MPNforum Magazine

ASH Report: Studies Suggest People with Blood Cancers May Not Be Optimally Protected after COVID-19 Vaccination

Yes, of course get vaccinated. We are in the midst of a surging global pandemic.  And while we’re all sick of the restrictions, all around us the world seems to be opening up. Crowds are often maskless, and hope for a return to normal life hope rises… MPN patients specially need to stay vigilant, We can’t let our Covid-19 guard just yetdown .

According to the American Society of Hematology, chances are after vaccination we’re not fully protected….

In the current TSR we focused on the covid variants that are no dominant in the US… and reported on the potential inflammatory response and destruction of native interferon defenses following vaccination. Now, ASH has issued preliminary findings warning of far lower antibody production by patients with hematopoietic disease.

“MPN patients with a compromised immune system due to disease, therapy, transplantation, or recovery status need to continue anti-covid infection actions despite full vaccination.”

Here are Q&A some highlights of the PRESS RELEASE COVERING THE ASH report…

Are any trials of SARS-CoV-2 vaccines being done in immunocompromised populations?

There are no published data on SARS-CoV-2 vaccines in immunosuppressed subjects. Most SARS-CoV-2 vaccine studies require patients to be off immunosuppression for a certain period of time to be eligible

Why might some hematology patients not respond to vaccines?

In order to generate optimal protective immunity following vaccination, intact host immunity is needed, particularly with respect to antigen presentation, B- and T-cell activation, and plasma B cell antibody generation. Therefore, hosts lacking functional adaptive immune cells may be unable to generate a fully protective immune response to a SARS-CoV-2 vaccine approved for use in the general population.

The following immunocompromised patient populations could have attenuated or absent response to SARS-CoV-2 vaccines:
a. Primary a. Primary and secondary immunodeficiencies involving adaptive immunity
b. Splenectomy or functional asplenia [e.g., sickle cell disease]
c. B cell directed therapies (e.g., blocking monoclonal antibodies against CD20 or CD22, bispecific agents like blinatumomab, CD19 or CD22-directed chimeric antigen receptor T cell [CAR-T] therapies, Bruton tyrosine kinase [BTK] inhibitors)
d. T-cell-directed therapies (e.g., calcineurin inhibitors, antithymocyte globulin, alemtuzumab)
e. Many chemotherapy regimens
f. High-dose corticosteroids (≥20 mg per dose or >2 mg/kg/day daily prednisone or equivalent)
g. Hematopoietic cell transplantation (HCT), especially within the first three to six months after autologous HCT and often longer after allogeneic HCT
h. Underlying aberrant immunity (e.g., graft-vs.-host disease, graft rejection, absent or incomplete immune reconstitution, neutropenia ANC <500/μL, lymphopenia ALC <200/μL)
If immunocompromised patients were not included in the vaccine trials and are less likely to respond to a SARS-CoV-2 vaccine, should they still receive it? What is the timing in relation to chemotherapy, transplant, antibody therapy, splenectomy etc. Should higher vaccine doses or multiple vaccine types be used?

ASH recommendations:

…. The risks and benefits for immunocompromised patients receiving a SARS-CoV-2 vaccine should be weighed on a case-by-case basis, with consideration of the incidence of infection in the community. This will depend on the approved vaccine formulation available, level of immunosuppression the patient has received, and the underlying reason for immunosuppressive therapy (e.g., cancer treatment, transplantation).

If plans to proceed with the SARS-CoV-2 vaccine are made, vaccination is recommended at least two to four weeks prior to the planned immunosuppressive therapy, transplant or splenectomy. If the patient is receiving or has received immunosuppressive therapy, consider vaccination six months after the patient has been taken off therapy to increase the likelihood of developing immunity (see potential laboratory testing).