AJH: Allogeneic SARS-CoV-2 vaccination for patients with B-cell lymphoma

The SARS-CoV-2 vaccine has been widely distributed due to its remarkable curative effect on patients with good immune function
.

Unfortunately, more and more literature shows that the efficacy of lymphoma patients has declined, especially those who receive b-cell targeted therapy

The SARS-CoV-2 vaccine has been widely distributed due to its remarkable curative effect on patients with good immune function

As part of an irb-approved trial conducted by the University of Washington/Fred Hutchinson Cancer Research Center, 7 patients with low-grade b-cell lymphoma were initially vaccinated with two doses of mRNA vaccination and subsequently received the Johnson virus vector vaccine
.

According to the evaluation of Roche Elecsys against sars-CoV-2S , the patient lacked sufficient spike antibody response to the initial two-dose mRNA series, and independently sought for heterologous vaccination, which is a semi-quantitative target against spike protein receptor binding domain Total antibody detection method

Seven patients with low-grade b-cell lymphoma received two doses of mRNA vaccination initially, and subsequently received the Johnson & Johnson virus vector vaccine .

The patient underwent a blood sample collection after receiving the Johnson & Johnson vaccine
.

The median time from Johnson & Johnson to collection was 38 days

After the US Centers for Disease Control and Prevention recommended the third mRNA vaccine for immunodeficiency patients, 5 out of 7 patients received the third mRNA vaccine and the fourth overall SARS-CoV-2 vaccine
.

In this subgroup, 4 cases had Johnson & Johnson seroconversion and 1 case did not

It is increasingly clear that the SARS-CoV-2 vaccine is not effective for many patients with lymphoid malignancies because of their innate immune dysfunction and/or receiving b-cell targeted therapy
.

Given the increased risk of complications and the prolonged pandemic, efforts must be focused on predicting who these people are and understanding the complexity or lack of complexity of their immune response

Here, the research team presented the first case series to evaluate the use of heterologous mRNA/vector/mRNA vaccination strategies in patients with lymphoma
.

Only by serological evaluation, the use of viral vector vaccine after 2 doses of mRNA series can successfully induce a response

These findings are promising for vulnerable patients who have difficulty understanding how they exist in their environment
.

However, it is impossible to be certain that this strategy will benefit from this small queue
.
Due to lack of data, they used transplantation literature to gain insights into the immune changes induced by other vaccines and recognized the differences in immunosuppressive mechanisms, namely calcineurin inhibitors and antimetabolites
.
In a German study of solid organ recipients, researchers found that the carrier/mRNA vaccine program resulted in a statistically significant increase in spike antibody levels, neutralizing antibody activity, and sars-cov-2 reactive CD4t cells, and The trend of increasing the number of CD8t cells
.
Unfortunately, the current scope of analysis does not allow the assessment of cellular immune responses
.

Based on these findings, there are also new challenges
.
After homologous mRNA vaccination fails, what immune changes make the viral vector/mRNA approach effective? Is the improvement in serological response correlated with actual clinical benefit? Before adopting a homologous method, which heterologous method should be considered? Is there a better vaccine for priming? Does it depend on the clinical characteristics of the patient? Finally, how can we improve the results of a patient population that is often excluded from vaccine trials?

 

Original source:

Ujjani, C.
, Greninger, AL, Shadman, M.
, Hill, JA, Lynch, RC, Warren, EH and Gopal, AK (2021), Heterologous SARS-CoV-2 Vaccinations in Patients with B-cell Lymphoid Malignancies.
Am J Hematol.
Accepted Author Manuscript.
  https://doi.
org/10.
1002/ajh.
26418

Ujjani, C.
, Greninger, AL, Shadman, M.
, Hill, JA, Lynch, RC, Warren, EH and Gopal, AK (2021), Heterologous SARS-CoV-2 Vaccinations in Patients with B-cell Lymphoid Malignancies.
Am J Hematol.
Accepted Author Manuscript.
  https://doi.
org/10.
1002/ajh.
26418 Leave a message here