COVID-19 vaccine immunogenicity and safety surrounding fourth and subsequent vaccine doses in patients with hematologic malignancies

Sita Bhella; Allison M Wilkin; Katrina Hueniken; Abi Vijenthira; Michael Sebag; Peng Wang; Lisa K Hicks; Annette E Hay; Sarit Assouline; Graeme Fraser; Amaris Balitsky; Joy Mangel; Carolyn Owen; Anthony Reiman; Laurie Sehn; Heather Sutherland; Tinghua Zhang; Corey Arnold; Tamara Leite; Erinn McCarthy; Curtis Cooper; Marc-Andre Langlois; C Arianne Buchan; VIP Study Investigators

doi:10.1016/j.vaccine.2024.06.041

COVID-19 vaccine immunogenicity and safety surrounding fourth and subsequent vaccine doses in patients with hematologic malignancies

Vaccine. 2024 Oct 24;42(24):126074. doi: 10.1016/j.vaccine.2024.06.041. Epub 2024 Jun 28.

Authors

Sita Bhella¹, Allison M Wilkin², Katrina Hueniken³, Abi Vijenthira³, Michael Sebag⁴, Peng Wang⁵, Lisa K Hicks⁶, Annette E Hay⁷, Sarit Assouline⁸, Graeme Fraser⁹, Amaris Balitsky⁹, Joy Mangel¹⁰, Carolyn Owen¹¹, Anthony Reiman¹², Laurie Sehn¹³, Heather Sutherland¹⁴, Tinghua Zhang², Corey Arnold¹⁵, Tamara Leite², Erinn McCarthy³, Curtis Cooper², Marc-Andre Langlois¹⁵, C Arianne Buchan²; VIP Study Investigators

Affiliations

¹ Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada. Electronic address: [email protected].
² Ottawa Hospital Research Institute, Ottawa ON, Canada.
³ Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto ON, Canada.
⁴ McGill University Health Centre, Montreal, QC, Canada.
⁵ Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Division of Hematology/Oncology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁷ Queen's University, Kingston, ON, Canada.
⁸ Jewish General Hospital, Montreal, QC, Canada.
⁹ Department of Oncology, McMaster University, Hamilton, ON, Canada.
¹⁰ Division of Hematology, Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada.
¹¹ University of Calgary, Tom Baker Cancer Centre, Division of Hematology and Hematological Malignancies, Calgary, AB, Canada.
¹² Department of Oncology, Saint John Regional Hospital, Saint John, NB, Canada.
¹³ BC Cancer Centre for Lymphoma Cancer, University of British Columbia, Vancouver, BC, Canada.
¹⁴ Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada.

PMID: 38944577
DOI: 10.1016/j.vaccine.2024.06.041

Abstract

Background: Immune response to COVID-19 vaccine is diminished in patients with hematologic malignancy. There is limited data regarding response to vaccine doses in these patients.

Purpose: To quantify the humoral immune response engendered by 4th and subsequent doses of SARS-CoV-2 vaccination as measured by anti-Spike (anti-S) antibody levels, based on dried blood spot (DBS) testing, in patients with hematologic malignancies. Anti-S binds to the spike protein of the SARS-CoV-2 virus and is indicative of vaccine immunogenicity.

Methods: We conducted a prospective study of hematologic malignancies between August 2021 and January 2023 at 12 sites across Canada. Participants were followed longitudinally and submitted finger-prick DBS cards at set intervals associated with vaccination. Samples were processed via high throughput ELISA assay to detect serum antibodies against nucleocapsid (N) and spike (S) proteins.

Results: We obtained 3071 samples on 790 unique patients. Of these, 372 unique participants with 1840 samples had anti-S results available post-4th, 5th or 6th COVID-19 vaccine dose and were included for analysis. Three hundred thirty-three patients of the 372 participants submitted a DBS sample post 4th dose. Of these, 257 patients (77.2%) had a positive anti-S antibody. A total of 198 patients had paired samples pre- and post-dose 4, of which 59 (29.7%) had a negative anti-S antibody pre-dose 4. Of these, 20 (33.4%) developed positive anti-S antibody post-dose 4. One hundred forty-nine patients submitted a DBS sample post-dose 5. Of these, 135 patients (90.6%) had positive anti-S antibody. A total of 52 had paired samples pre- and post-dose 5. Six (8.7%) had a negative anti-S antibody pre-dose 5, of which two (33.3%) developed positive anti-S antibody post-dose 5. Of these 372 patients, 123 (34%) reported COVID-19 infection and 4 (1%) had a COVID-19 related hospitalization. There were no reported deaths from COVID-19.

Conclusions: This prospective cohort study showed that humoral immune response improved with subsequent doses of COVID-19 vaccines.

Keywords: COVID-19 vaccination; Fourth and subsequent COVID-19 vaccines; Hematologic malignancies.

MeSH terms

Adult
Aged
Aged, 80 and over
Antibodies, Viral* / blood
Antibodies, Viral* / immunology
COVID-19 Vaccines* / administration & dosage
COVID-19 Vaccines* / immunology
COVID-19* / immunology
COVID-19* / prevention & control
Canada
Female
Hematologic Neoplasms* / immunology
Hematologic Neoplasms* / therapy
Humans
Immunity, Humoral
Immunogenicity, Vaccine*
Male
Middle Aged
Prospective Studies
SARS-CoV-2* / immunology
Spike Glycoprotein, Coronavirus* / immunology
Vaccination / methods

Substances

COVID-19 Vaccines
Antibodies, Viral
Spike Glycoprotein, Coronavirus
spike protein, SARS-CoV-2