Elsevier

European Journal of Cancer

Volume 165, April 2022, Pages 184-194
European Journal of Cancer

Original Research
Third dose of SARS-CoV-2 vaccination in hemato-oncological patients and health care workers: immune responses and adverse events – a retrospective cohort study

https://doi.org/10.1016/j.ejca.2022.01.019Get rights and content
Under a Creative Commons license
open access

Highlights

  • Anti-SARS-CoV-2 antibody levels diminished over time after the second vaccination.

  • Antibody levels increased after the third dose, supporting its administration.

  • Patients under B cell-targeting therapy showed considerably lower antibody levels.

  • Antibody levels correlated with CD19+ and CD56+ peripheral blood cell counts.

  • Lower antibody levels than in controls underline the need for further studies.

Abstract

Background

Due to potentially immune-escaping virus variants and waning immunity, a third SARS-CoV-2 vaccination dose is increasingly recommended. However, data in patients with cancer are limited.

Patients and methods

We measured anti-SARS-CoV-2 spike protein antibody levels after the third vaccination dose in 439 patients with cancer and 41 health care workers (HCW) at an academic centre in Austria and a rural community hospital in Italy. Adverse events were retrieved from questionnaires.

Results

Overall, 439 patients and 41 HCW were included. SARS-CoV-2 infections were observed in 62/439 (14.1%) patients before vaccination and in 5/439 (1.1%) patients after ≥1 dose. Longitudinal analysis revealed a decrease of antibody levels between 3 and 6 months after second vaccination in patients with solid tumours (p < 0.001) and haematological malignancies without anti-B cell therapies (p < 0.001). After the third dose, anti-S levels increased compared to the first/second dose. Patients receiving B cell-targeted agents had lower antibody levels than patients with haematological malignancies undergoing other treatments (p < 0.001) or patients with solid tumours (p < 0.001). Moreover, anti-S levels correlated with CD19+ (B cell) and CD56+ (NK cell) counts in peripheral blood. The most frequent adverse events after the third dose were local pain (75/160, 46.9%), fatigue (25/160, 15.6%) and fever/chills (16/160, 10.0%). Patients with cancer had lower anti-S levels than HCW (p = 0.015).

Conclusions

This study in patients with cancer shows improved antibody levels after the third vaccination dose at an acceptable side-effect profile. Lower antibody levels than in controls underline the need for further follow-up studies and dedicated trials.

Keywords

SARS-CoV-2
COVID-19
Cancer
Oncology
Vaccination

Cited by (0)

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M. J. Mair and J. M. Berger as well as D. Fong and M. Preusser should be regarded co-first/co-last authors.