Department of Haematology, 3RdFaculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Srobarova 50, 100 34, Prague 10, Czech Republic.
Central Laboratories of the Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
Clin Exp Med. 2023 Jun;23(2):371-379. doi: 10.1007/s10238-022-00809-0. Epub 2022 Mar 29.
Patients treated with B-cell-targeting therapies like Rituximab or Ibrutinib have decreased serological response to various vaccines. In this study, we tested serological and cellular response to SARS-CoV-2 mRNA vaccines in 16 patients treated with Ibrutinib, 16 treated with maintenance Rituximab, 18 patients with chronic lymphocytic leukaemia (CLL) with watch and wait status and 21 healthy volunteers. In comparison with the healthy volunteers, where serological response was achieved by 100% subjects, patients on B-cell-targeting therapy (Ibrutinib and Rituximab) had their response dramatically impaired. The serological response was achieved in 0% of Rituximab treated, 18% of Ibrutinib treated and 50% of untreated CLL patients. Cell-mediated immunity analysed by the whole blood Interferon-γ Release immune Assay developed in 80% of healthy controls, 62% of Rituximab treated, 75% of Ibrutinib treated and 55% of untreated CLL patients. The probability of cell-mediated immune response development negatively correlates with disease burden mainly in CLL patients. Our study shows that even though the serological response to SARS-CoV-2 vaccine is severely impaired in patients treated with B-cell-targeting therapy, the majority of these patients develop sufficient cell-mediated immunity. The vaccination of these patients therefore might be meaningful in terms of protection against SARS-CoV-2 infection.
接受 B 细胞靶向治疗（如利妥昔单抗或伊布替尼）的患者对各种疫苗的血清学反应降低。在这项研究中，我们检测了 16 名接受伊布替尼治疗、16 名接受维持性利妥昔单抗治疗、18 名慢性淋巴细胞白血病（CLL）患者和 21 名健康志愿者对 SARS-CoV-2 mRNA 疫苗的血清学和细胞免疫反应。与健康志愿者相比，其中 100%的受试者产生了血清学反应，而接受 B 细胞靶向治疗（伊布替尼和利妥昔单抗）的患者其反应明显受损。利妥昔单抗治疗组有 0%、伊布替尼治疗组有 18%、未治疗的 CLL 患者有 50%达到血清学反应。通过全血干扰素-γ释放免疫测定分析的细胞介导免疫在 80%的健康对照者、62%的利妥昔单抗治疗者、75%的伊布替尼治疗者和 55%的未治疗的 CLL 患者中发展。细胞介导免疫反应的发展概率与疾病负担呈负相关，主要在 CLL 患者中。我们的研究表明，尽管接受 B 细胞靶向治疗的患者对 SARS-CoV-2 疫苗的血清学反应严重受损，但这些患者中的大多数产生了足够的细胞介导免疫。因此，这些患者的疫苗接种在预防 SARS-CoV-2 感染方面可能具有意义。
