Analysis of vaccine responses after anti-CD20 maintenance in B-cell lymphoma in the Balearic Islands. A single reference center experience.

Abstract

Introduction:

The use of maintenance approaches with anti-CD20 monoclonal antibodies has improved the outcomes of B-cell indolent lymphomas but may lead to significant peripheral B-cell depletion. This depletion can potentially hinder the serological response to neoantigens.

Methods:

Our objective was to analyze the effect of anti-CD20 maintenance therapy in a reliable model of response to neoantigens: SARS-CoV-2 vaccine responses and the incidence/severity ofCOVID-19 in a reference hospital.

Results:

In our series (n=118), the rate of vaccination failures was 31%. Through ROC curve analysis, we determined a cutoff for SARS-CoV-2 vaccine serologic response at 24 months from the last anti-CD20 dose. The risk of severe COVID-19 was notably higher within the first 24months following the last anti-CD20 dose (52%) compared to after this period (just 18%) (p=0.007). In our survival analysis, neither vaccine response nor hypogammaglobulinemia significantly affected OS. While COVID-19 led to a modest mortality rate of 2.5%, this figure was comparable to the OS reported in the general immunocompetent population. However, most patients with hypogammaglobulinemia received intravenous immunoglobulin therapy and all were vaccinated. In conclusion, anti-CD20 maintenance therapy impairs serological responses to SARS-CoV-2 vaccines.

Discussion:

We report for the first time that patients during maintenance therapy and up to 24 months after the last anti-CD20 dose are at a higher risk of vaccine failure and more severe cases of COVID-19. Nevertheless, with close monitoring, intravenous immunoglobulin supplementation or proper vaccination, the impact on survival due to the lack of serological response in this high-risk population can be mitigated, allowing for the benefits of anti-CD20 maintenance therapy, even in the presence of hypogammaglobulinemia.

• Authors: Antonio Gutierrez, Aser Alonso, Marta Garcia-Recio, Sandra Perez, Lucia Garcia-Maño, Jordi Martinez-Serra, Teresa Ros, Mercedes Garcia-Gasalla, Joana Ferrer, Oliver Vögler, Regina Alemany, Antonio Salar, Antonia Sampol, Leyre Bento
• Journal: Frontiers in immunology (Front Immunol) Vol. 14 Pg. 1267485 ( 2023) ISSN: 1664-3224 [Electronic] Switzerland
• PMID: 38022668 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Gutierrez, Alonso, Garcia-Recio, Perez, Garcia-Maño, Martinez-Serra, Ros, Garcia-Gasalla, Ferrer, Vögler, Alemany, Salar, Sampol and Bento.

Chemical References

• COVID-19 Vaccines
• Immunoglobulins, Intravenous
• Vaccines

Topics

• Humans
• COVID-19 Vaccines
• Spain
• Agammaglobulinemia
• Immunoglobulins, Intravenous
• Vaccines
• COVID-19
• Lymphoma, B-Cell (drug therapy)