SARS-CoV-2 vaccine responses following CD20-depletion treatment in patients with haematological and rheumatological disease: a West Midlands Research Consortium study.
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Authors
Venkatachalam, Srinivasan
Ford, Mark
Sheeran, Thomas
De Silva, Neelakshi
Stones, Jacqueline
Lee, Sophie
Khawaja, Jahanzeb
Kaudlay, Praveen Kumar
Whitmill, Richard
Kakepoto, Ghulam Nabi
Issue Date
2022-01-28
Journal
Type
Cohort Study
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
CD20 depletion
COVID-19
Haematological malignancies
Rheumatoid arthritis
Rituximab
Vaccination
Haematological diseases
Rheumatological diseases
COVID-19
Haematological malignancies
Rheumatoid arthritis
Rituximab
Vaccination
Haematological diseases
Rheumatological diseases
Journal Title
Clinical and Experimental Immunology
Volume
207
Issue
1
Begin page
3
End page
10
Abstract
B-cell-depleting agents are among the most commonly used drugs to treat haemato-oncological and autoimmune diseases. They rapidly induce a state of peripheral B-cell aplasia with the potential to interfere with nascent vaccine responses, particularly to novel antigens. We have examined the relationship between B-cell reconstitution and SARS-CoV-2 vaccine responses in two cohorts of patients previously exposed to B-cell-depleting agents: a cohort of patients treated for haematological B-cell malignancy and another treated for rheumatological disease. B-cell depletion severely impairs vaccine responsiveness in the first 6 months after administration: SARS-CoV-2 antibody seroprevalence was 42.2% and 33.3% in the haemato-oncological patients and rheumatology patients, respectively and 22.7% in patients vaccinated while actively receiving anti-lymphoma chemotherapy. After the first 6 months, vaccine responsiveness significantly improved during early B-cell reconstitution; however, the kinetics of reconstitution was significantly faster in haemato-oncology patients. The AstraZeneca ChAdOx1 nCoV-19 vaccine and the Pfizer BioNTech 162b vaccine induced equivalent vaccine responses; however, shorter intervals between vaccine doses (<1 m) improved the magnitude of the antibody response in haeamto-oncology patients. In a subgroup of haemato-oncology patients, with historic exposure to B-cell-depleting agents (>36 m previously), vaccine non-responsiveness was independent of peripheral B-cell reconstitution. The findings have important implications for primary vaccination and booster vaccination strategies in individuals clinically vulnerable to SARS-CoV-2.
Citation
Shields AM, Venkatachalam S, Shafeek S, Paneesha S, Ford M, Sheeran T, Kelly M, Qureshi I, Salhan B, Karim F, De Silva N, Stones J, Lee S, Khawaja J, Kaudlay PK, Whitmill R, Kakepoto GN, Parry HM, Moss P, Faustini SE, Richter AG, Drayson MT, Basu S. SARS-CoV-2 vaccine responses following CD20-depletion treatment in patients with haematological and rheumatological disease: a West Midlands Research Consortium study. Clin Exp Immunol. 2022 Jan 28;207(1):3-10. doi: 10.1093/cei/uxab018. PMID: 35020852; PMCID: PMC8767851.