SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders

Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by...

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Autores: Piñana, José Luis, López Corral, Lucía, Martino, Rodrigo, Vazquez, Lourdes, Pérez, Ariadna, Martin Martin, Gabriel, Gago, Beatriz, Sanz Linares, Gabriela, Sánchez Salinas, Andrés, Villalón, Lucia, Conesa García, Venancio, Olave, María T., Corona, Magdalena, Marcos Corrales, Sara, Tormo, Mar, Hernández Rivas, José Ángel, Montoro, Juan, Rodriguez Fernandez, Alicia, Risco Gálvez, Irene, Rodríguez Belenguer, Pablo, Hernandez Boluda, Juan Carlos, García Cadenas, Irene, Ruíz García, Montserrat, Muñoz Bellido, Juan Luis, Solano, Carlos, Cedillo, Ángel, Sureda, Anna, Navarro, David, Infectious Complications Subcommittee Of The Spanish Hematopoietic Stem Cell Transplantation And Cell Therapy Group (GETH-TC)
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/185934
Acceso en línea:https://hdl.handle.net/2445/185934
Access Level:acceso abierto
Palabra clave:SARS-CoV-2
Vacunació
Malalties hematològiques
Vaccination
Hematologic diseases
Descripción
Sumario:Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3-6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7-195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3-6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2-4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0-4854.93) vs 730.81 BAU/mL (range 0-56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants.

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