Suboptimal Response to Coronavirus Disease 2019 Messenger RNA Vaccines in Patients With Hematologic Malignancies: A Need for Vigilance in the Postmasking Era

Abstract

We measured severe acute respiratory syndrome coronavirus 2 immunoglobulin G responses in 67 patients with hematological malignancies after 2 messenger RNA vaccine doses. Forty-six percent were nonresponders; patients with B-cell chronic lymphocytic leukemia were at highest risk (77% nonresponders). Patients with hematological malignancies should continue wearing masks and socially distancing. Studies of revaccination, boosters, and humoral immune correlates of protection are needed.

Keywords: 19 vaccine; 2; COVID; CoV; SARS; antibody; hematological malignancy.

Figure 1.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike immunoglobulin G (IgG) levels for all patients (A) and those with negative antibody results (B). A, All patients. Dotted red line indicates threshold for “reactive” antibody result (level of (≥1.00). Dashed red line shows median antibody level (14.42) for patients with positive results. B, Patients with negative antibody results. Dashed red line shows median antibody level (0.03) for patients with negative results. *Comparison between chronic lymphocytic leukemia (CLL) vs non-CLL patients. There was no difference between lymphoma and myeloma patients. Levels for the 4 patients with other myeloid malignancies were not available. Solid lines indicate medians.