SARS-CoV-2 vaccine response and rate of breakthrough infection in patients with hematological disorders
Por:
Pinana, JL, Lopez-Corral, L, Martino, R, Vazquez, L, Perez, A, Martin-Martin, G, Gago, B, Sanz-Linares, G, Sanchez-Salinas, A, Villalon, L, Conesa-Garcia, V, Olave, MT, Corona, M, Marcos-Corrales, S, Tormo, M, Hernandez-Rivas, JA, Montoro, J, Rodriguez-Fernandez, A, Risco-Galvez, I, Rodriguez-Belenguer, P, Hernandez-Boluda, JC, Garcia-Cadenas, I, Ruiz-Garcia, M, Munoz-Bellido, JL, Solano, C, Cedillo, A, Sureda, A, Navarro, D
Publicada:
7 may 2022
Resumen:
Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3-6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7-195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3-6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2-4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0-4854.93) vs 730.81 BAU/mL (range 0-56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants.
Filiaciones:
Pinana, JL:
Hosp Clin Univ Valencia, Hematol Dept, Div Clin Hematol, Avda Blasco Ibanez 17, Valencia 46010, Spain
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Lopez-Corral, L:
Hosp Univ Salamanca, Hematol Div, Salamanca, Spain
Martino, R:
Hosp Santa Creu & Sant Pau, Hematol Div, Barcelona, Spain
Vazquez, L:
Hosp Univ Salamanca, Hematol Div, Salamanca, Spain
Perez, A:
Hosp Clin Univ Valencia, Hematol Dept, Div Clin Hematol, Avda Blasco Ibanez 17, Valencia 46010, Spain
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Martin-Martin, G:
Hosp Univ Salamanca, Hematol Div, Salamanca, Spain
Gago, B:
Hosp Reg Univ Carlos Haya, Hematol Div, Malaga, Spain
Sanz-Linares, G:
Univ Barcelona, Inst Catala Oncol, Hematol Div, IDIBELL,Hosp Duran & Reynals, Barcelona, Spain
Sanchez-Salinas, A:
Hosp Clin Univ Virgen de la Arrixaca, Hematol Div, Murcia, Spain
Villalon, L:
Hosp Univ Fdn Alcorcon, Hematol Div, Madrid, Spain
Conesa-Garcia, V:
Hosp Gen Univ Elche, Hematol Div, Elche, Spain
Olave, MT:
IIS Aragon, Hematol Div, Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Corona, M:
Hosp Ramon & Cajal, Hematol Div, Madrid, Spain
Marcos-Corrales, S:
Hosp Univ Salamanca, Hematol Div, Salamanca, Spain
Tormo, M:
Hosp Clin Univ Valencia, Hematol Dept, Div Clin Hematol, Avda Blasco Ibanez 17, Valencia 46010, Spain
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Hernandez-Rivas, JA:
Hosp Univ Infanta Leonor, Hematol Div, Madrid, Spain
Montoro, J:
Hosp Univ & Politecn La Fe, Hematol Div, Valencia, Spain
Rodriguez-Fernandez, A:
Hosp Univ Virgen Macarena, Hematol Div, Seville, Spain
Risco-Galvez, I:
Hosp Arnau Vilanova, Hematol Div, Valencia, Spain
Rodriguez-Belenguer, P:
Univ Pompeu Fabra, Hosp del Mar, Dept Expt & Hlth Sci,Med Res Inst IMIM, Res Program Biomed Informat GRIB, Barcelona, Spain
Hernandez-Boluda, JC:
Hosp Clin Univ Valencia, Hematol Dept, Div Clin Hematol, Avda Blasco Ibanez 17, Valencia 46010, Spain
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Univ Valencia, Sch Med, Dept Med, Valencia, Spain
Garcia-Cadenas, I:
Hosp Santa Creu & Sant Pau, Hematol Div, Barcelona, Spain
Ruiz-Garcia, M:
Hosp Gen Univ Elx, Elche, Spain
Munoz-Bellido, JL:
Hosp Univ Salamanca, Salamanca, Spain
Solano, C:
Hosp Clin Univ Valencia, Hematol Dept, Div Clin Hematol, Avda Blasco Ibanez 17, Valencia 46010, Spain
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Univ Valencia, Sch Med, Dept Med, Valencia, Spain
Cedillo, A:
Hematopoiet Stem Cell Transplantat & Cell Therapy, Madrid, Spain
Sureda, A:
Univ Barcelona, Inst Catala Oncol, Hematol Div, IDIBELL,Hosp Duran & Reynals, Barcelona, Spain
Navarro, D:
Univ Valencia, Fdn INCLIVA, Inst Invest Sanitaria Hosp Clin, Valencia, Spain
Hosp Clin Univ Valencia, Valencia, Spain
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