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. 2023 Sep 28;11(10):1534.
doi: 10.3390/vaccines11101534.

Successful SARS-CoV-2 mRNA Vaccination Program in Allogeneic Hematopoietic Stem Cell Transplant Recipients-A Retrospective Single-Center Analysis

Alexander Nikoloudis  1   2   3 , Ines Julia Neumann  2 , Veronika Buxhofer-Ausch  1   2   3 , Sigrid Machherndl-Spandl  1   2   3 , Michaela Binder  1   3 , Emine Kaynak  1   3 , Robert Milanov  1   3 , Stefanie Nocker  1   3 , Olga Stiefel  1   2   3 , Irene Strassl  1   2   3 , Dagmar Wipplinger  1   3 , Margarete Moyses  1   3 , Heidrun Kerschner  3   4 , Petra Apfalter  3   4 , Michael Girschikofsky  1   3 , Andreas Petzer  1   2   3 , Ansgar Weltermann  1   2   3 , Johannes Clausen  1   2   3
Affiliations

Successful SARS-CoV-2 mRNA Vaccination Program in Allogeneic Hematopoietic Stem Cell Transplant Recipients-A Retrospective Single-Center Analysis

Alexander Nikoloudis et al. Vaccines (Basel). .

Abstract

(1) Background: mRNA COVID-19 vaccines are effective but show varied efficacy in immunocompromised patients, including allogeneic hematopoietic stem cell transplant (HSCT) recipients. (2) Methods: A retrospective study on 167 HSCT recipients assessed humoral response to two mRNA vaccine doses, using the manufacturer cut-off of ≥7.1 BAU/mL, and examined factors affecting non-response. (3) Results: Twenty-two percent of HSCT recipients failed humoral response. Non-responders received the first vaccine a median of 10.2 (2.5-88.9) months post-HSCT versus 35.3 (3.0-215.0) months for responders (p < 0.001). Higher CD19 (B cell) counts favored vaccination response (adjusted odds ratio (aOR) 3.3 per 100 B-cells/microliters, p < 0.001), while ongoing mycophenolate mofetil (MMF) immunosuppression hindered it (aOR 0.04, p < 0.001). By multivariable analysis, the time from transplant to first vaccine did not remain a significant risk factor. A total of 92% of non-responders received a third mRNA dose, achieving additional 77% seroconversion. Non-converters mostly received a fourth dose, with an additional 50% success. Overall, a cumulative seroconversion rate of 93% was achieved after up to four doses. (4) Conclusion: mRNA vaccines are promising for HSCT recipients as early as 3 months post-HSCT. A majority seroconverted after four doses. MMF usage and low B cell counts are risk factors for non-response.

Keywords: COVID-19; HSCT; transplantation; vaccination.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot showing the results of the multivariate logistic regression model (humoral responders versus non-responders). 1 Calcineurin inhibitors; 2 mycophenolate mofetil.
Figure 2
Figure 2
The receiver operating characteristic (ROC) analysis curve for CD19-positive cells between humoral responders and non-responders after two mRNA SARS-CoV-2 vaccinations.
Figure 3
Figure 3
Illustration of humoral responses to mRNA vaccinations. The chart categorizes individuals as responders (purple), non-responders (orange), and those lost to follow-up (green; e.g., those declining further vaccinations). The data are segmented into three bar charts representing the number of vaccination doses received. Notably, after each dose, only non-responders are charted for subsequent doses to evaluate their responsiveness.
See this image and copyright information in PMC

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