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. 2022 Dec;101(12):2711-2717.
doi: 10.1007/s00277-022-05003-6. Epub 2022 Oct 22.

Immunogenicity of a third dose of the BNT162b2 COVID-19 vaccine in patients with CLL: effects on treatment selection

Panagiotis T Diamantopoulos  1 , Christina-Nefeli Kontandreopoulou  2 , Christos Stafylidis  2 , Dimitra Vlachopoulou  2 , Nefeli Giannakopoulou  2 , Maria Vardaka  3 , Anthi Mpouhla  4 , Eleni Variami  2 , Athanasios Galanopoulos  3 , Vassiliki Pappa  4 , Mina Psichogiou  2 , Angelos Hatzakis  5 , Nora-Athina Viniou  2
Affiliations

Immunogenicity of a third dose of the BNT162b2 COVID-19 vaccine in patients with CLL: effects on treatment selection

Panagiotis T Diamantopoulos et al. Ann Hematol. 2022 Dec.

Abstract

Patients with chronic lymphocytic leukemia (CLL) show suboptimal responses to the vaccines against SARS-CoV-2; it has been shown though that a booster dose of the BNT162b2 vaccine may lead to a significant increase in the seroconversion rates of immunocompromised patients. We conducted a prospective, non-interventional study to evaluate the immunogenicity of a third dose of the BNT162b2 vaccine in adult patients with CLL. Sera were tested before the first, after the second, and before and after the third dose for anti-SARS-CoV-2 receptor binding domain (RBD) spike protein IgG (anti-RBD). Thirty-nine patients with CLL were included in the study. The seroconversion rate increased from 28.2% before the third dose to 64.1% after the third dose and was higher in treatment-naïve patients (72.7% versus 47.1% in actively treated patients, p = 0.042). All but one patient achieving a seroconversion after the second dose retained after the third, while eight patients not achieving a seroconversion after the second dose (38.1%), did so after the third. Moreover, patients actively treated with venetoclax had a higher seroconversion rate than those treated with ibrutinib (87.5% versus 14.3%, p = 0.001). This study confirms the beneficial effect of a third dose of the BNT162b2 vaccine on the seroconversion rate in patients with CLL. Our results also strongly suggest that the use of venetoclax is correlated with higher immunogenicity/seroconversion rates than that of ibrutinib, a finding that has been reported by another study. A treatment strategy change during the pandemic favoring the use of venetoclax may be suggested based on our results, although these results should be validated in larger studies.

Keywords: BNT162b2 mRNA COVID-19 vaccine; Booster/3rd dose; Chronic lymphocytic leukemia; Ibrutinib; Venetoclax.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Immunogenicity (A) and seroconversion rate (B) after the second, before and after the third dose of the BNT162b2 vaccine against SARS-CoV-2 in 39 patients with chronic lymphocytic leukemia
Fig. 2
Fig. 2
Titres of the antibody against the spike protein of SARS-CoV-2 in patients with chronic lymphocytic leukemia treated with ibrutinib and venetoclax monotherapy after the third dose of the BNT162b2 vaccine against SARS-CoV-2
See this image and copyright information in PMC

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