COVID-19 Vaccine Response in Immunocompromised Patients With cGVHD

By Patrick Daly - Last Updated: September 15, 2022

According to a study published in Transplantation and Cellular Therapy, immunosuppressive therapies (IST) for chronic graft-versus-host disease (cGVHD) increase an individual’s susceptibility to SARS-CoV-2 infection and progression to severe COVID-19.

The study’s authors, led by Shivaprasad Manjappa and Huy Phi, evaluated the efficacy of vaccination in patients with cGVHD. In their cohort, 72% of patients mounted neutralizing antibody responses, which, while lower than in healthy subjects, still led the researchers to support vaccination against COVID-19 in patients with cGVHD.

Vaccination responses were measured after the initial series and before and after the third dose.
Humoral responses were assessed via quantitative anti-spike and neutralizing antibody levels. T-cell responses were assessed via the relative proportion of unique SARS-CoV-2-associated T-cell receptor sequences (breadth) and clonal expansion of the response (depth) compared with a reference population.

The study enrolled 32 patients with cGHVD on IST to receive the vaccine. A total of 17 (53%) patients achieved both neutralizing antibody and T-cell responses, 8 (25%) had no responses, and all but 1 of 7 (22%) patients exhibited humoral responses but no T-cell responses.

Furthermore, significant positive correlations were observed between the strength of cellular and humoral responses after the initial series. In 20 patients with paired samples from before and after the third dose, a third vaccination increased neutralizing antibody titers. Notably, cGVHD worsened in 6 patients after the initial series and in 4 patients after the third dose.

The authors concluded their data supported recommending vaccination in patients with cGVHD, but they acknowledged that “larger studies and long-term follow-ups will help us better understand the kinetics, effectiveness, and durability of the immune response to COVID vaccination in patients with cGVHD.”

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