Vaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit... Show moreVaccination guidelines for patients treated for hematological diseases are typically conservative. Given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. We prospectively quantified serum immunoglobulin G (IgG) antibodies to spike subunit 1 (S1) antigens during and after 2-dosemRNA-1273 (Spikevax/Moderna) vaccination in hematology patients. Obtaining S1 IgG >= 300 binding antibody units (BAUs)/mLwas considered adequate as it represents the lower level of S1 IgG concentration obtained in healthy individuals, and it correlates with potent virus neutralization. Selected patients (n = 723) were severely immunocompromised owing to their disease or treatment thereof. Nevertheless, >= 50% of patients obtained S1 IgG >= 300 BAUs/mL after 2-dosemRNA-1273. All patients with sickle cell disease or chronicmyeloid leukemia obtained adequate antibody concentrations. Around 70% of patients with chronic graft-versus-host disease (cGVHD), multiple myeloma, or untreated chronic lymphocytic leukemia (CLL) obtained S1 IgG >= 300 BAUs/mL. Ruxolitinib or hypomethylating therapy but not high-dose chemotherapy blunted responses inmyeloidmalignancies. Responses in patients with lymphoma, patients with CLL on ibrutinib, and chimeric antigen receptor T-cell recipients were low. The minimal time interval after autologous hematopoietic cell transplantation (HCT) to reach adequate concentrations was <= 2months formultiplemyeloma, 8months for lymphoma, and 4 to 6 months after allogeneic HCT. Serum IgG4, absolute B- and natural killer-cell number, and number of immunosuppressants predicted S1 IgG >= 300 BAUs/mL. Hematology patients on chemotherapy, shortly after HCT, or with cGVHD should not be precluded fromvaccination. Show less
Veldt, A.A.M. van der; Oosting, S.F.; Dingemans, A.M.C.; Fehrmann, R.S.N.; GeurtsvanKessel, C.; Jalving, M.; ... ; Vries, E.G.E. de 2021
