Vaccination against COVID-19 protects people with B-cell lymphoma and multiple myeloma

People with haematological malignancies are at increased risk of developing severe coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); However, studies that explore the immune response to the COVID-19 vaccine are scarce. newly nature cancer A study has documented that people with B-cell lymphoma (LY) and multiple myeloma (MM) develop potent infection-neutralizing abilities against several variants related to SARS-CoV-2 (VoC).

​​​​​​​​STUDY: Highly potent neutralizing antibody and T-cell responses after COVID-19 vaccination in subjects with B-cell lymphoma and multiple myeloma. Image credit: Design_Cells/Shutterstock

about studying

Cancer patients have shown high mortality and morbidity rates due to SARS-CoV-2 infection. These people often have secondary immunodeficiency and become seriously ill. Studies have demonstrated the effectiveness of available vaccines in reducing disease severity in immunocompetent individuals, stimulating both T-cell and humoral responses.

The present study published a longitudinal approach to investigate humoral and T-cell immune responses induced by two and three doses of vaccine, primarily using the BNT162b2 mRNA vaccine. The group of individuals had different LY and MM B cells. The researchers were able to get a complete picture of the vaccine-induced immune responses in this group compared to a healthy control group. Parallel time-resolved evaluation of antibody titers against the viral spike protein, neutralizing ability and viability of antibodies against six original and replication-competent viruses, and directed T-cell responses to HCoV OC43 and SARS-CoV-2 viruses were analyzed.

Main conclusions

Six main findings were reported in this study. First, compared to healthy individuals, individuals with hematological malignancies showed a slightly lower ability to neutralize infection against SARS-CoV-2 variants. This is despite a lower antibody titer against spike protein in the treated group.

Second, the neutralizing efficacy per unit of antibody to Sanabel was significantly improved in individuals with hematologic malignancies (20.8-fold, on average), compared to the control group. This improvement was noticed shortly after the second vaccination. Third, compared to healthy individuals, the treated group showed greater avidity for binding of serum IgG to viral thorn protein before receiving the third dose of vaccine.

Fourth, Omicron (BA.1) and to a lesser extent, VoC beta and delta showed the greatest humoral immune evasion. This finding was consistent with recent findings in healthy individuals after vaccination or infection. Fifth, the dominant part of the study participants elicited robust vaccine-induced T-cell responses to several novel VOCs. This group included participants who experienced LY and were receiving Rx treatment. Sixth, no deaths related to COVID-19 were reported in the study cohort, and clinical presentation during penetrant infection demonstrated that the vaccine provided partial protection for immunocompromised individuals with hematologic malignancies.

The results indicated that subjects with LY without a humoral immune response were more likely to develop breakthrough symptoms. This severely immunocompromised group may benefit from prior prophylaxis with neutralizing mAbs, although most currently available mAbs have shown to lose the antiviral efficacy of modern VOCs.

It was noted that the third vaccination was significant in both groups to raise the antibody titer. However, it has been suggested that quality rather than quantity of spike-targeting antibodies matter more. Thus MU can reduce the potency of the humoral response in vaccines containing MM or LY.

Research has shown that mRNA-based vaccines induce specific T-cell responses in most healthy recipients. However, more heterogeneous responses have been reported in people with cancer. Results on vaccine-induced T-cell responses achieved by 85% of subjects with leukemia included in the study were consistent with those documented in a large cohort study of cancer patients in the UK. In the latest study, the response rate in a group of people with leukemia was 80%.

Strengths and limitations of the current study

The main strength of the study is the longitudinal sampling of individuals with clinically well-characterized cancer and their subsequent matching with a cohort of healthcare workers. A robust systemic approach, including anti-spiking IgG viscosity measurement and live virus neutralization assays, is another strength of the current study.

A critical limitation of the study is the small number of subjects with leukemia (N = 60). The contemporary control group of solid tumors or other hematological malignancies was also absent. In addition, no adjustment for multiple testing was performed in the correlation analysis, which may introduce confounding factors.

conclusion

More detailed longitudinal studies of infection- and vaccine-induced immunity against COVID-19 should use multifactorial evaluation. This is critical as we are deepening our understanding of quantitative markers as being associated with protection in subjects with haematological malignancies with the emergence of novel SARS-CoV-2 VoCs.