Seroconversion rates following COVID-19 vaccination among patients with cancer

Astha Thakkar, Jesus D Gonzalez-Lugo, Niyati Goradia, Radhika Gali, Lauren C Shapiro, Kith Pradhan, Shafia Rahman, So Yeon Kim, Brian Ko, R Alejandro Sica, Noah Kornblum, Lizamarie Bachier-Rodriguez, Margaret McCort, Sanjay Goel, Roman Perez-Soler, Stuart Packer, Joseph Sparano, Benjamin Gartrell, Della Makower, Yitz D Goldstein, Lucia Wolgast, Amit Verma, Balazs Halmos, Astha Thakkar, Jesus D Gonzalez-Lugo, Niyati Goradia, Radhika Gali, Lauren C Shapiro, Kith Pradhan, Shafia Rahman, So Yeon Kim, Brian Ko, R Alejandro Sica, Noah Kornblum, Lizamarie Bachier-Rodriguez, Margaret McCort, Sanjay Goel, Roman Perez-Soler, Stuart Packer, Joseph Sparano, Benjamin Gartrell, Della Makower, Yitz D Goldstein, Lucia Wolgast, Amit Verma, Balazs Halmos

Abstract

As COVID-19 adversely affects patients with cancer, prophylactic strategies are critically needed. Using a validated antibody assay against SARS-CoV-2 spike protein, we determined a high seroconversion rate (94%) in 200 patients with cancer in New York City that had received full dosing with one of the FDA-approved COVID-19 vaccines. On comparison with solid tumors (98%), a significantly lower rate of seroconversion was observed in patients with hematologic malignancies (85%), particularly recipients following highly immunosuppressive therapies such as anti-CD20 therapies (70%) and stem cell transplantation (73%). Patients receiving immune checkpoint inhibitor therapy (97%) or hormonal therapies (100%) demonstrated high seroconversion post vaccination. Patients with prior COVID-19 infection demonstrated higher anti-spike IgG titers post vaccination. Relatively lower IgG titers were observed following vaccination with the adenoviral than with mRNA-based vaccines. These data demonstrate generally high immunogenicity of COVID-19 vaccination in oncology patients and identify immunosuppressed cohorts that need novel vaccination or passive immunization strategies.

Keywords: COVID-19; cancer; hematologi malignancies; vaccine.

Conflict of interest statement

Declaration of interests A.V. has received research funding from GlaxoSmithKline, BMS, Janssen, Incyte, MedPacto, Celgene, Novartis, Curis, Prelude, and Eli Lilly and Company, has received compensation as a scientific advisor to Novartis, Stelexis Therapeutics, Acceleron Pharma, and Celgene, and has equity ownership in Stelexis Therapeutics. All other authors declare no competing interests.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
CONSORT diagram showing the patient cohort Two hundred and thirteen patients consented to study participation and 29 were enrolled via retrospective chart review. Ultimately based on study criteria, 233 patients were evaluable for vaccine safety analysis and 200 patients were evaluable for vaccine efficacy analysis. One hundred and eighty-five of the 200 patients evaluated for vaccine efficacy analysis were then further assessed as a vaccinated cohort for antibody titer comparisons.
Figure 2
Figure 2
Association of anti-SARS-CoV-2 spike IgG with vaccine types and cancer types (A) Patients with hematologic malignancies had lowest titers when compared with those with solid tumors and non-cancer patient controls. No difference was seen between patients with solid tumors and controls. (B) Anti-spike protein IgG antibody titers (AU/mL) were significantly higher in patients who received mRNA vaccines than in those who received adenoviral vaccine. Box plots here and in subsequent figures show median (horizontal bar), the 75th and 25th quartiles, and error bars depicting the largest and smallest values (up to 1.5 times the interquartile range). Differences assessed by Kruskal-Wallis test.
Figure 3
Figure 3
Association of anti-SARS-CoV-2 spike IgG with therapy (A–C) Anti-spike protein IgG antibody titers (AU/mL) after full vaccination did not significantly differ in patients receiving active therapy (A), chemotherapy (B), or radiation therapy (C) when compared with respective counterparts. (D)Patients that had received surgery versus no surgery had no significant difference in titer levels (p = 0.08). Box plots are shown with differences assessed by Kruskal-Wallis test.
Figure 4
Figure 4
Association of anti-SARS-CoV-2 spike IgG with immunosuppressive therapies (A and B) Anti-spike protein IgG antibody titers (AU/mL) after full vaccination did not significantly differ in patients having received stem cell transplantation (SCT) (A) or anti-CD38 antibody therapy (B) when compared with respective counterparts. (C and D) Patients receiving anti-CD20 antibody treatments (C) or CAR-T cell therapy (D) had a significantly lower titer after vaccination when compared with respective counterparts. Box plots are shown with differences assessed by Kruskal-Wallis test.
Figure 5
Figure 5
Association of anti-SARS-CoV-2 spike IgG with type of therapy and prior COVID-19 history (A) Anti-spike protein IgG antibody titers (AU/mL) after full vaccination did not significantly differ in patients receiving immune checkpoint inhibitor (ICI) therapy when compared with those who did not. (B) Patients receiving hormonal therapy had a significantly higher titer after vaccination. (C) Patients receiving CDK4/6 inhibitor therapy had a significantly lower titer after vaccination. (D) Patients with prior COVID-19 infection had significantly higher IgG titers. Box plots are shown with differences assessed by Kruskal-Wallis test.

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