Comprehensive humoral and cellular immune responses to COVID-19 vaccination in adults with cancer

被引:0
作者
Body, Amy [1 ,2 ]
Lal, Luxi [1 ,2 ]
Srihari, Sriganesh [3 ]
Macintyre, C. Raina
Buttery, Jim [4 ,5 ,6 ]
Ahern, Elizabeth Stephanie [1 ,2 ]
Opat, Stephen [1 ,2 ]
Leahy, Michael Francis [7 ,8 ]
Hamad, Nada [9 ,10 ]
Milch, Vivienne [11 ,12 ,13 ]
Turville, Stuart [14 ,15 ]
Smith, Corey [16 ,17 ,18 ]
Lineburg, Katie [16 ,17 ]
Naing, Zin [19 ]
Rawlinson, William [19 ,20 ,21 ]
Segelov, Eva [2 ,22 ,23 ]
机构
[1] Monash Hlth, Dept Oncol, Melbourne, Vic, Australia
[2] Monash Univ, Sch Clin Sci, Melbourne, Vic, Australia
[3] Queensland Inst Med Res Berghofer, Brisbane, Qld, Australia
[4] Univ Melbourne, Dept Paediat, Parkville, Vic, Australia
[5] Royal Childrens Hosp, Melbourne, Vic, Australia
[6] Murdoch Childrens Res Inst, Parkville, Vic, Australia
[7] Royal Perth Hosp, Dept Haematol, Perth, WA, Australia
[8] Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia
[9] St Vincents Hosp, Dept Haematol, Kinghorn Canc Ctr, Sydney, NSW, Australia
[10] Univ New South Wales, Sydney, NSW, Australia
[11] Canc Australia, Sydney, NSW, Australia
[12] Flinders Univ S Australia, Caring Futures Inst, Adelaide, SA, Australia
[13] Univ Notre Dame Australia, Sch Med, Sydney, NSW, Australia
[14] Univ New South Wales, Kirby Inst, Sydney, NSW, Australia
[15] Univ Sydney, Sydney, NSW, Australia
[16] QIMR Berghofer Med Res Inst, QIMR Berghofer Ctr Immunotherapy & Vaccine Dev, Herston, Qld, Australia
[17] QIMR Berghofer Med Res Inst, Infect & Inflammat Program, Translat & Human Immunol Lab, Herston, Qld, Australia
[18] Univ Queensland, Brisbane, Qld, Australia
[19] Prince Wales Hosp, Dept Microbiol, Serol & Virol Div SAViD, NSW Hlth Pathol East, Sydney, NSW, Australia
[20] Prince Wales Hosp, Virol Res Lab, Sydney, NSW, Australia
[21] Univ New South Wales, Fac Med, Sch Med Sci, Sydney, NSW, Australia
[22] Univ Bern, Dept Clin Res Med, Bern, Switzerland
[23] Univ Canc Ctr, Bern, Switzerland
关键词
COVID-19; SARS-CoV-2; Vaccine response; Cancer; Antibody response; T cell response;
D O I
10.1016/j.vaccine.2024.126547
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: The COVID-19 pandemic has significantly impacted people with cancer. Initial vaccine studies excluded patients with malignancy. Immunocompromised individuals remain vulnerable to SARS-CoV-2, necessitating detailed understanding of vaccine response. The epidemiology of COVID-19 in Australia offered unique opportunities to study cancer populations with minimal community exposure to SARS-CoV-2. Methods: SerOzNET prospectively examined previously unvaccinated patients with solid and haematological malignancies receiving up to five COVID-19 vaccine doses. Antibody response was measured by live virus neutralisation assay (neutralising antibody (NAb); positive titre >= 1:20; study primary endpoint) and commercial assay. T cell response was measured by cytometric bead array; positive defined as interferon gamma (IFN-gamma) >= 10 pg/mL in response to Spike antigen. Patient and physician-reported adverse events were secondary endpoints. Outcomes: 395 adults were enrolled prior to receiving mRNA vaccine (BNT162b2 = 347; mRNA-1273 = 1) or viral vector vaccine (ChadOx1-S = 43) for initial two-dose course, plus up to three additional doses. Median age was 58 years (range: 20-85); 60 % were female; 35 % had haematological malignancy, 2/395 (0.5 %) had baseline positive nucleocapsid antibody indicating prior SARS-CoV-2 exposure. NAb response post dose three was demonstrated in 84 % overall; 96 % of patients with solid cancers and 64 % with haematological cancer (p < 0.001). Risk factors for non-response were haematological cancer and anti B-cell therapies. Some patients with haematological cancer seroconverted for the first time after the fourth or fifth dose. IFN-gamma response was seen in many patients with haematological cancer who lacked NAb response. Serious adverse events were rare. COVID19 infection occurred in 29 % with no deaths. Interpretation: COVID-19 vaccination elicits B and T cell responses in patients with solid and haematological cancers, with an acceptable safety profile. A significant proportion of haematological cancer patients require >3 doses to elicit NAb, with many demonstrating T cell response, which may be an alternative pathway of immune protection.
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