Abstract
Understanding antibody-based SARS-CoV-2 immunity in hematologic malignancy (HM) patients following infection is crucial to inform vaccination strategies for this highly vulnerable population. This cross-sectional study documents the anti-SARS-CoV-2 humoral response and serum neutralizing activity in 189 HM patients recovering from a PCR-confirmed infection. The overall seroconversion rate was 85.7%, with the lowest values in patients with lymphoid malignancies or undergoing chemotherapy. Therapy-naive patients in the “watch and wait” status were more likely to seroconvert and display increased anti-s IgG titers. Enhanced serum neutralizing activity was observed in the following SARS-CoV-2-infected HM patient groups: (i) males; (ii) severe COVID-19; and (iii) “watch and wait” or “complete/partial response”. The geometric mean (GeoMean) ID50 neutralization titers in patients analyzed before or after 6 months post-infection were 299.1 and 306.3, respectively, indicating that >50% of the patients in either group had a neutralization titer sufficient to provide 50% protection from symptomatic COVID-19. Altogether, our findings suggest that therapy-naive HM patients mount a far more robust immune response to SARS-CoV-2 infection vs. patients receiving anti-cancer treatment, raising the important question as to whether HM patients should be vaccinated before therapy and/or receive vaccine formats capable of better recapitulating the natural infection.
Highlights
Post-coronavirus disease 2019 (COVID-19) patients with hematologic malignancies (HM) often experience prolonged length-ofhospital stay and high mortality rates—as high as 34%—deriving from their poor general health status and immunosuppressed condition caused by the cancer itself and/or anti-cancer therapies [1,2,3,4]
HM patients have been prioritized for access to COVID-19 vaccines, emerging evidence indicates that, following vaccination, they are less likely to mount an immune response as robust as that achieved by solid cancer patients or healthy subjects [5,6,7,8]
All participants provided written informed consent; samples and associated data were pseudonymized and recorded on the REDCap web application in compliance with current GDPR and Italian legislation on the protection of sensitive data and RESULTS Seroconversion rate and magnitude of the IgG antibody response to SARS-CoV-2 according to patient clinical characteristics From March 2020 to April 2021, a total of 189 patients (70 female, 119 male) with a confirmed diagnosis of HM and concomitant SARS-CoV-2 infection were enrolled in this study
Summary
Post-coronavirus disease 2019 (COVID-19) patients with hematologic malignancies (HM) often experience prolonged length-ofhospital stay and high mortality rates—as high as 34%—deriving from their poor general health status and immunosuppressed condition caused by the cancer itself and/or anti-cancer therapies [1,2,3,4]. HM patients have been prioritized for access to COVID-19 vaccines, emerging evidence indicates that, following vaccination, they are less likely to mount an immune response as robust as that achieved by solid cancer patients or healthy subjects [5,6,7,8] It is today more urgent than ever to identify the immune correlate(s) of protection (CoPs) from natural SARSCoV-2 infection that may help predict how HM patients will respond to current COVID-19 vaccines and, at the same time, allow us to understand whether these patients may benefit from alternative vaccine formats that better recapitulate the natural infection. NAbs are crucial to overcome infectious diseases and are important CoPs from SARS-CoV-2 re-infection
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