1. Humoral immunogenicity of the seasonal influenza vaccine before and after CAR-T-cell therapy: a prospective observational study
- Author
-
Jesse D. Bloom, Elizabeth M Krantz, Carla S Walti, Caitlin R Wolf, Rebecca Gardner, Kiel Shuey, Jim Boonyaratanakornkit, Jacob Keane-Candib, Damian J. Green, Steven A. Pergam, Tillie Loeffelholz, Andrea N. Loes, Justin J. Taylor, Helen Y. Chu, Cameron J. Turtle, David G. Maloney, Joshua A. Hill, and Andrew J. Cowan
- Subjects
Cancer Research ,Cell- and Tissue-Based Therapy ,receptors ,immunogenicity ,humoral ,Hypogammaglobulinemia ,Immunogenicity, Vaccine ,vaccine ,Immunology and Allergy ,hematologic neoplasms ,Prospective Studies ,RC254-282 ,education.field_of_study ,biology ,Immunogenicity ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,antibody formation ,CAR-T ,Vaccination ,immunocompromised ,Oncology ,Molecular Medicine ,Respiratory virus ,Antibody ,influenza ,Adult ,Adolescent ,Immunology ,Population ,Article ,Young Adult ,Immune system ,Immunity ,Influenza, Human ,medicine ,Humans ,education ,Aged ,Pharmacology ,Immune Cell Therapies and Immune Cell Engineering ,business.industry ,Hemagglutination Inhibition Tests ,vaccination ,medicine.disease ,immunity ,chimeric antigen ,biology.protein ,business - Abstract
Recipients of chimeric antigen receptor-modified T (CAR-T) cell therapies for B cell malignancies have profound and prolonged immunodeficiencies and are at risk for serious infections, including respiratory virus infections. Vaccination may be important for infection prevention, but there are limited data on vaccine immunogenicity in this population. We conducted a prospective observational study of the humoral immunogenicity of commercially available 2019–2020 inactivated influenza vaccines in adults immediately prior to or while in durable remission after CD19-, CD20-, or B cell maturation antigen-targeted CAR-T-cell therapy, as well as controls. We tested for antibodies to all four vaccine strains using neutralization and hemagglutination inhibition (HAI) assays. Antibody responses were defined as at least fourfold titer increases from baseline. Seroprotection was defined as a HAI titer ≥40. Enrolled CAR-T-cell recipients were vaccinated 14–29 days prior to (n=5) or 13–57 months following therapy (n=13), and the majority had hypogammaglobulinemia and cellular immunodeficiencies prevaccination. Eight non-immunocompromised adults served as controls. Antibody responses to ≥1 vaccine strain occurred in 2 (40%) individuals before CAR-T-cell therapy and in 4 (31%) individuals vaccinated after CAR-T-cell therapy. An additional 1 (20%) and 6 (46%) individuals had at least twofold increases, respectively. One individual vaccinated prior to CAR-T-cell therapy maintained a response for >3 months following therapy. Across all tested vaccine strains, seroprotection was less frequent in CAR-T-cell recipients than in controls. There was evidence of immunogenicity even among individuals with low immunoglobulin, CD19+ B cell, and CD4+ T-cell counts. These data support consideration for vaccination before and after CAR-T-cell therapy for influenza and other relevant pathogens such as SARS-CoV-2, irrespective of hypogammaglobulinemia or B cell aplasia. However, relatively impaired humoral vaccine immunogenicity indicates the need for additional infection-prevention strategies. Larger studies are needed to refine our understanding of potential correlates of vaccine immunogenicity, and durability of immune responses, in CAR-T-cell therapy recipients.
- Published
- 2021
- Full Text
- View/download PDF