Benjamin M. Greenberg , John D. Minna , David E. Gerber , Roberto S. Hernandez , Nancy Monson , Alagarraju Muthukumar , Kaniel Cassady , Erica Chio , Andrea T. Hooper , Matthew F. Wipperman , David E. Greenberg
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引用次数: 0
Abstract
Background
Determining individual responses to vaccination is critical for effective prevention of SARS-CoV-2 infection, particularly in populations at risk of vaccine failure.
Methods
In this prospective study, we collected serum specimens prior to the first and post-second and -third vaccinations to examine the quantity, quality, and durability of immune responses to SARS-CoV-2 vaccination in patients receiving various immune-modulating therapies. To determine rates of vaccine failure, we measured SARS-CoV-2 anti-spike protein immunoglobulin G and neutralisation titres.
Findings
We analysed post-vaccination serum samples from 293 potentially immunocompromised patients (10·2 % haematologic malignancies, 56·0 % solid tumours, 27·6 % neuroimmunological conditions, and 6·1 % other). Based on IgG titres, 22·4 % and 12·0 % of cases were deemed vaccine failures by serology within 6 months of the second and third COVID-19 vaccinations, respectively; these rates were 32·7 % and 13·9 %, respectively, based on neutralisation. Notably, 12·2 % of samples did not have functional neutralising antibodies despite positive serology (mismatched result) within 6 months of the second COVID-19 vaccine dose. The highest rate of vaccine failure occurred in patients receiving active B-cell depleting therapies (primarily haematological malignancies or neuroimmunological conditions); those receiving cytotoxic chemotherapy or immune checkpoint inhibitors (predominantly patients with solid tumours) were at the lowest risk for vaccine failure.
Interpretation
Among patients receiving potentially immunosuppressive therapies, individuals treated with B-cell depletion therapies have high risk for vaccine failure after COVID-19 vaccination, but the rate of failure declines significantly with subsequent doses. In these populations, positive serology tests alone may not signify a protective immune response.
Funding
Supported by a grant from Regeneron Pharmaceuticals, Inc., and P54 CA260560.
期刊介绍:
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