Production and persistence of specific antibodies in COVID-19 patients with hematologic malignancies: role of rituximab

C Cattaneo,G Rossi,L D Notarangelo,A Tucci,J A Chiorini,A Sottini,A Anastasia,A Belotti,C Pagani,H C Su,V Cancelli,P D Burbelo,A Re,K Dobbs,J I Cohen,L Imberti,V Quaresima

doi:10.1038/s41408-021-00546-9

Abstract

The ability of patients with hematologic malignancies (HM) to develop an effective humoral immune response after COVID-19 is unknown. A prospective study was performed to monitor the immune response to SARS-CoV-2 of patients with follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), chronic lymphoproliferative disorders (CLD), multiple myeloma (MM), or myelodysplastic/myeloproliferative syndromes (MDS/MPN). Antibody (Ab) levels to the SARS-CoV-2 nucleocapsid (N) and spike (S) protein were measured at +1, +3, +6 months after nasal swabs became PCR-negative. Forty-five patients (9 FL, 8 DLBCL, 8 CLD, 10 MM, 10 MDS/MPS) and 18 controls were studied. Mean anti-N and anti-S-Ab levels were similar between HM patients and controls, and shared the same behavior, with anti-N Ab levels declining at +6 months and anti-S-Ab remaining stable. Seroconversion rates were lower in HM patients than in controls. In lymphoma patients mean Ab levels and seroconversion rates were lower than in other HM patients, primarily because all nine patients who had received rituximab within 6 months before COVID-19 failed to produce anti-N and anti-S-Ab. Only one patient requiring hematological treatment after COVID-19 lost seropositivity after 6 months. No reinfections were observed. These results may inform vaccination policies and clinical management of HM patients.

Highlights

COVID-19 carries an increased risk of death in patients with cancer, in particular for those with hematologic malignancies (HM), with mortality rates up to 40% among hospitalized patients [1,2,3,4].In the absence of treatments of proven efficacy, vaccination could be a viable resource to prevent infection or reduce the risk of severe disease
Characterizing the quality, strength, and durability of adaptive immune responses to SARS-CoV-2 infection in patients with HM as compared with the general population would be of fundamental importance
We performed a prospective longitudinal study of HM patients who had been hospitalized with COVID-19 and monitored their clinical outcome and immune response to SARS-CoV-2 in relation to both their underlying hematologic disease and the treatment received

Summary

INTRODUCTION

COVID-19 carries an increased risk of death in patients with cancer, in particular for those with hematologic malignancies (HM), with mortality rates up to 40% among hospitalized patients [1,2,3,4]. The long-term prognosis of HM patients surviving the acute phase of COVID-19 and their ability to develop and maintain robust specific Ab responses despite the need for immunosuppressive treatments are unknown To elucidate this point, we performed a prospective longitudinal study of HM patients who had been hospitalized with COVID-19 and monitored their clinical outcome and immune response to SARS-CoV-2 in relation to both their underlying hematologic disease and the treatment received. We report data on the levels of antiSARS-CoV-2 Ab during the first 6 months of convalescence This was a prospective observational study, performed at the Hematology Department of ASST-Spedali Civili in Brescia, Italy, on patients with HM followed longitudinally after hospitalization during the acute phase of. Phase of hematologic disease, treatment received before and after COVID-19, time in which the swab became negative, and severity of SARS-Cov-2 infection were collected.

RESULTS

Cattaneo et al 3

DISCUSSION