Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Clin Exp Med. 2023 Aug;23(4):1197-1203. doi: 10.1007/s10238-022-00877-2. Epub 2022 Sep 8.
Vaccination represents the best strategy to fight COVID-19 pandemics, especially in immune compromised subjects. In chronic lymphatic leukemia patients, a marked impairment of the immune response to mRNA SARS-CoV-2 vaccine was observed. In this report, we analyzed anti-RBD and neutralizing antibodies in CLL patients after two doses of mRNA SARS CoV 2 vaccine and evaluated the impact of Bruton kinase inhibitory agents. Twenty-seven CLL patients vaccinated with mRNA vaccines against SARS CoV-2 were recruited. Serum IgG, IgM and IgA anti-RBD antibodies and neutralizing antibodies were detected, and antibody avidity was measured. Peripheral blood leukocytes subsets were evaluated by flow cytometry. After two vaccine doses anti-RBD IgG were produced in 11/27 (40.5%) of patients and levels of IgG and IgA anti RBD in CLL patients were sensibly lower than in controls. Neutralizing antibodies were detectable in 12/27 (44.5%) of the patients and their level was lower than that observed in controls. Disease burden and treatment with Bruton kinases inhibitors markedly impaired vaccine induced antibody response. However, in responder patients, antibody avidity was comparable to normal subjects, indicating that the process of clonal selection and affinity maturation takes place as expected. Taken together, these data confirm the impact of disease burden and therapy on production of anti-RBD and neutralizing antibodies and support the current policy of vaccinating CLL patients.
疫苗接种是应对 COVID-19 大流行的最佳策略，尤其是在免疫功能受损的人群中。在慢性淋巴细胞白血病患者中，观察到对 mRNA SARS-CoV-2 疫苗的免疫反应明显受损。在本报告中，我们分析了 27 例接受 mRNA SARS-CoV-2 疫苗接种的 CLL 患者接种两剂 mRNA SARS-CoV-2 疫苗后的抗 RBD 和中和抗体，并评估了 Bruton 激酶抑制剂的影响。募集了 27 例接受 mRNA 疫苗接种的 CLL 患者。检测了血清 IgG、IgM 和 IgA 抗 RBD 抗体和中和抗体，并测量了抗体亲和力。通过流式细胞术评估外周血白细胞亚群。接种两剂疫苗后，11/27（40.5%）的患者产生了抗 RBD IgG，CLL 患者 IgG 和 IgA 抗 RBD 的水平明显低于对照组。12/27（44.5%）的患者可检测到中和抗体，其水平低于对照组。疾病负担和 Bruton 激酶抑制剂的治疗显著损害了疫苗诱导的抗体反应。然而，在应答者患者中，抗体亲和力与正常受试者相当，表明克隆选择和亲和力成熟过程按预期进行。总之，这些数据证实了疾病负担和治疗对产生抗 RBD 和中和抗体的影响，并支持为 CLL 患者接种疫苗的现行政策。
