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B-cell-guided strategy for SARS-CoV2 vaccination after autologous stem cell transplantation for B-cell lymphoma — a case report

B-cell-guided strategy for SARS-CoV2 vaccination after autologous stem cell transplantation for... Annals of Hematology (2022) 101:2541–2542 https://doi.org/10.1007/s00277-022-04935-3 LE T TER TO  THE   EDITOR B‑cell‑guided strategy for SARS‑CoV2 vaccination after autologous stem cell transplantation for B‑cell lymphoma — a case report 1 1 1 Ben‑Niklas Baermann  · Paul Jäger  · Guido Kobbe Received: 16 July 2022 / Accepted: 24 July 2022 / Published online: 3 August 2022 © The Author(s) 2022 count could be identified. There was no evidence of SARS ‑ Dear Editor, CoV2‑ infection prior to HSCT or vaccination. Since the beginning of the COVID‑ 19 pandemic, recipi‑ BI did not result in significant antibody production ents of hematopoietic stem stell transplantation (HSCT) although the recommended interval to autoHSCT was are challenging high‑ risk for critical infections with SARS‑ respected. Between day + 251 and day + 308 (July 2021), CoV2 [1]. After successful implementation of vaccination there was a sudden increase of peripheral B‑ cells from 3 in healthy individuals, the immunization strategy for HSCT to 295/µl. Following a first BNT162b2 booster in August recipients has been discussed due to divergent immune 2021, the titer of Anti‑ SARS‑ CoV‑ 2‑ S increased from < 0.4 responses in this population. B‑ cell lymphomas have been to over 60U/ml one month later and to > 2500U/ml after a identified as an important risk factor for insufficient sero‑ second booster which was given in September 2021. Two logic response to vaccination, especially in patients with months later titers remained stable, concomitant with normal recent B‑ cell‑ directed therapy, e.g., BTK inhibitors and CD19 + B‑ cell counts in peripheral blood (Fig. 1). CD20‑ directed antibodies [2]. Vaccination of vulnerable individuals has greatly reduced So far recommendations for vaccination after autologous the threat of SARS‑ CoV2 infection. Its side effects are HSCT (autoHSCT) rely on time intervals to transplant. We reported to be mild to moderate and short‑ term, except here report on cellular immune reconstitution and associated extremely rare but serious complications such as myocardi‑ serologic response to SARS‑ CoV2 vaccination in a 54‑ year‑ tis and thrombotic thrombocytopenia [3–5]. Therefore, vac‑ old male patient with DLBCL after autoHSCT. cination timing must be adapted to the individual patient’s He suffered from late relapse of DLBCL in 2020. After cellular immune status. three cycles of rituximab‑ based immune chemotherapy and We report on the importance of B‑ cell recovery after documented complete remission, high‑ dose chemotherapy CD20‑ directed therapy and HSCT serving as a parameter with R‑ TEAM and autoHSCT was performed in September to decide on timepoint especially for booster vaccinations. 2020. We observed normal hematopoietic reconstitution in Even after CD4 + ‑ T‑ cell reconstitution BI didn’t result the early phase and until last observation in November 2021, in any serologic response. Only a sudden and prominent the patient remained in complete remission. increase in the peripheral B‑ cell count months later paved The patient received two doses of BNT162b2 for basic the way for measurable antibody production in this patient, immunization (BI) seven months after HSCT. Prior to first emphasizing the importance of B‑ cell reconstitution for vaccination, absolute T‑ helper‑ cell count had almost reached successful vaccination. T‑ cell and innate immunity are also normal levels with 441 cells/µl, but nearly total B‑ cell deple‑ important to avoid severe COVID‑ 19 as patients with auto‑ tion was still present. In August and September 2021, two immune diseases receiving B‑ cell‑ depleting therapy gener‑ booster vaccinations with BNT162b2 were administered in ally show successful recovery from COVID‑ 19 [6]. an interval of six weeks. Before booster vaccination, a sig‑ However, humoral immune responses represent one nificant and steady increase in the peripheral CD19 + ‑ B‑ cell important column of virus defense, which cannot be achieved without a functional B‑ cell compartment. We therefore recommend to guide vaccination after autoHSCT * Ben‑Niklas Baermann ben‑niklas.baermann@med.uni‑duesseldorf.de not by fixed time intervals but by cellular immune recon‑ stitution. Vaccination may start as early as T‑ cell reconsti‑ Onkologie Und Klinische Immunologie, Klinik Für tution after autoHSCT is observed. As patients who have Haematologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40223 Düsseldorf, Germany Vol.:(0123456789) 1 3 2542 Annals of Hematology (2022) 101:2541–2542 Response-correlation between CD19+ B-cell count Consent to participate Informed consent was obtained from the patient and antibody production being included in the case report. Conflict of interest The authors declare no competing interests. Open Access This article is licensed under a Creative Commons Attri‑ bution 4.0 International License, which permits use, sharing, adapta‑ tion, distribution and reproduction in any medium or format, as long 500 as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are Oct 9 Nov 13 Mar 03 Apr 27 May 26 Jul 22 Sep 09 Sep 30 Nov 10 2020 2020 2021 2021 2021 2021 2021 2021 2021 included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in CD19+ B-cells CD3/CD4+ T-cells Anti-SARS-CoV2 S AK the article's Creative Commons licence and your intended use is not Vaccination permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a Fig. 1 Response‑ correlation between CD19 + B‑ cell count and anti‑ copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . body production. SARS‑ CoV2 S AK, SARS CoV2 spike protein anti‑ body References received B‑ cell depleting antibodies before autoHSCT may, 1. Lafarge A et al (2022) Coronavirus disease 2019 in immunocom‑ promised patients: a comprehensive review of coronavirus disease at the same time, have delayed B‑ cell recovery, anti‑ virus‑ 2019 in hematopoietic stem cell recipients. Curr Opin Crit Care titers may be low or even absent following a first vaccination 28(1):83–89 round. Repeated booster vaccinations at the time of B‑ cell 2. Greenberger LM et al (2021) Antibody response to SARS‑ CoV‑ 2 recovery should therefore be applied in order to achieve high vaccines in patients with hematologic malignancies. Cancer Cell 39(8):1031–1033 antibody responses. This may be true not only for SARS‑ 3. Polack FP et  al (2020) Safety and efficacy of the BNT162b2 CoV2 vaccines but also for other vaccines routinely applied mRNA Covid‑ 19 vaccine. N Engl J Med 383(27):2603–2615 after autoHSCT. 4. Mevorach D et al (2021) Myocarditis after BNT162b2 mRNA vac‑ cine against Covid‑ 19 in Israel. N Engl J Med 385(23):2140–2149 5. Greinacher A et  al (2021) Thrombotic thrombocytope‑ Funding Open Access funding enabled and organized by Projekt nia after ChAdOx1 nCov‑ 19 vaccination. N Engl J Med DEAL. 384(22):2092–2101 6. Baker D et al (2020) COVID‑ 19 vaccine‑ readiness for anti‑ CD20‑ depleting therapy in autoimmune diseases. Clin Exp Immunol Declarations 202(2):149–161 Publisher's note Springer Nature remains neutral with regard to Ethical approval This article does not contain any studies with human jurisdictional claims in published maps and institutional affiliations. participants performed by any of the authors. 1 3 cell count /µl, Antibody U/ml http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annals of Hematology Springer Journals

B-cell-guided strategy for SARS-CoV2 vaccination after autologous stem cell transplantation for B-cell lymphoma — a case report

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Springer Journals
Copyright
Copyright © The Author(s) 2022
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0939-5555
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1432-0584
DOI
10.1007/s00277-022-04935-3
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Abstract

Annals of Hematology (2022) 101:2541–2542 https://doi.org/10.1007/s00277-022-04935-3 LE T TER TO  THE   EDITOR B‑cell‑guided strategy for SARS‑CoV2 vaccination after autologous stem cell transplantation for B‑cell lymphoma — a case report 1 1 1 Ben‑Niklas Baermann  · Paul Jäger  · Guido Kobbe Received: 16 July 2022 / Accepted: 24 July 2022 / Published online: 3 August 2022 © The Author(s) 2022 count could be identified. There was no evidence of SARS ‑ Dear Editor, CoV2‑ infection prior to HSCT or vaccination. Since the beginning of the COVID‑ 19 pandemic, recipi‑ BI did not result in significant antibody production ents of hematopoietic stem stell transplantation (HSCT) although the recommended interval to autoHSCT was are challenging high‑ risk for critical infections with SARS‑ respected. Between day + 251 and day + 308 (July 2021), CoV2 [1]. After successful implementation of vaccination there was a sudden increase of peripheral B‑ cells from 3 in healthy individuals, the immunization strategy for HSCT to 295/µl. Following a first BNT162b2 booster in August recipients has been discussed due to divergent immune 2021, the titer of Anti‑ SARS‑ CoV‑ 2‑ S increased from < 0.4 responses in this population. B‑ cell lymphomas have been to over 60U/ml one month later and to > 2500U/ml after a identified as an important risk factor for insufficient sero‑ second booster which was given in September 2021. Two logic response to vaccination, especially in patients with months later titers remained stable, concomitant with normal recent B‑ cell‑ directed therapy, e.g., BTK inhibitors and CD19 + B‑ cell counts in peripheral blood (Fig. 1). CD20‑ directed antibodies [2]. Vaccination of vulnerable individuals has greatly reduced So far recommendations for vaccination after autologous the threat of SARS‑ CoV2 infection. Its side effects are HSCT (autoHSCT) rely on time intervals to transplant. We reported to be mild to moderate and short‑ term, except here report on cellular immune reconstitution and associated extremely rare but serious complications such as myocardi‑ serologic response to SARS‑ CoV2 vaccination in a 54‑ year‑ tis and thrombotic thrombocytopenia [3–5]. Therefore, vac‑ old male patient with DLBCL after autoHSCT. cination timing must be adapted to the individual patient’s He suffered from late relapse of DLBCL in 2020. After cellular immune status. three cycles of rituximab‑ based immune chemotherapy and We report on the importance of B‑ cell recovery after documented complete remission, high‑ dose chemotherapy CD20‑ directed therapy and HSCT serving as a parameter with R‑ TEAM and autoHSCT was performed in September to decide on timepoint especially for booster vaccinations. 2020. We observed normal hematopoietic reconstitution in Even after CD4 + ‑ T‑ cell reconstitution BI didn’t result the early phase and until last observation in November 2021, in any serologic response. Only a sudden and prominent the patient remained in complete remission. increase in the peripheral B‑ cell count months later paved The patient received two doses of BNT162b2 for basic the way for measurable antibody production in this patient, immunization (BI) seven months after HSCT. Prior to first emphasizing the importance of B‑ cell reconstitution for vaccination, absolute T‑ helper‑ cell count had almost reached successful vaccination. T‑ cell and innate immunity are also normal levels with 441 cells/µl, but nearly total B‑ cell deple‑ important to avoid severe COVID‑ 19 as patients with auto‑ tion was still present. In August and September 2021, two immune diseases receiving B‑ cell‑ depleting therapy gener‑ booster vaccinations with BNT162b2 were administered in ally show successful recovery from COVID‑ 19 [6]. an interval of six weeks. Before booster vaccination, a sig‑ However, humoral immune responses represent one nificant and steady increase in the peripheral CD19 + ‑ B‑ cell important column of virus defense, which cannot be achieved without a functional B‑ cell compartment. We therefore recommend to guide vaccination after autoHSCT * Ben‑Niklas Baermann ben‑niklas.baermann@med.uni‑duesseldorf.de not by fixed time intervals but by cellular immune recon‑ stitution. Vaccination may start as early as T‑ cell reconsti‑ Onkologie Und Klinische Immunologie, Klinik Für tution after autoHSCT is observed. As patients who have Haematologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40223 Düsseldorf, Germany Vol.:(0123456789) 1 3 2542 Annals of Hematology (2022) 101:2541–2542 Response-correlation between CD19+ B-cell count Consent to participate Informed consent was obtained from the patient and antibody production being included in the case report. Conflict of interest The authors declare no competing interests. Open Access This article is licensed under a Creative Commons Attri‑ bution 4.0 International License, which permits use, sharing, adapta‑ tion, distribution and reproduction in any medium or format, as long 500 as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are Oct 9 Nov 13 Mar 03 Apr 27 May 26 Jul 22 Sep 09 Sep 30 Nov 10 2020 2020 2021 2021 2021 2021 2021 2021 2021 included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in CD19+ B-cells CD3/CD4+ T-cells Anti-SARS-CoV2 S AK the article's Creative Commons licence and your intended use is not Vaccination permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a Fig. 1 Response‑ correlation between CD19 + B‑ cell count and anti‑ copy of this licence, visit http://cr eativ ecommons. or g/licen ses/ b y/4.0/ . body production. SARS‑ CoV2 S AK, SARS CoV2 spike protein anti‑ body References received B‑ cell depleting antibodies before autoHSCT may, 1. Lafarge A et al (2022) Coronavirus disease 2019 in immunocom‑ promised patients: a comprehensive review of coronavirus disease at the same time, have delayed B‑ cell recovery, anti‑ virus‑ 2019 in hematopoietic stem cell recipients. Curr Opin Crit Care titers may be low or even absent following a first vaccination 28(1):83–89 round. Repeated booster vaccinations at the time of B‑ cell 2. Greenberger LM et al (2021) Antibody response to SARS‑ CoV‑ 2 recovery should therefore be applied in order to achieve high vaccines in patients with hematologic malignancies. Cancer Cell 39(8):1031–1033 antibody responses. This may be true not only for SARS‑ 3. Polack FP et  al (2020) Safety and efficacy of the BNT162b2 CoV2 vaccines but also for other vaccines routinely applied mRNA Covid‑ 19 vaccine. N Engl J Med 383(27):2603–2615 after autoHSCT. 4. Mevorach D et al (2021) Myocarditis after BNT162b2 mRNA vac‑ cine against Covid‑ 19 in Israel. N Engl J Med 385(23):2140–2149 5. Greinacher A et  al (2021) Thrombotic thrombocytope‑ Funding Open Access funding enabled and organized by Projekt nia after ChAdOx1 nCov‑ 19 vaccination. N Engl J Med DEAL. 384(22):2092–2101 6. Baker D et al (2020) COVID‑ 19 vaccine‑ readiness for anti‑ CD20‑ depleting therapy in autoimmune diseases. Clin Exp Immunol Declarations 202(2):149–161 Publisher's note Springer Nature remains neutral with regard to Ethical approval This article does not contain any studies with human jurisdictional claims in published maps and institutional affiliations. participants performed by any of the authors. 1 3 cell count /µl, Antibody U/ml

Journal

Annals of Hematology – Springer Journals

Published: Nov 1, 2022

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