Abstract
B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10–12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.
Highlights
Chronic lymphocytic leukaemia (CLL) is associated with profound immune dysregulation that progresses over the disease course
Patient characteristics A total of 299 patients were enrolled in the study together with 93 age-matched healthy donors
286 patients (96%) were vaccinated with an ‘extended interval’ regimen of 10–12 weeks between the first and second vaccine. In this group blood samples were taken after the first vaccine in most cases in order to assess the immune response to single vaccine delivery
Summary
Chronic lymphocytic leukaemia (CLL) is associated with profound immune dysregulation that progresses over the disease course. The underlying aetiology is multifactorial, with hypogammaglobulinaemia, impaired cellular immunity and therapy-related immunosuppression commonly observed [1]. These perturbations in immunity predispose patients to an increased risk of infection and infection-related mortality remains a common cause of death [2]. Vaccination against common infectious agents is of paramount importance in supportive care but vaccine-induced immune responses and associated clinical efficacy are often reduced in this patient group. Several studies have shown increased rates of morbidity and mortality after SARSCoV-2 infection in patients with CLL and this is exacerbated by the age of many patients with this condition [3,4,5]
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