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. 2022 May 1;8(5):748-754.
doi: 10.1001/jamaoncol.2022.0001.

Evaluation of Antibody Response to SARS-CoV-2 mRNA-1273 Vaccination in Patients With Cancer in Florida

Anna R Giuliano  1 , Jeffrey E Lancet  1 , Shari Pilon-Thomas  1 , Ning Dong  1 , Akriti G Jain  1 , Elaine Tan  1 , Somedeb Ball  1 , Shelley S Tworoger  1 , Erin M Siegel  1 , Junmin Whiting  1 , Qianxing Mo  1 , Christopher L Cubitt  1 , Christopher W Dukes  1 , Jonathan A Hensel  1 , Robert J Keenan  1 , Patrick Hwu  1
Affiliations

Evaluation of Antibody Response to SARS-CoV-2 mRNA-1273 Vaccination in Patients With Cancer in Florida

Anna R Giuliano et al. JAMA Oncol. .

Abstract

Importance: Patients with cancer experience high rates of morbidity and mortality after SARS-CoV-2 infection. Immune response to mRNA-1273 vaccination across multiple cancer types and treatments remains to be established.

Objective: To quantitate antibody responses after mRNA-1273 vaccination among patients with solid tumors and hematologic cancer and to assess clinical and treatment factors associated with vaccine response.

Design, setting, and participants: This cohort study included patients with cancer who were aged 18 years or older, spoke English or Spanish, had received their first mRNA-1273 dose between January 12 and 25, 2021, and agreed to blood tests before and after vaccination.

Exposures: Receipt of 1 and 2 mRNA-1273 SARS-CoV-2 vaccine doses.

Main outcomes and measures: Seroconversion after each vaccine dose and IgG levels against SARS-CoV-2 spike protein obtained immediately before the first and second vaccine doses and 57 days (plus or minus 14 days) after the first vaccine dose. Cancer diagnoses and treatments were ascertained by medical record review. Serostatus was assessed via enzyme-linked immunosorbent assay. Paired t tests were applied to examine days 1, 29, and 57 SARS-CoV-2 antibody levels. Binding antibody IgG geometric mean titers were calculated based on log10-transformed values.

Results: The 515 participants were a mean (SD) age of 64.5 (11.4) years; 262 (50.9%) were women; and 32 (6.2%) were Hispanic individuals and 479 (93.0%) White individuals; race and ethnicity data on 4 (0.7%) participants were missing. Seropositivity after vaccine dose 2 was 90.3% (465; 95% CI, 87.4%-92.7%) among patients with cancer, was significantly lower among patients with hematologic cancer (84.7% [255]; 95% CI, 80.1%-88.6%) vs solid tumors (98.1% [210]; 95% CI, 95.3%-99.5%), and was lowest among patients with lymphoid cancer (70.0% [77]; 95% CI, 60.5%-78.4%). Patients receiving a vaccination within 6 months after anti-CD20 monoclonal antibody treatment had a significantly lower seroconversion (6.3% [1]; 95% CI, 0.2%-30.2%) compared with those treated 6 to 24 months earlier (53.3% [8]; 95% CI, 26.6%-78.7%) or those who never received anti-CD20 treatment (94.2% [456]; 95% CI, 91.7%-96.1%). Low antibody levels after vaccination were observed among patients treated with anti-CD20 within 6 months before vaccination (GM, 15.5 AU/mL; 95% CI, 9.8-24.5 AU/mL), patients treated with small molecules (GM, 646.7 AU/mL; 95% CI, 441.9-946.5 AU/mL), and patients with low lymphocyte (GM, 547.4 AU/mL; 95% CI, 375.5-797.7 AU/mL) and IgG (GM, 494.7 AU/mL; 95% CI, 304.9-802.7 AU/mL) levels.

Conclusions and relevance: This cohort study found that the mRNA-1273 SARS-CoV-2 vaccine induced variable antibody responses that differed by cancer diagnosis and treatment received. These findings suggest that patients with hematologic cancer and those who are receiving immunosuppressive treatments may need additional vaccination doses.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Giuliano reported receiving grants from Merck & Co, Inc, through Moffitt Cancer Center and personal fees from Merck & Co, Inc, as an advisory board member outside the submitted work. Dr Lancet reported receiving personal fees from Novartis, Bristol Myers Squibb, AbbVie, Astellas Pharma, Takeda Pharmaceutical Co, Daiichi Sankyo, Jazz Pharmaceuticals, Agios Pharmaceuticals, ElevateBio, and Jasper Therapeutics, Inc, outside the submitted work. Dr Tworoger reported receiving grants from the US Department of Defense, Florida Department of Health, and the National Institutes of Health outside the submitted work. Dr Hwu reported receiving grants from Merck & Co, Inc, and from the National Cancer Institute–designated comprehensive cancer center funded in part by a Moffitt Cancer Center support grant during the conduct of the study; he reported receiving personal fees from the Dragonfly Scientific Advisory Board and Immatics Scientific Advisory Board outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Antibody Titer Kinetics 28 Days After 2 Vaccine Doses
Figure shows the antibody levels among 18 adults without cancer who participated in a separate community study compared with those of 301 patients with hematologic cancer and 214 patients with solid tumors (A) as well as the antibody levels among 17 patients with cancer and seropositive status vs 498 with cancer and seronegative status. AU indicates arbirary units.
See this image and copyright information in PMC

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