Vaccination against COVID-19 for hematologic patients: A review of clinical guidelines
https://doi.org/10.35754/0234-5730-2021-66-3-458-470
Abstract
Introduction. The COVID-19 pandemic has led to the need to accelerate the development of vaccines targeting SARSCoV-2. A large number of researchers have already confi rmed that patients with cancer have a high risk of mortality from COVID-19. Hematologic diseases and the therapy of these diseases are very heterogeneous, therefore it is expected that the immune response to infection or vaccination will be more variable in this cohort of patients. Accordingly, questions arise regarding the safety and effi cacy of vaccines in the context of immune changes caused either by the hematological disease itself or by the therapy that is administered to the patient.
Aim — to summarize the current understanding of the effi cacy and safety of vaccination against the SARS-CoV-2 in patients with hemoblastosis and other hematological diseases.
Basic information. Legalized COVID-19 vaccines are safe and effective for the general population. Given the high mortality rate among patients with hematological diseases, which is ten times higher than the mortality rate in the general population, vaccination is a priority for this group of patients. The current lack of clinical trial data on the effectiveness and safety of vaccines against COVID-19 in hematological patients raises a large number of questions among specialists and patients. This is also due to the fact that for most of the approved vaccines immunocompromised patients were not included in the phase III clinical trials. Thus, most patients with hematological diseases could not participate in these studies, and therefore the effectiveness and safety of vaccines against the causative agent of COVID-19 have not been thoroughly studied in this group.
Current recommendations for vaccination against COVID-19 in hematological patients are based on expert opinion, including past experience of immunizing these patients against other viral infections.
Conclusions. Vaccination of patients with hematological diseases and their environment (medical staff, relatives, caregivers) is one of the necessary methods to prevent high mortality from a new coronavirus infection during the COVID-19 pandemic.
About the Authors
O. A. Gavrilina
National Research Center for Hematology
Russian Federation
Russian Federation
Olga A. Gavrilina*, Cand. Sci. (Med.), Head of the Observational Department
125167, Moscow
А. N. Vasileva
National Research Center for Hematology
Russian Federation
Russian Federation
Anastasia N. Vasileva, Clinical Resident, Observatory Department
125167, Moscow
References
1. Our World in Data. https://ourworldindata.org/coronavirus-data
2. Desai A., Sachdeva S., Parekh T., et al. COVID-19 and Cancer: Lessons from a pooled meta-analysis. JCO Glob Oncol. 2020; (6): 557–9. DOI: 10.1200/go.20.00097.
3. Kuderer N.M., Choueiri T.K., Shah D.P., et al. Clinical impact of COVID-19 on patients with cancer (CCC19): A cohort study. Lancet. 2020; 395(10241): 1907–18. DOI: 10.1016/S0140-6736(20)31187-9.
4. Gavrilina O., Zakurdaeva K., Vorobyev V., et al. Outcomes in patients with hematologic disease and COVID-19 in Russia: Interim analysis of CHRONOS19 Registry. Blood. 2020; 136(Suppl. 1): 41–2. DOI: 10.1182/blood-2020-138504.
5. Desai A., Gupta R., Advani S., et al. Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta-analysis of cohort studies. Cancer. 2021; 127(9): 1459–68. DOI: 10.1002/cncr.33386.
6. WHO draft landscape of Covid-19 candidate vaccines. https://bit.ly/2WPuad6
7. Ou X., Liu Y., Lei X., et al. Characterization of spike glycoprotein of SARS-CoV-2 on virus entry and its immune cross-reactivity with SARS-CoV. Nat Commun. 2020; 11(1): 1620. DOI: 10.1038/s41467-020-15562-9.
8. COVID-19 vaccine tracker and landscape. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
9. Hwang J.K., Zhang T., Wang A.Z., Li Z. COVID-19 vaccines for patients with cancer: Benefi ts likely outweigh risks. J Hematol Oncol. 2021; 14(1): 38. DOI: 10.1186/s13045-021-01046-w.
10. Interim guidelines “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” Ministry of Health of the Russian Federation. 2020; Version 10. 07.05.2021. (In Russian). https://xn--80aesfpebagmfblc0a.xn--p1ai/ai/doc/872/attach/Bmr_COVID-19_compressed.pdf
11. Polack F.P., Thomas S.J., Kitchin N., et al. Safety and effi cacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020; 383(27): 2603–15. DOI: 10.1056/nejmoa2034577.
12. Oliver S.E., Gargano J.W., Scobie H., et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for use of Janssen COVID-19 vaccine — United States, February 2021. MMWR Surveill Summ. 2021; 70(9): 329–32. DOI: 10.15585/mmwr.mm7009e4.
13. Frenck R.W., Klein N.P., Kitchin N., et al. Safety, immunogenicity, and effi cacy of the BNT162b2 Covid-19 vaccine in adolescents. N Engl J Med. 2021; 385(3): 239–50. DOI: 10.1056/nejmoa2107456.
14. Baden L.R., El Sahly H.M., Essink B., et al. Effi cacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021; 384(5): 403–16. DOI: 10.1056/nejmoa2035389.
15. Bernal J.L., Andrews N., Gower C., et al. Effectiveness of the Pfi zer-BioNTech and Oxford-AstraZeneca vaccines on Covid-19 related symptoms, hospital admissions, and mortality in older adults in England: Test negative case-control study. Brit Med J. 2021; 373: n1088. DOI: 10.1136/bmj.n1088.
16. Tenforde M.W., Olson S.M., Self W.H., et al. Effectiveness of Pfi zer-BioNTech and Moderna vaccines against COVID-19 among hospitalized adults aged ≥ 65 years — United States, January-March 2021. MMWR Recomm Reports. 2021; 70(18): 674–9. DOI: 10.15585/mmwr.mm7018e1.
17. Dagan N., Barda N., Kepten E., et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. 2021; 384(15): 1412–23. DOI: 10.1056/nejmoa2101765.
18. Haas E.J., Angulo F.J., McLaughlin J.M., et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: An observational study using national surveillance data. Lancet. 2021; 397(10287): 1819–29. DOI: 10.1016/S0140-6736(21)00947-8.
19. Boyarsky B.J., Werbel W.A., Avery R.K., et al. Immunogenicity of a single dose of SARS-CoV-2 Messenger RNA vaccine in solid organ transplant recipients. JAMA. 2021; 325(17): 1784–6. DOI: 10.1001/jama.2021.4385.
20. Rozen-Zvi B., Yahav D., Agur T., et al. Antibody response to SARS-CoV-2 mRNA vaccine among kidney transplant recipients: A prospective cohort study. Clin Microbiol Infect. 2021; 27(8): 1173.e1–4. DOI: 10.1016/j.cmi.2021.04.028.
21. Itzhaki Ben Zadok O., Shaul A.A., Ben-Avraham B., et al. Immunogenicity of the BNT162b2 mRNA vaccine in heart transplant recipients — a prospective cohort study. Eur J Heart Fail. 2021; 1–5. DOI: 10.1002/ejhf.2199.
22. Boyarsky B.J., Werbel W.A., Avery R.K., et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA. 2021; 325(21): 2204–6. DOI: 10.1001/jama.2021.7489.
23. Rabinowich L., Grupper A., Baruch R., et al. Low immunogenicity to SARSCoV-2 vaccination among liver transplant recipients. J Hepatol. 2021; 75(2): 435–8. DOI: 10.1016/j.jhep.2021.04.020.
24. Grupper A., Rabinowich L., Schwartz D., et al. Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus. Am J Transplant. 2021; 21(8): 2719–26. DOI: 10.1111/ajt.16615.
25. Marion O., Del Bello A., Abravanel F., et al. Safety and immunogenicity of anti-SARS-CoV-2 messenger RNA vaccines in recipients of solid organ transplants. Ann Intern Med. 2021: M21–1341. DOI: 10.7326/m21-1341.
26. Benotmane I., Gautier-Vargas G., Cognard N., et al. Low immunization rates among kidney transplant recipients who received 2 doses of the mRNA-1273 SARS-CoV-2 vaccine. Kidney Int. 2021; 99(6): 1498–1500. DOI: 10.1016/j.kint.2021.04.005.
27. Herishanu Y., Avivi I., Aharon A., et al. Effi cacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood. 2021; 137(23): 3165–73. DOI: 10.1182/blood.2021011568.
28. Gavriatopoulou M., Terpos E., Kastritis E., et al. Low neutralizing antibody responses in WM, CLL and NHL patients after the fi rst dose of the BNT162b2 and AZD1222 vaccine. Clin Exp Med. 2021; DOI: 10.1007/s10238-021-00746-4.
29. Roeker L.E., Knorr D.A., Thompson M.C., et al. COVID-19 vaccine effi cacy in patients with chronic lymphocytic leukemia. Leukemia. 2021; 35(9): 2703–5. DOI: 10.1038/s41375-021-01270-w.
30. Pimpinelli F., Marchesi F., Piaggio G., et al. Fifth-week immunogenicity and safety of anti-SARS-CoV-2 BNT162b2 vaccine in patients with multiple myeloma and myeloproliferative malignancies on active treatment: preliminary data from a single institution. J Hematol Oncol. 2021;14(1):1–12. DOI:10.1186/s13045-021-01090-6.
31. Monin L., Laing A.G., Muñoz-Ruiz M., et al. Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: Interim analysis of a prospective observational study. Lancet Oncol. 2021; 22(6): 765–78. DOI: 10.1016/S1470-2045(21)00213-8.
32. Agha M., Blake M., Chilleo C., et al. Suboptimal response to COVID-19 mRNA vaccines in hematologic malignancies patients. medRxiv. 2021: 2021.04.06.21254949. DOI: 10.1101/2021.04.06.21254949.
33. WHO. AZD1222 vaccine against COVID-19 developed by Oxford University and Astra Zeneca: Background paper. Prepared by the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on COVID-19 vaccines 10 February 2021; https://apps.who.int/iris/handle/10665/339474
34. Logunov D.Y., Dolzhikova I.V., Shcheblyakov D.V., et al. Safety and effi cacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: An interim analysis of a randomised controlled phase 3 trial in Russia. Lancet. 2021; 397(10275): 671–81. DOI: 10.1016/S0140-6736(21)00234-8.
35. Shimabukuro T.T., Cole M., Su J.R. Reports of anaphylaxis after receipt of mRNA COVID-19 vaccines in the US — December 14, 2020 – January 18,2021. JAMA. 2021; 325(11): 1101–2. DOI: 10.1001/jama.2021.1967.
36. Platton S., Bartlett A., MacCallum P., et al. Evaluation of laboratory assays for anti-platelet factor 4 antibodies after ChAdOx1 nCOV-19 vaccination. J Thromb Haemost. 2021; 19(8): 2007–13. DOI: 10.1111/jth.15362.
37. Xie X., Liu Y., Liu J., et al. Neutralization of SARS-CoV-2 spike 69/70 deletion, E484K and N501Y variants by BNT162b2 vaccine-elicited sera. Nat Med. 2021; 27(4): 620–1. DOI: 10.1038/s41591-021-01270-4.
38. Wang Z., Schmidt F., Weisblum Y., et al. mRNA vaccine-elicited antibodies to SARS-CoV-2 and circulating variants. Nature. 2021; 592(7855): 616–22. DOI: 10.1038/s41586-021-03324-6.
39. Thompson C.N., Hughes S., Ngai S., et al. Rapid emergence and epidemiologic characteristics of the SARS-CoV-2 B.1.526 variant — New York City, New York, January 1 –April 5, 2021. Morb Mortal Wkly Rep. 2021; 70(19): 712–6. DOI: 10.15585/mmwr.mm7019e.
40. EBMT COVID Recommendations. COVID-19 vaccines. Version 6.0, May 27, 2021. https://www.ebmt.org/sites/default/fi les/2021-05/COVID%20vaccines%20version%206.02%20-%202021-05-28.pdf
41. Expert opinions for COVID-19 vaccination in patients with hematologic cancer https://ehaweb.org/covid-19/eha-statement-on-covid-19-vaccines/recommendations-for-covid-19-vaccination-in-patients-with-hematologic-cancer/
42. American Society of Hematology COVID-19 resources https://www.hematology.org/covid-19
43. Algassim A.A., Elghazaly A.A., Alnahdi A.S., et al. Prognostic signifi cance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection. Ann Hematol. 2021; 100(1): 37–43. DOI: 10.1007/s00277-020-04256-3.
44. Cecinati V., Principi N., Brescia L., et al. Vaccine administration and the development of immune thrombocytopenic purpura in children. Hum Vaccines Immunother. 2013; 9(5): 1158–62. DOI: 10.4161/hv.23601.
45. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003; 120(4): 574–96. DOI: 10.1046/j.1365-2141.2003.04131.x.
46. Coronavirus disease 2019 (COVID-19) and supply of substances of human origin in the EU/EEA – Second update. 10.12.2020. https://www.ecdc.europa.eu/en/publications-data/coronavirus-disease-2019-covid-19-and-supply-substances-human-origin
47. Robin C., Bahuaud M., Redjoul R., et al. Antipneumococcal seroprotection years after vaccination in allogeneic hematopoietic cell transplant recipients. Clin Infect Dis. 2020; 71(8): e301–7. DOI: 10.1093/cid/ciz1168.
48. Cordonnier C., Labopin M., Chesnel V., et al. Randomized study of early versus late immunization with pneumococcal conjugate vaccine after allogeneic stem cell transplantation. Clin Infect Dis. 2009; 48(10): 1392–401. DOI: 10.1086/598324.
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For citations:
Gavrilina O.A., Vasileva А.N. Vaccination against COVID-19 for hematologic patients: A review of clinical guidelines. Russian journal of hematology and transfusiology. 2021;66(3):458-470. (In Russ.) https://doi.org/10.35754/0234-5730-2021-66-3-458-470
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