Factors Associated with IgG/IgM Levels after SARS-CoV-2 Vaccination in Patients with Head and Neck Cancer

Abstract

This study evaluated the factors influencing IgG/IgM antibody levels in 120 patients with head and neck cancer (HNC) following vaccination with inactivated SARS-CoV-2 vaccines. Each patient's demographic and clinical data were documented, and serum IgG and IgM antibodies were detected using a commercial magnetic chemiluminescence enzyme immunoassay kit. The results indicated that while all patients had received at least one vaccine dose, 95 tested positive for IgG and 25 were negative. A higher proportion of IgG-positive patients had received three vaccine doses. Comparatively, gamma-glutamyl transferase levels were elevated in IgM-negative patients. The study further differentiated patients based on their treatment status: 46 were treatment-naive and 74 had received chemotherapy combined with immune checkpoint inhibitors (ICT) at enrollment. Despite similar baseline characteristics and time from vaccination to antibody detection, IgM positivity was significantly lower in the ICT group, with no significant difference in IgG positivity between the treatment-naive and ICT groups. A multivariable analysis identified the number of vaccine doses as an independent factor of IgG positivity, while ICT emerged as an independent risk factor for IgM positivity. Additionally, IgG titers generally declined over time, although patients with higher baseline IgG levels maintained higher titers longer. In conclusion, ICT in patients with HNC does not significantly affect IgG levels post-vaccination. However, booster vaccinations have been shown to be associated with higher IgG positivity, although these levels gradually decrease over time.

Keywords: COVID-19; IgG/IgM; SARS-CoV-2 vaccination; head and neck cancer; immunochemotherapy.

Figure 1

A schematic figure of the study. This observational cross-sectional study involved 120 patients with head and neck cancer. All patients had received at least one shot of inactivated SARS-CoV-2 vaccine. We aim to evaluate the factors influencing IgG/IgM antibody levels in those patients following vaccination with inactivated SARS-CoV-2 vaccines. This Figure was created by Figdraw (www.figdraw.com, accessed on 14 September 2024).

Figure 2

Clinical Variables Associated with IgG Titers. (A). IgG titers for patients receiving 1-shot, 2-shot, 3-shot, and 4-shot vaccinations were 1.28 ± 2.56, 0.69 ± 1.39, 1.73 ± 2.33, and 7.36 ± 2.31, respectively (p < 0.001). (B). There was a significant negative correlation (r = −0.28, p = 0.002) between IgG titer and time after vaccination. (C). The IgG-positive rate was 84.9% for patients with normal cystatin C and 66.7% for those with elevated cystatin C (p = 0.027). (D). The area under the curve for cystatin C level predicting IgG positivity was 0.64 (95%CI 0.52–0.76, p = 0.035). ULN: Upper Limit of Normal.

Figure 3

Association between cystatin C levels and IgG Titers. (A). Among patients receiving one shot, two shots, and more than three shots of vaccine, IgG titers for patients with normal cystatin C and elevated cystatin C were 1.85 ± 3.41 vs. 0.51 ± 0.86 ug/mL (p = 0.544), 0.79 ± 1.54 vs. 0.26 ± 0.48 ug/mL (p = 0.418), and 1.98 ± 2.52 vs. 1.89 ± 2.69 (p = 0.890), respectively. (B). Cystatin C level was significantly positively correlated with age (r = 0.362, p = 0.001). (C). No significant correlation was observed between Cystatin C and IgG levels in patients who received 1–2 shots of vaccination. (D). No significant correlation was observed between Cystatin C and IgG levels in patients who received 3–4 shots of vaccination. ULN: Upper Limit of Normal.

Figure 4

Dynamic Changes of IgG Titers in HNC Patients after Receiving ICT. (A). IgG titers for HNC patients before receiving ICT and after 1 cycle, 2 cycles, and 3 cycles of ICT were 2.54 ± 3.34, 0.89 ± 1.85, 0.23 ± 0.42, and 0.28 ± 0.36 ug/mL. (B). IgG-positive rates before ICT and after 1 cycle and 2 cycles of ICT were 81.8%, 72.7%, and 55.6%, respectively. (C). IgG titer before ICT was significant;y positively correlated with IgG titer after one cycle of ICT (r = 0.714, p = 0.014).

Figure 5

Impact of Immunochemotherapy on IgG/IgM positivity rate. (A). The IgG-positive rate in the control group (35/46) was 76.1%, and 60/74 (81.1%) in ICT group (p = 0.512). (B). The IgM-positive rate in the control group was 13/46 (28.3%), significantly higher than 6/74 (8.1%) in ICT group (p = 0.003). (C). IgG-positive rate of patients in control group was 76.1% and in patients in the ICT group who had received one, two, and three cycles ICT were 78.6%, 83.3%, and 85.7%, respectively (p = 0.843). (D). For the ICT group, IgM-positive rates for patients in control group was 28.3%, while in patients who had received one cycle, two cycles, and three cycles of ICT were 7.1%, 11.1%, and 7.1%, respectively (p = 0.032).

Figure 6

Impact of Immunochemotherapy on IgG/IgM titers. (A). The IgG titer in control group was 1.56 ± 2.28 ug/mL, compared with 1.59 ± 2.43 in ICT group (p = 0.945). (B). IgG titers in control group and in ICT patients who had received one cycle, two cycles, and three cycles of ICT were 1.56 ± 2.28, 1.86 ± 2.62, 0.56 ± 0.56, and 2.13 ± 3.01, respectively (p = 0.194). (C). The IgM titer in the control group was 0.28 ± 0.07, and for the ICT group, it was 0.24 ± 0.04 (p = 0.003). (D). IgM titers in the control group and ICT patients who received one cycle, two cycles, and three cycles of ICT were 0.28 ± 0.07, 0.24 ± 0.03, 0.24 ± 0.04, and 0.24 ± 0.04, respectively (p = 0.010).

Figure 7

Univariate and Multivariate Analysis of IgG/IgM positivity after Vaccination in HNC Patients. (A). Univariate analysis of IgG positivity in HNC patients after SARS-CoV-2 vaccination. (B). Multivariate analysis of IgG positivity in HNC patients after SARS-CoV-2 vaccination. (C). Univariate analysis of IgM positivity in HNC patients after SARS-CoV-2 vaccination. (D). Multivariate analysis of IgM positivity in HNC patients after SARS-CoV-2 vaccination.