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Humoral response to mRNA anti-COVID-19 vaccines BNT162b2 and mRNA-1273 in patients with chronic lymphocytic leukemia. 2022
Cristina Bagacean, and
Rémi Letestu, and
Chadi Al-Nawakil, and
Ségolène Brichler, and
Vincent Lévy, and
Nanthara Sritharan, and
Alain Delmer, and
Caroline Dartigeas, and
Véronique Leblond, and
Damien Roos-Weil, and
Cécile Tomowiak, and
Fatiha Merabet, and
Marie C Béné, and
Aline Clavert, and
Driss Chaoui, and
Philippe Genet, and
Romain Guieze, and
Kamel Laribi, and
Bernard Drénou, and
Lise Willems, and
Christian Puppinck, and
Hugo Legendre, and
Xavier Troussard, and
Stéphanie Malartre, and
Florence Cymbalista, and
Anne-Sophie Michallet
Department of Hematology, INSERM UMR 1227, Centre Hospitalier Universitaire (CHU) Brest, Brest, France.
Immunocompromised individuals such as patients with chronic lymphocytic leukemia (CLL) are at risk of impaired immune responses to vaccination. The objective of our study was to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody responses in patients with CLL after the first, second, and third doses of the BNT162b2 or mRNA-1273 vaccines and after a single dose for patients with confirmed previous COVID-19. In all, 530 patients were included in the study. Patients received 2 doses at a 4-week interval and a third dose if they were seronegative after the second dose. Response rate was 27% after dose 1 and 52% after dose 2. Post-dose 2 treatment-naïve patients had the highest response rate (72%) followed by patients previously treated by chemoimmunotherapy (60%). Among patients receiving therapy, those receiving Bruton tyrosine kinase inhibitor alone (22%) or in combination with anti-CD20 monoclonal antibodies or venetoclax (0%) had the poorer response rate whereas patients who received venetoclax monotherapy achieved a significantly higher response rate (52%). A multivariable analysis identified age older than 65 years, ongoing CLL treatment, and gamma globulin ≤6 g/L as independent predictors of the absence of seroconversion. Post-dose 2 seronegative patients had a global response rate of 35% after dose 3. This study provides an argument for the use of a third dose and for prophylactic SARS-CoV-2 neutralizing monoclonal antibodies.
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