SARS-CoV-2 vaccination in the first year after allogeneic hematopoietic cell transplant: a prospective, multicentre, observational study

• Type of Material: Article
• Authors: Joshua A Hill, Fred Hutchinson Cancer Center; Michael J Martens, Medical College of Wisconsin; Jo-Anne H Young, University of Minnesota, Minneapolis; Kavita Bhavsar, Medical College of Wisconsin; Jianqun Kou, Medical College of Wisconsin; Min Chen, Medical College of Wisconsin; Lik Wee Lee, Adaptive Biotechnologies Corp; Aliyah Baluch, H. Lee Moffitt Cancer Center and Research Institute; Madhav Dhodapkar, Emory University; Ryotaro Nakamura, City of Hope, Duarte, CA, USA; Kristin Peyton, The Emmes Company; Zainab Shahid, Memorial Sloan Kettering Cancer Center, New York; Paul Armistead, University of North Carolina; Peter Westervelt, Washington University; John McCarty, Virginia Commonwealth University; Joseph McGuirk, University of Kansas; Mehdi Hamadani, Medical College of Wisconsin; Susan DeWolf, Memorial Sloan Kettering Cancer Center, New York; Kinga Hosszu, Memorial Sloan Kettering Cancer Center, New York; Elad Sharon, National Cancer Institute, Bethesda; Ashley Spahn, National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis; Amir A Toor, Virginia Commonwealth University; Stephanie Waldvogel, National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA; Lee M Greenberger, The Leukemia and Lymphoma Society, Rye Brook, New York, NY, USA; Jeffrey J Auletta, National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA; Mary M Horowitz, Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA; Marcie L Riches, Center for International Blood and Marrow Transplantation Research, Medical College of Wisconsin, Milwaukee, WI, USA; Miguel-Angel Perales, Memorial Sloan Kettering Cancer Center, New York, NY, USA
• Language: English
• Date: 2023-04-27
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.eclinm.2023.101983
• Title of Journal or Parent Work: ECLINICALMEDICINE
• Volume: 59
• Start Page: 101983
• End Page: 101983
• Keywords: Covid-19; Transplant; Science & Technology; RECIPIENTS; Life Sciences & Biomedicine; SARS-CoV-2; IMMUNOGENICITY; Vaccine; Hematopoietic cell transplant; COVID-19; Medicine, General & Internal; General & Internal Medicine
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: The optimal timing for SARS-CoV-2 vaccines within the first year after allogeneic hematopoietic cell transplant (HCT) is poorly understood. Methods: We conducted a prospective, multicentre, observational study of allogeneic HCT recipients who initiated SARS-CoV-2 vaccinations within 12 months of HCT. Participants were enrolled at 22 academic cancer centers across the United States. Participants of any age who were planning to receive a first post-HCT SARS-CoV-2 vaccine within 12 months of HCT were eligible. We obtained blood prior to and after each vaccine dose for up to four vaccine doses, with an end-of-study sample seven to nine months after enrollment. We tested for SARS-CoV-2 spike protein (anti-S) IgG; nucleocapsid protein (anti-N) IgG; neutralizing antibodies for Wuhan D614G, Delta B.1.617.2, and Omicron B.1.1.529 strains; and SARS-CoV-2-specific T-cell receptors (TCRs). The primary outcome was a comparison of anti-S IgG titers at the post-V2 time point in participants initiating vaccinations <4 months versus 4–12 months after HCT using a propensity-adjusted analysis. We also evaluated factors associated with high-level anti-S IgG titers (≥2403 U/mL) in logistic regression models. Findings: Between April 22, 2021 and November 17, 2021, 175 allogeneic HCT recipients were enrolled in the study, of whom all but one received mRNA SARS-CoV-2 vaccines. SARS-CoV-2 anti-S IgG titers, neutralizing antibody titers, and TCR breadth and depth did not significantly differ at all tested time points following the second vaccination among those initiating vaccinations <4 months versus 4–12 months after HCT. Anti-S IgG ≥2403 U/mL correlated with neutralizing antibody levels similar to those observed in a prior study of non-immunocompromised individuals, and 57% of participants achieved anti-S IgG ≥2403 U/mL at the end-of-study time point. In models adjusted for SARS-CoV-2 infection pre-enrollment, SARS-CoV-2 vaccination pre-HCT, CD19+ B-cell count, CD4+ T-cell count, and age (as applicable to the model), vaccine initiation timing was not associated with high-level anti-S IgG titers at the post-V2, post-V3, or end-of-study time points. Notably, prior graft-versus-host-disease (GVHD) or use of immunosuppressive medications were not associated with high-level anti-S IgG titers. Grade ≥3 vaccine-associated adverse events were infrequent. Interpretation: These data support starting mRNA SARS-CoV-2 vaccination three months after HCT, irrespective of concurrent GVHD or use of immunosuppressive medications. This is one of the largest prospective analyses of vaccination for any pathogen within the first year after allogeneic HCT and supports current guidelines for SARS-CoV-2 vaccination starting three months post-HCT. Additionally, there are few studies of mRNA vaccine formulations for other pathogens in HCT recipients, and these data provide encouraging proof-of-concept for the utility of early vaccination targeting additional pathogens with mRNA vaccine platforms. Funding: National Marrow Donor Program, Leukemia and Lymphoma Society, Multiple Myeloma Research Foundation, Novartis, LabCorp, American Society for Transplantation and Cellular Therapy, Adaptive Biotechnologies, and the National Institutes of Health.