Lymphoma patients are capable of mounting a humoral response to the COVID mRNA vaccines. Further studies are required to confirm our findings, including whether T-cell immunity would be of clinical relevance in this patient population.

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  1. ScreenIT

    SciScore for 10.1101/2022.03.24.22272883: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Institutional Review Board (IRB) approval was obtained.
    Consent: The requirement for patient informed consent was waived by the IRB as this project represented a non-interventional study utilizing routinely collected data for secondary research purposes.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Among patients who had anti-COVID spike protein antibody results, COVID-19 history was collected and included the following (if available): type of COVID vaccine received and number of doses, history of positive COVID infection, and therapies received for COVID treatment (if applicable).
    anti-COVID spike protein
    suggested: None
    Secondary outcomes included positive anti-COVID spike protein antibody titers in the following patient subgroups: patients who received an additional primary shot; different lymphoma subtypes; patients who received anti-CD20 monoclonal antibody therapy within the previous 12 months; and patients who received active anticancer treatment.
    anti-CD20
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are some limitations to this study. Firstly, this was a single-center, retrospective chart review. Some patients received their COVID vaccine at an outside facility, therefore, the exact date and the type of vaccine received was not consistently available. Secondly, the timing of the additional primary shot of COVID vaccine was not uniform among all patients, and not all patients received this additional dose. As the COVID-19 pandemic progressed and the Center for Disease Control updated recommendations based on available evidence, some patients received the additional primary shot of the COVID vaccine closer to the recommended 28 days after completion of the primary series than others, and some have yet to receive their additional primary shot. Lastly, although there were 243 patients evaluated in the overall analysis, some subgroups of particular interest had smaller numbers of patients. In conclusion, lymphoma patients are capable of mounting a humoral response to the COVID mRNA vaccines. Although seroconversion is lower than in the normal population, it is still significant and warrants administration of COVID vaccine without delay, particularly during continuing high rate of infection. CLL/SLL appears predictive of a negative antibody response to the COVID vaccine, while HL/TCL histologies appeared to correlate to a positive antibody response, even with treatment within 6 months of vaccination. Our study suggests anti-CD20 monoclonal antibody therapy in the last 12...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.03.24.22272883v1 on medRxiv