Abstract
BackgroundDue to potentially immune-escaping virus variants and waning immunity, a third SARS-CoV-2 vaccination dose is increasingly recommended. However, data in patients with cancer are limited. Patients and methodsWe measured anti-SARS-CoV-2 spike protein antibody levels after the third vaccination dose in 439 patients with cancer and 41 health care workers (HCW) at an academic centre in Austria and a rural community hospital in Italy. Adverse events were retrieved from questionnaires. ResultsOverall, 439 patients and 41 HCW were included. SARS-CoV-2 infections were observed in 62/439 (14.1%) patients before vaccination and in 5/439 (1.1%) patients after ≥1 dose. Longitudinal analysis revealed a decrease of antibody levels between 3 and 6 months after second vaccination in patients with solid tumours (p < 0.001) and haematological malignancies without anti-B cell therapies (p < 0.001). After the third dose, anti-S levels increased compared to the first/second dose. Patients receiving B cell-targeted agents had lower antibody levels than patients with haematological malignancies undergoing other treatments (p < 0.001) or patients with solid tumours (p < 0.001). Moreover, anti-S levels correlated with CD19+ (B cell) and CD56+ (NK cell) counts in peripheral blood. The most frequent adverse events after the third dose were local pain (75/160, 46.9%), fatigue (25/160, 15.6%) and fever/chills (16/160, 10.0%). Patients with cancer had lower anti-S levels than HCW (p = 0.015). ConclusionsThis study in patients with cancer shows improved antibody levels after the third vaccination dose at an acceptable side-effect profile. Lower antibody levels than in controls underline the need for further follow-up studies and dedicated trials.
Highlights
Patients with cancer are affected by the COVID-19 pandemic
Longitudinal analysis revealed a decrease of antibody levels between 3 and 6 months after second vaccination in patients with solid tumors (p
Anti-S levels correlated with CD19+ (B cell) and CD56+ (NK cell) counts in peripheral blood
Summary
Patients with cancer are affected by the COVID-19 pandemic. They are prone to adverse outcomes and severe COVID-19 when infected with SARS-CoV2, and at risk of disruptions of anticancer treatment or monitoring visits because of SARS-CoV-2 infections [1,2,3,4]. Journal Pre-proof SARS-CoV-2 vaccination shows immunogenicity in patients with cancer, seroconversion rates and antibody levels are lower compared to healthy cohorts, especially in patients undergoing antineoplastic treatment [9,10,11,12,13,14]. A third vaccination dose shows the ability to lower the rates of SARS-CoV-2 infection and severe COVID-19 in comparison to non-boostered elderly populations [17]. Studies in immunosuppressed transplant recipients report improved antibody responses after the third dose [18,19]. We aimed to assess clinical factors impacting humoral immune responses after the third SARS-CoV-2 vaccination dose in a large real-life cohort of patients with hemato-oncological malignancies
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