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. 2022 Apr:165:184-194.
doi: 10.1016/j.ejca.2022.01.019. Epub 2022 Feb 7.

Third dose of SARS-CoV-2 vaccination in hemato-oncological patients and health care workers: immune responses and adverse events - a retrospective cohort study

Maximilian J Mair  1 , Julia M Berger  2 , Manfred Mitterer  3 , Margaretha Gansterer  4 , Arne C Bathke  5 , Wolfgang Trutschnig  5 , Anna S Berghoff  2 , Thomas Perkmann  6 , Helmuth Haslacher  6 , Wolfgang W Lamm  2 , Markus Raderer  2 , Selma Tobudic  7 , Thorsten Fuereder  2 , Thomas Buratti  3 , Dominic Fong  3 , Matthias Preusser  8
Affiliations

Third dose of SARS-CoV-2 vaccination in hemato-oncological patients and health care workers: immune responses and adverse events - a retrospective cohort study

Maximilian J Mair et al. Eur J Cancer. 2022 Apr.

Abstract

Background: Due to potentially immune-escaping virus variants and waning immunity, a third SARS-CoV-2 vaccination dose is increasingly recommended. However, data in patients with cancer are limited.

Patients and methods: We measured anti-SARS-CoV-2 spike protein antibody levels after the third vaccination dose in 439 patients with cancer and 41 health care workers (HCW) at an academic centre in Austria and a rural community hospital in Italy. Adverse events were retrieved from questionnaires.

Results: Overall, 439 patients and 41 HCW were included. SARS-CoV-2 infections were observed in 62/439 (14.1%) patients before vaccination and in 5/439 (1.1%) patients after ≥1 dose. Longitudinal analysis revealed a decrease of antibody levels between 3 and 6 months after second vaccination in patients with solid tumours (p < 0.001) and haematological malignancies without anti-B cell therapies (p < 0.001). After the third dose, anti-S levels increased compared to the first/second dose. Patients receiving B cell-targeted agents had lower antibody levels than patients with haematological malignancies undergoing other treatments (p < 0.001) or patients with solid tumours (p < 0.001). Moreover, anti-S levels correlated with CD19+ (B cell) and CD56+ (NK cell) counts in peripheral blood. The most frequent adverse events after the third dose were local pain (75/160, 46.9%), fatigue (25/160, 15.6%) and fever/chills (16/160, 10.0%). Patients with cancer had lower anti-S levels than HCW (p = 0.015).

Conclusions: This study in patients with cancer shows improved antibody levels after the third vaccination dose at an acceptable side-effect profile. Lower antibody levels than in controls underline the need for further follow-up studies and dedicated trials.

Keywords: COVID-19; Cancer; Oncology; SARS-CoV-2; Vaccination.

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Conflict of interest statement

Conflict of interest statement Anna Sophie Berghoff has received research support from Daiichi Sankyo, Roche, and honoraria for lectures, consultation or advisory board participation from Roche, Bristol-Meyers Squibb, Merck, Daiichi Sankyo as well as travel support from Roche, Amgen and AbbVie. Thorsten Fuereder has received honoraria for lectures, consultation or advisory board participation from the following for-profit companies: MSD, Merck Darmstadt, Roche, Bristol-Myers Squibb, Accord, Sanofi, Boehringer Ingelheim as well as travel support from Roche, MSD and Bristol-Myers Squibb. The following for-profit companies have supported clinical trials and contracted research conducted by TF with payments made to his institution: MSD, Merck Darmstadt, Bristol-Myers Squibb. Matthias Preusser has received honoraria for lectures, consultation or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen. The following for-profit companies have supported clinical trials and contracted research conducted by MP with payments made to his institution: Boehringer-Ingelheim, Bristol-Myers Squibb, Roche, Daiichi Sankyo, Merck Sharp & Dome, Novocure, GlaxoSmithKline, AbbVie. All other authors declare that they have no conflict of interest related to the present study.

Figures

Fig. 1
Fig. 1
(A) Anti-S levels after the second and third vaccination dose in the Vienna cohort. (B) Anti-S levels after the first, second and third vaccination dose in the Meran cohort. Anti-S levels after the second dose were only determined if no seroconversion was seen after the first dose. P-values as determined by Wilcoxon signed-rank test. (C) Anti-S levels after the third dose in patients with solid tumours and haematological malignancies with/without B cell-targeted treatment in the Meran cohort. (D) Anti-S levels in patients with solid tumours of the Meran cohort according to applied treatment modalities. P-values as determined by Mann-Whitney-U/Kruskal–Wallis test.
Fig. 2
Fig. 2
Anti-S levels 3, 4.5 and 6 months after the second as well as after the third dose in patients with solid tumours and haematological malignancies with/without B cell-targeted therapy (A) and patients with/without prior SARS-CoV-2 infection (B). P-values as determined by Wilcoxon signed-rank test.
Fig. 3
Fig. 3
Anti-S levels 6 months after the 2nd vaccination dose (A) and after the 3rd vaccination dose (B), as well as total leucocyte (C), absolute lymphocyte (D), relative lymphocyte (E), CD3+ (F), CD4+ (G), CD8+ (H), CD56+ (I) and CD19+ (J) cell counts.
Fig. 4
Fig. 4
(A) Anti-S levels in HCWs after the first, second and third dose. P-values as determined by Wilcoxon signed-rank test. (B) Anti-S levels in HCWs and patients with cancer after the second/third dose. P-values as determined by Mann-Whitney-U test.
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