Adaptive humoral immune response and cellular immune status in cancer patients and patients under immunosuppression vaccinated against SARS-CoV-2

ABSTRACT

Background

Patients with cancer and autoimmune diseases are at higher risk of severe COVID-19. They may not develop protective immune responses following vaccination. We investigated patients’ cellular and humoral immune response after two COVID-19 vaccine doses.

Research design and methods

Subjects were stratified into subgroups according to therapy and grade of immunosuppression at time of vaccination.

Results

Antibody titers were compared to healthy controls. 32/122 (26%) did not develop detectable antibody titers. Of these, 22 (66.6%) had active therapy. Patients showed significant lower antibody titers compared to controls (median 790 vs. 3923 AU/mL, p = 0.026). Patients with active therapy had significant lower antibody titers compared to those without (median 302 vs. 3952 U/L P < 0.001). B-cell count was lower in the group without antibody titers (median 29.97 vs. 152.8; p = 0.002). 100% of patients under anti-CD20 therapy had no detectable antibody titer, followed by anti-TNF (66%), BTK inhibitors (50%), ruxolitinib (35.5%), TKI (14.2%), and lenalidomide (12.5%). Anti-CD20 therapy, ruxolitinib, BTK inhibitors, and anti-CD38 therapy presented significant lower antibody titers compared to controls.

Conclusions

Patients undergoing therapy for cancer or autoimmune diseases are at higher risk of insufficient humoral immune response following COVID-19 vaccination. Furthermore, alterations in the B-cell compartment correlate with lower antibody titers.

KEYWORDS:

• Cancer
• COVID-19
• immunosuppression
• vaccine
• vaccine response

Declaration of interests

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception and design: I.A.K., M.K., L.T. and M.B. Investigation: M.B. and I.A.K. were responsible for flow cytometry data, S.S. and S.L. provided data on antibody titers. Statistical analysis: I.A.K. and M.K. Interpretation: All authors. Writing of the initial manuscript: I.A.K., M.K., L.T. and M.B. Review of the first draft: K.B., O.C., J.T.B., M.A., S.S., S.L., K.C., D.K.-M., and F.N. Final approval of manuscript: All authors

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors received no financial support for this work.