抗SARS-CoV-2加强针疫苗后血清免疫应答作为血液学与肿瘤患者抗新冠病毒保护的指标

Humoral immune response as an indicator for protection against Covid-19 after anti-SARS-COV2-booster vaccination in hematological and oncological patients

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

分区:医学2区 / 肿瘤学2区

发表日期:2024 Dec 15

作者: Dieter Mainka, Nathalie Bauer, Lutz Dietze, Sonja Lehnert, Johanna Krandick, Daniel Himmelreich, Hassan Jomaa, Maximilian Zimmermann, Peter Borchmann, Swetlana Herbrandt, Achim Rothe

DOI: 10.1002/ijc.35162

摘要

癌症患者在感染SARS-CoV-2后更易出现严重COVID-19症状，且其对疫苗的免疫反应常受损。在我们的肿瘤中心，追踪了357例血液学和肿瘤性疾病患者，从2021年10月至2022年10月连续12个月检测中和抗体。所有患者均接受了三剂mRNA疫苗（如Comirnaty/BioNTech或Spikevax/Moderna）或病毒载体疫苗（如Vaxzevria/AstraZeneca或Jcovden/Johnson&Johnson）。在加强针接种前3个月、3-10周和5-7个月时检测患者血清中的抗SARS-CoV-2 IgG抗体。观察期内，有112例患者出现了突破性感染。感染前抗体水平越高，显著降低了出现有症状COVID-19的风险（p = 0.003）。无症状患者的中位抗体滴度为2080 BAU/ml，而有症状者为765 BAU/ml。在接种加强针后，98%的实体瘤患者实现血清转化，而血液学疾病患者为79%。抗体滴度超过2080 BAU/ml的患者比例为61%（肿瘤）及34.8%（血液学）。加强针后7-10个月，抗体滴度下降至平均849 BAU/ml。考虑到癌症患者的血清免疫反应具有异质性，建议采用基于定期检测抗SARS-CoV-2抗体水平的个性化疫苗策略，而非固定的接种间隔。

Abstract

Cancer patients are at a higher risk to develop severe COVID-19 symptoms after SARS-CoV-2 infection compared to the general population and regularly show an impaired immune response to SARS-CoV-2 vaccination. In our oncological center, 357 patients with hematological and oncological diseases were monitored for neutralizing antibodies from October 2021 over 12 months. All patients had received three anti-SARS-CoV-2 vaccinations with an mRNA-(Comirnaty/BionTech or Spikevax/Moderna) or a vector vaccine (Vakzevria/AstraZeneca or JCOVDEN/Johnson&Johnson). Neutralizing anti-SARS-CoV-2 IgG antibodies in the patients' sera were detected within 3 months before, 3-10 weeks and 5-7 months after the booster vaccination (third vaccination). 112 patients developed a breakthrough SARS-CoV-2 infection during the observation period. High anti-SARS-Cov-2 antibody levels before infection significantly protected against symptomatic Covid-19 disease (p = .003). The median antibody titer in patients with asymptomatic Covid-19 disease was 2080 BAU/ml (binding antibody units per Milliliter) and 765 BAU/ml in symptomatic patients. 98% of the solid tumor patients reached seroconversion after the booster vaccination in comparison to 79% of the hematological patients. High antibody titers of >2080 BAU/ml after the booster vaccination were detected in 61% of the oncological and 34.8% of the hematological patients. 7-10 months after the booster vaccination, the anti-SARS-CoV-2 antibody titer declined to an average of 849 BAU/ml. Considering the heterogenous humoral immune response of cancer patients observed in this study, an individual vaccination strategy based on regular measurement of anti-SARS-CoV-2 antibody levels should be considered in contrast to fixed vaccination intervals.