Abstract
The COVID-19 pandemic threatens patients with a compromised immune and endothelial system, including patients who underwent allogeneic stem cell transplantation (alloSCT). Thus, there is an unmet need for optimizing vaccination management in this high-risk cohort. Here, we monitored antibodies against SARS-CoV-2 spike protein (anti-S1) in 167 vaccinated alloSCT patients. Humoral immune responses were detectable in 81% of patients after two vaccinations with either mRNA-, vector-based, or heterologous regimens. Age, B-cell counts, time interval from vaccination, and the type of vaccine determined antibody titres in patients without systemic immunosuppression (sIS). Similar to a healthy control cohort, mRNA vaccine-based regimens induced higher titres than vector-based vaccines. Patients on two or more immunosuppressants rarely developed immunity. In contrast, 62% and 45% of patients without or on only one immunosuppressant, respectively, showed a strong humoral vaccination response (titre > 100). Exacerbation of cGVHD upon vaccination was observed in 6% of all patients and in 22% of patients receiving immunosuppression for cGVHD. cGVHD exacerbation and low antibody titres were both associated with higher angiopoietin-2 (ANG2) serum levels. In conclusion, mRNA-based vaccines elicit strong humoral responses in alloSCT patients in the absence of double sIS. Biomarkers such as ANG2 might help with weighing cGVHD risk versus beneficial responses.
Highlights
Vaccination against COVID-19 is recommended in allogeneic stem cell transplantation (alloSCT) patients as early as three months post transplantation [1]
We described the humoral responses after COVID-19 vaccination in a large cohort of 167 post alloSCT patients
Whether ANG2 may serve as a biomarker prior to vaccination to estimate the chances of successful vaccination versus chronic graft-versus-host disease (cGVHD) aggravation and whether there is a mechanistic link between high ANG2 serum levels and low humoral responses will have to be addressed in future studies
Summary
Vaccination against COVID-19 is recommended in alloSCT patients as early as three months post transplantation [1]. Previous studies identified immunosuppressive treatment or ongoing chronic graft-versus-host disease (cGVHD), low B-cell counts, B cell-depleting therapy, anti-thymocyte globulin (ATG) prophylaxis, and time from alloSCT as factors significantly impacting humoral vaccination responses post alloSCT [1,2]. Most patient cohorts were small (
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