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异基因造血细胞移植后患者对 SARS-CoV-2 疫苗接种的抗体反应。

Antibody Response to SARS-CoV-2 Vaccination in Patients following Allogeneic Hematopoietic Cell Transplantation.

机构信息

Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.

Institute of Medical Virology, University of Zurich, Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.

出版信息

Transplant Cell Ther. 2022 Apr;28(4):214.e1-214.e11. doi: 10.1016/j.jtct.2022.01.019. Epub 2022 Jan 31.

Abstract

Vaccines against SARS-CoV-2 have been rapidly approved. Although pivotal studies were conducted in healthy volunteers, little information is available on the safety and efficacy of mRNA vaccines in immunocompromised patients, including recipients of allogeneic hematopoietic cell transplantation (allo-HCT). Here we used a novel assay to analyze patient- and transplantation-related factors and their influence on immune responses to SARS-CoV-2 vaccination over an extended period (up to 6 months) in a large and homogenous group of allo-HCT recipients at a single center in Switzerland. We examined longitudinal antibody responses to SARS-CoV-2 vaccination with BNT162b2 (BioNTech/Pfizer) and mRNA-1273 (Moderna) in 110 allo-HCT recipients and 86 healthy controls. Seroprofiling recording IgG, IgA, and IgM reactivity against SARS-CoV-2 antigens (receptor-binding domain, spike glycoprotein subunits S1 and S2, and nucleocapsid protein) was performed before vaccination, before the second dose, and at 1, 3, and 6 months after the second dose. Patients were stratified to 3 groups: 3 to 6 months post-allo-HCT, 6 to 12 months post-allo-HCT, and >12 months post-allo-HCT. Patients in the 3 to 6 months and 6 to 12 months post-allo-HCT groups developed significantly lower antibody titers after vaccination compared with patients in the >12 months post-allo-HCT group and healthy controls (P < .001). Within the cohort of allo-HCT recipients, patients age >65 years (P = .030), those receiving immunosuppression for prevention or treatment of graft-versus-host disease (GVHD) (P = .033), and patients with relapsed disease (P = .014) displayed low humoral immune responses to the vaccine. In contrast, the intensity of the conditioning regimen, underlying disease (myeloid/lymphoid/other), and presence of chronic GVHD had no impact on antibody levels. Antibody titers achieved the highest levels at 1 month after the second dose of the vaccine but waned substantially in all transplantation groups and healthy controls over time. This analysis of long-term vaccine antibody response is of critical importance to allo-HCT recipients and transplant physicians to guide treatment decisions regarding revaccination and social behavior during the SARS-CoV-2 pandemic.

摘要

针对 SARS-CoV-2 的疫苗已迅速获得批准。尽管关键研究是在健康志愿者中进行的,但关于 mRNA 疫苗在免疫功能低下患者(包括接受异基因造血细胞移植(allo-HCT)的患者)中的安全性和有效性的数据很少。在这里,我们使用一种新的分析方法,在瑞士的一个单一中心,对大量同质的 allo-HCT 受者进行了长达 6 个月的随访,分析了与患者和移植相关的因素及其对 SARS-CoV-2 疫苗接种免疫反应的影响。我们使用 BNT162b2(BioNTech/Pfizer)和 mRNA-1273(Moderna)对 110 名 allo-HCT 受者和 86 名健康对照者进行了 SARS-CoV-2 疫苗接种的纵向抗体反应检测。在接种疫苗前、接种第二剂疫苗前以及第二剂疫苗接种后 1、3 和 6 个月,对血清学分析记录了针对 SARS-CoV-2 抗原(受体结合域、刺突糖蛋白亚单位 S1 和 S2 以及核衣壳蛋白)的 IgG、IgA 和 IgM 反应性。将患者分为 3 组:allo-HCT 后 3-6 个月、allo-HCT 后 6-12 个月和 allo-HCT 后>12 个月。与 allo-HCT 后>12 个月的患者和健康对照组相比,allo-HCT 后 3-6 个月和 6-12 个月的患者接种疫苗后的抗体滴度明显较低(P<.001)。在 allo-HCT 受者队列中,年龄>65 岁的患者(P=.030)、接受免疫抑制治疗预防或治疗移植物抗宿主病(GVHD)的患者(P=.033)和患有疾病复发的患者(P=.014)对疫苗的体液免疫反应较低。相比之下,预处理方案的强度、基础疾病(髓系/淋巴系/其他)和慢性 GVHD 的存在对抗体水平没有影响。抗体滴度在接种疫苗后的第 1 个月达到最高水平,但随着时间的推移,所有移植组和健康对照组的抗体水平都大幅下降。这项关于长期疫苗抗体反应的分析对于 allo-HCT 受者和移植医生来说至关重要,可指导关于加强针接种和 SARS-CoV-2 大流行期间社交行为的治疗决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f313/8802693/e04ec88e21f4/ga1_lrg.jpg

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