Frontiers in Immunology (Nov 2023)

Analysis of vaccine responses after anti-CD20 maintenance in B-cell lymphoma in the Balearic Islands. A single reference center experience

  • Antonio Gutierrez,
  • Aser Alonso,
  • Marta Garcia-Recio,
  • Sandra Perez,
  • Lucia Garcia-Maño,
  • Jordi Martinez-Serra,
  • Teresa Ros,
  • Mercedes Garcia-Gasalla,
  • Joana Ferrer,
  • Oliver Vögler,
  • Oliver Vögler,
  • Regina Alemany,
  • Regina Alemany,
  • Antonio Salar,
  • Antonia Sampol,
  • Leyre Bento

DOI
https://doi.org/10.3389/fimmu.2023.1267485
Journal volume & issue
Vol. 14

Abstract

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IntroductionThe use of maintenance approaches with anti-CD20 monoclonal antibodies has improved the outcomes of B-cell indolent lymphomas but may lead to significant peripheral B-cell depletion. This depletion can potentially hinder the serological response to neoantigens.MethodsOur objective was to analyze the effect of anti-CD20 maintenance therapy in a reliable model of response to neoantigens: SARS-CoV-2 vaccine responses and the incidence/severity ofCOVID-19 in a reference hospital.ResultsIn our series (n=118), the rate of vaccination failures was 31%. Through ROC curve analysis, we determined a cutoff for SARS-CoV-2 vaccine serologic response at 24 months from the last anti-CD20 dose. The risk of severe COVID-19 was notably higher within the first 24months following the last anti-CD20 dose (52%) compared to after this period (just 18%) (p=0.007). In our survival analysis, neither vaccine response nor hypogammaglobulinemia significantly affected OS. While COVID-19 led to a modest mortality rate of 2.5%, this figure was comparable to the OS reported in the general immunocompetent population. However, most patients with hypogammaglobulinemia received intravenous immunoglobulin therapy and all were vaccinated. In conclusion, anti-CD20 maintenance therapy impairs serological responses to SARS-CoV-2 vaccines.DiscussionWe report for the first time that patients during maintenance therapy and up to 24 months after the last anti-CD20 dose are at a higher risk of vaccine failure and more severe cases of COVID-19. Nevertheless, with close monitoring, intravenous immunoglobulin supplementation or proper vaccination, the impact on survival due to the lack of serological response in this high-risk population can be mitigated, allowing for the benefits of anti-CD20 maintenance therapy, even in the presence of hypogammaglobulinemia.

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