Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain.
Bone Marrow Transplant. 2023 May;58(5):567-580. doi: 10.1038/s41409-023-01946-0. Epub 2023 Feb 28.
The kinetics of SARS-CoV-2 reactive IgG antibodies after full vaccination and booster in allogeneic and autologous stem cell transplantation (allo-HSCT, ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) are of utmost importance for estimating risk of infection. A prospective multicenter registry-based cohort study, conducted from December 2020 to July 2022 was used to analyze antibody waning over time, booster effect and the relationship of antibody response and breakthrough infection in 572 recipients (429 allo-HSCT, 121 ASCT and 22 CAR-T cell therapy). A significant decline in antibody titers was observed at 3 and 6 months after full vaccination in recipients without pre-vaccine SARS-CoV-2 infection, whereas recipients infected prior to vaccination showed higher and stable antibody titers over time. In poor responders, a booster dose was able to increase antibody titers in 83% of allo-HSCT and 58% of ASCT recipients but not in CART-T cell recipients [0%] (p < 0.01). One-year cumulative incidence of breakthrough infection was 15%, similar among cell therapy procedures. Immunosuppressive drugs at the time of vaccination [hazard ratio (HR) 1.81, p = 0.0028] and reduced intensity conditioning (HR 0.49, p = 0.011) were identified as the only conditions associated with different risk of breakthrough infection in allo-HSCT recipients. Antibody titers were associated with breakthrough infection and disease severity. No death was observed among the 72 breakthrough infections. Antibody level decay after the first two vaccine doses was common except in recipients with pre-vaccination SARS-CoV-2 infection. Poorly responding allo-HSCT recipients showed a response advantage with the booster as compared to ASCT and, especially, the null response found in CAR-T cell recipients. Antibody titers were positively correlated with the risk of breakthrough SARS-CoV-2 infection which was mainly driven by the immunosuppression status.
全疫苗接种和加强针后，SARS-CoV-2 反应性 IgG 抗体的动力学在异基因和自体造血干细胞移植（allo-HSCT，ASCT）和嵌合抗原受体 T 细胞治疗（CAR-T）中对于估计感染风险至关重要。一项前瞻性、多中心基于登记的队列研究，于 2020 年 12 月至 2022 年 7 月进行，用于分析随时间推移的抗体衰减、加强针效果以及抗体反应与突破感染的关系，共纳入 572 名接受者（429 名 allo-HSCT、121 名 ASCT 和 22 名 CAR-T 细胞治疗）。在未感染 SARS-CoV-2 的接受者中，全疫苗接种后 3 个月和 6 个月时观察到抗体滴度显著下降，而在接种前感染的接受者中，抗体滴度随时间推移而升高且稳定。在反应不佳的患者中，加强剂量能够使 83%的 allo-HSCT 和 58%的 ASCT 接受者的抗体滴度增加，但不能使 CAR-T 细胞接受者增加[0%]（p<0.01）。1 年突破性感染累积发生率为 15%，各细胞治疗程序相似。接种时的免疫抑制药物[风险比（HR）1.81，p=0.0028]和减强度预处理（HR 0.49，p=0.011）被确定为与 allo-HSCT 接受者突破性感染风险不同的唯一条件。抗体滴度与突破性感染和疾病严重程度相关。在 72 例突破感染中，未观察到死亡。除了接种前感染 SARS-CoV-2 的接受者外，全疫苗接种后前两剂疫苗的抗体水平下降很常见。与 ASCT 相比，反应不佳的 allo-HSCT 接受者加强针后表现出优势反应，尤其是在 CAR-T 细胞接受者中发现的无反应。抗体滴度与突破性 SARS-CoV-2 感染的风险呈正相关，主要受免疫抑制状态的驱动。
Zotero 插件
