BNT162b2 mRNA COVID-19 疫苗在慢性淋巴细胞白血病患者中的疗效：血清学和细胞研究。

Efficacy of the BNT162b2 mRNA COVID-19 Vaccine in Patients with Chronic Lymphocytic Leukemia: A Serologic and Cellular Study.

机构信息

Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.

Bio-statistical Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy.

出版信息

Chemotherapy. 2022;67(2):91-95. doi: 10.1159/000521229. Epub 2021 Dec 6.

DOI:10.1159/000521229

PMID:34872098

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8805055/

Abstract

BACKGROUND

Antibody response following SARS-CoV-2 vaccination is somewhat defective in chronic lymphocytic leukemia (CLL). Moreover, the correlation between serologic response and status of cellular immunity has been poorly studied.

OBJECTIVE

This study was undertaken to assess humoral immune and cellular responses to the BNT162b2 messenger RNA (mRNA) COVID-19 vaccination in CLL.

METHODS

The presence of the spike antibodies was assessed at a median time of 14 days from the second vaccine dose of SARS-CoV-2 in 70 CLL patients followed up at a single institution.

RESULTS

The antibody response rate (RR) in CLL patients was 58.5%, compared to 100% of 57 healthy controls of the same sex and age (p < 0.0001). Treatment-naïve patients and those in sustained clinical remission after therapy had the highest RR (87.0% and 87.7%, respectively). In contrast, patients on therapy with a pathway inhibitor as monotherapy and those treated with an association of anti-CD20 antibody were unlikely to respond to the SARS-CoV-2 vaccine (52% and 10%, respectively). In multivariate analysis, early Rai stage (OR, 0.19 [0.05-0.79]; p = 0.02) and no previous therapy (OR, 0.06 [0.02-0.27]; p < 0.0001) were found to be independent predictors of vaccination response. An increase in absolute NK cells (i.e., CD16/CD56 positive cells) in patients with a serological response was found following the second dose of vaccine (p = 0.02).

CONCLUSIONS

These results confirm that serological response to the BNT162b2 vaccine in patients with CLL is impaired. A third boosting vaccine dosage should be considered for these patients.

摘要

背景

慢性淋巴细胞白血病（CLL）患者接种 SARS-CoV-2 疫苗后的抗体反应存在一定缺陷。此外，血清学反应与细胞免疫状态之间的相关性尚未得到充分研究。

目的

本研究旨在评估 CLL 患者接受 BNT162b2 信使 RNA（mRNA）COVID-19 疫苗接种后的体液免疫和细胞免疫反应。

方法

在单一机构接受随访的 70 例 CLL 患者中，在第二剂 SARS-CoV-2 疫苗接种后 14 天中位数时间评估刺突抗体的存在。

结果

CLL 患者的抗体反应率（RR）为 58.5%，而相同性别和年龄的 57 名健康对照者的 RR 为 100%（p < 0.0001）。初治患者和治疗后持续临床缓解的患者具有最高的 RR（分别为 87.0%和 87.7%）。相比之下，接受单一途径抑制剂治疗的患者和接受抗 CD20 抗体联合治疗的患者不太可能对 SARS-CoV-2 疫苗产生反应（分别为 52%和 10%）。在多变量分析中，早期 Rai 分期（OR，0.19 [0.05-0.79]；p = 0.02）和无既往治疗（OR，0.06 [0.02-0.27]；p < 0.0001）被发现是疫苗反应的独立预测因素。在接受第二剂疫苗后，血清学反应患者的绝对 NK 细胞（即 CD16/CD56 阳性细胞）增加（p = 0.02）。