Evaluating COVID-19 vaccination in immunocompromised patients with blood cancers

The study aimed to investigate if immunocompromised patients with blood cancers benefit from COVID-19 vaccination. This study concluded that these patients should not be excluded from COVID-19 vaccination. 

Patients with blood cancers are at high risk for severe forms of COVID-19 disease due to lower immune responses (immunocompromised). This is due to both the blood cancer and its treatments. Vaccination guidelines for patients treated for blood cancer are typically conservative. This is mainly because it is considered that immunocompromised patients do not respond that well to vaccinations and do not make enough antibodies to have a protective effect. 

However, given their high risk for severe COVID-19, it is important to identify those patients that benefit from vaccination. 

This study involved 723 patients with blood cancers who were severely immunocompromised due to their disease or its treatment. All patients were either undergoing treatments for blood cancers or were 6-12 months after therapy with immunochemotherapy, targeted agents, and/or stem cell transplantations. All patients received 2 doses of the mRNA-1273 (Spikevax/Moderna) vaccine 28 days apart. 

Serum IgG antibodies bound to spike subunit 1 (S1) antigens were measured during and after dose 2 of the Covid-19 vaccination. S1 IgG greater than or equal to 300 binding antibody units (BAU)/ml was considered an adequate level to provide benefit.  

4.9% of patients had positive IgG antibodies before vaccination which indicates previous COVID-19 infection. More than 50% of patients obtained S1 IgG greater than or equal to 300 BAU/ml after dose 2 of the vaccine. All patients with sickle cell disease or chronic myeloid leukemia (CML) obtained adequate antibody concentrations.  

Around 70% of patients with chronic graft versus host disease (GvHD; a complication of stem cell transplantation where the transplanted cells attack the patient), multiple myeloma (MM), or untreated chronic lymphocytic leukemia (CLL) obtained adequate S1 IgG concentrations. 

Ruxolitinib (Jakavi) or hypomethylating therapy and a short time after stem cell transplant reduced vaccine responses. The minimum time after stem cell transplant to reach adequate antibody levels ranged from 2-to 8 months.  

This study concluded that patients with blood cancers on chemotherapy, shortly after HCT, or with chronic GvHD should not be excluded from COVID19 vaccination. 

This study only evaluated one type of COVID-19 vaccination.

Consult your physician about COVID19 vaccination.