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Risk factors and characteristics influencing humoral response to COVID-19 vaccination in patients after allogeneic stem cell transplantation

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Item Type:Article
Title:Risk factors and characteristics influencing humoral response to COVID-19 vaccination in patients after allogeneic stem cell transplantation
Creators Name:Hütter-Krönke, M.L. and Neagoie, A. and Blau, I.W. and Wais, V. and Vuong, L. and Gantner, A. and Ahn, J. and Penack, O. and Schnell, J. and Nogai, K.A. and Eberspächer, B. and Saadati, M. and Benner, A. and Bullinger, L. and Döhner, H. and Bunjes, D. and Sala, E.
Abstract:INTRODUCTION: Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is approved and recommended for immunocompromised patients such as patients after allogeneic stem cell transplantation (allo-SCT). Since infections represent a relevant cause of transplant related mortality we analyzed the advent of immunization to SARS-CoV-2 vaccination in a bicentric population of allogeneic transplanted patients. METHODS: We retrospectively analyzed data of allo-SCT recipients in two German transplantation centers for safety and serologic response after two and three SARS-CoV-2 vaccinations. Patients received mRNA vaccines or vector-based vaccines. All patients were monitored for antibodies against SARS-CoV2-spike protein (anti-S-IgG) with an IgG ELISA assay or an EIA Assay after two and three doses of vaccination. RESULTS: A total of 243 allo-SCT patients underwent SARS-CoV-2 vaccination. The median age was 59 years (range 22-81). While 85% of patients received two doses of mRNA vaccines, 10% had vector-based vaccines and 5% received a mixed vaccination. The two vaccine doses were well tolerated with only 3% patients developing a reactivation of graft versus host disease (GvHD). Overall, 72% of patients showed a humoral response after two vaccinations. In the multivariate analysis age at time of allo-SCT (p=0.0065), ongoing immunosuppressive therapy (p= 0.029) and lack of immune reconstitution (CD4-T-cell counts <200/μl, p< 0.001) were associated with no response. Sex, intensity of conditioning and the use of ATG showed no influence on seroconversion. Finally, 44 out of 69 patients that did not respond after the second dose received a booster and 57% (25/44) showed a seroconversion. DISCUSSION: We showed in our bicentric allo-SCT patient cohort, that a humoral response could be achieve after the regular approved schedule, especially for those patients who underwent immune reconstitution and were free from immunosuppressive drugs. In over 50% of the initial non-responders after 2-dose vaccination, a seroconversion can be achieved by boostering with a third dose.
Keywords:COVID 19-Vaccination, Humoral Response, Allogeneic Stem Cell Transplantation, SARS-CoV-2 Antibodies, Vaccine, Booster, SARS-CoV-2-Vaccination
Source:Frontiers in Immunology
Publisher:Frontiers Media SA
Page Range:1174289
Date:3 May 2023
Official Publication:https://doi.org/10.3389/fimmu.2023.1174289
PubMed:View item in PubMed

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