In a study reported in JAMA Oncology, Mair et al found that antibody response to COVID-19 vaccination was poorer in patients with hematologic or solid malignancies compared with health-care workers. The investigators also identified factors associated with poorer antibody response among patients.
Study Details
The study involved data from two cohorts consisting of 24 patients from Medical University of Vienna and 484 patients from a rural center (Franz Tappeiner Hospital in Meran, Italy) who were treated for malignancies between October 2020 and May 2021 and who were partially or fully vaccinated with BioNTech/Pfizer (BNT162b2), Moderna (mRNA-1273), or AstraZeneca (AZD1222) vaccines. Outcomes were compared with 58 fully vaccinated health-care workers from the Division of Oncology at Medical University of Vienna.
Total anti–SARS–CoV-2 anti-spike protein antibodies (anti-S) were measured retrospectively using the Elecsys Anti–SARS–CoV-2 S electrochemiluminescence sandwich immunoassay (quantification range = 0.4–2500.0 U/mL) in the Vienna cohort and the SARS–CoV-2 IgGII Quant-test (quantification range = 0–40,000 AU/mL) in the Meran cohort.
In this cohort study of patients with hemato-oncological diseases and a control group of health-care workers, anti–SARS–CoV-2 antibodies after vaccination could be detected in patients with cancer. Lower antibody levels compared with health-care workers and differences in seroconversion in specific subgroups underscore the need for further studies on SARS–CoV-2 vaccination in patients with hemato-oncological disease.— Mair et al
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Key Findings
In the Vienna cohort, median anti-S levels after first vaccination were 0.0 U/mL (range = 0.0–135 U/mL) among 15 partially vaccinated patients, 57.7 U/mL (range = 0.0–2,007 U/mL) among 7 fully vaccinated patients without prior COVID-19 infection, and 295 and 2,500 U/mL in 2 fully vaccinated patients with prior COVID-19 infection.
In the Meran cohort, median anti-S level after the first dose was 201.2 AU/mL (range= 0–40,000 AU/mL). Assessment of response after the second dose in 125 patients with anti-S levels < 50 AU/mL after the first dose showed an increase from 1.7 AU/mL (range = 0–49.4 AU/mL) to 50 AU/mL (range = 0–40,000 AU/mL).
After the first dose in the Meran cohort, patients with hematologic cancers who received B cell–targeting agents had lower anti-S levels (median = 1.6 AU/mL, range = 0–17,244 AU/mL) vs patients who received other therapies (median = 191.6 AU/mL, range = 0–40,000, P < .001) and vs patients with solid tumors (median = 246.4 AU/mL, range = 0–40,000 AU/mL, P < .001).
In the Meran cohort, median anti-S levels after the first dose were 157.7 AU/mL (range = 0–40,000 AU/mL) among patients with ongoing chemotherapy alone, 118.7 AU/mL (range = 14.1–38,727 AU/mL) among those with ongoing chemotherapy plus immunotherapy, and 634.3 AU/mL (range = 0–40,000 AU/mL) among those with no ongoing treatment (P = .01).
Median anti-S levels after full vaccination were 2,500 U/mL (range = 485–2,500 U/mL) among health-care workers vs 117.0 U/mL (range = 0–2,500 U/mL) among patients in the Vienna cohort (P < .001).
The investigators concluded, “In this cohort study of patients with hemato-oncological diseases and a control group of health-care workers, anti–SARS–CoV-2 antibodies after vaccination could be detected in patients with cancer. Lower antibody levels compared with health-care workers and differences in seroconversion in specific subgroups underscore the need for further studies on SARS–CoV-2 vaccination in patients with hemato-oncological disease.”
Matthias Preusser, MD, of the Division of Oncology, Medical University of Vienna, is the corresponding author for the JAMA Oncology article.
Disclosure: This study was funded by the research budgets of the Medical University of Vienna and Südtiroler Sanitätsbetrieb. For full disclosures of the study authors, visit jamanetwork.com.
