COVID-19 Vaccine Booster Responses in Patients with Hematologic Malignancies

Patients with hematologic malignancies have varying degrees of immunodeficiency related to the underlying disease and to anti-cancer therapy, with well-documented impairment of COVID-19 vaccine responses and an increased risk for severe or fatal COVID-19 infection. Investigators in the Netherlands assessed humoral anti-spike glycoprotein (S1) and nucleoprotein responses to a third dose of the COVID-19 mRNA-1273 (Moderna) vaccine in patients with hematologic malignancy. The third dose was given 5 months after completion of the standard two-dose schedule.

Both SARS-CoV-2 antibody response and neutralizing capacity against the wild type and variant COVID-19 strains were determined and compared with responses in a cohort of randomly selected, age-matched healthy controls. Patients and controls with a history of COVID-19 infection were excluded.

The analysis included 584 patients with lymphoid, myeloid, and plasma cell neoplasms, some of whom had recently received autologous or allogeneic hematopoietic cell transplantation or CAR-T-cell therapy, and 44 controls. The third vaccine dose was associated with a significant increase in anti-S1-IgG levels — comparable to that in controls — among all disease and therapy subsets except patients with B-cell lymphoma receiving an anti-CD20 monoclonal antibody or CAR T-cell therapy and those with chronic lymphocytic leukemia taking the Bruton tyrosine kinase inhibitor ibrutinib. Neutralizing antibody capacity against COVID variants improved among patients with S1 responses.