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Vaccinations following CAR-T cell therapy: summary of reported cases and state-of-the-art review of current recommendations
Affiliations- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Jurasz University Hospital 1, Bydgoszcz, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
- Student Scientific Society, Medical University, Poznań, Poland
- Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Jurasz University Hospital 1, Bydgoszcz, Poland
- Laboratory for Medical Education, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
open access
Abstract
Introduction: Chimeric antigen receptor T-cell (CAR-T) therapy is a modern breakthrough technology used in the treatment of B-lineage lymphoid malignancies. These malignancies include acute lymphoblastic leukemia, non-Hodgkin lymphoma, and plasma cell disorders. CAR-T therapy combines cellular therapy, gene therapy, and individualized therapy. The objective of this paper was to review the latest clinical knowledge, and summarize the reported data pertaining to vaccinations in patients after CAR-T therapy.
Material and methods: We carried out a review of published original studies as indexed in PubMed, and a review of abstracts presented during major hematology meetings.
Results: Overall, 22 original studies were reviewed and considered suitable for analysis regarding the efficacy of vaccinations for patients who had received CAR-T therapy. Data was divided into three groupings: the efficacy of vaccination against coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the efficacy of vaccination against influenza; and the efficacy of post-CAR-T immunization persistence of vaccination performed before CAR-T therapy. Humoral and cellular response to SARS-CoV-2 vaccination was positive for 36.5% and 72.2% of patients, respectively. The positive response to the influenza vaccine was 40% when administered prior to CAR-T therapy, as opposed to 31% after. Seroprotection for vaccine-preventable infections within 3-6 months after CAR-T was comparable to that of the general population, although it was determined to be less effective against specific pathogens (S. pneumoniae, B. pertussis, H. influenzae) in most patients.
Conclusions: In cases of incomplete immune reconstitution, there is a high likelihood of a limited response to vaccination. Regarding the SARS-CoV-2/COVID-19 vaccine, T-cell-induced protection is relatively significant. Therefore, B-cell aplasia is not a contraindication for vaccination in CAR-T patients. The consensus of European Society of Blood and Marrow Transplantation/European Hematology Association experts is that vaccination after CAR-T therapy is beneficial in order to reduce the rates of infection, and eventually to improve clinical course.
Abstract
Introduction: Chimeric antigen receptor T-cell (CAR-T) therapy is a modern breakthrough technology used in the treatment of B-lineage lymphoid malignancies. These malignancies include acute lymphoblastic leukemia, non-Hodgkin lymphoma, and plasma cell disorders. CAR-T therapy combines cellular therapy, gene therapy, and individualized therapy. The objective of this paper was to review the latest clinical knowledge, and summarize the reported data pertaining to vaccinations in patients after CAR-T therapy.
Material and methods: We carried out a review of published original studies as indexed in PubMed, and a review of abstracts presented during major hematology meetings.
Results: Overall, 22 original studies were reviewed and considered suitable for analysis regarding the efficacy of vaccinations for patients who had received CAR-T therapy. Data was divided into three groupings: the efficacy of vaccination against coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the efficacy of vaccination against influenza; and the efficacy of post-CAR-T immunization persistence of vaccination performed before CAR-T therapy. Humoral and cellular response to SARS-CoV-2 vaccination was positive for 36.5% and 72.2% of patients, respectively. The positive response to the influenza vaccine was 40% when administered prior to CAR-T therapy, as opposed to 31% after. Seroprotection for vaccine-preventable infections within 3-6 months after CAR-T was comparable to that of the general population, although it was determined to be less effective against specific pathogens (S. pneumoniae, B. pertussis, H. influenzae) in most patients.
Conclusions: In cases of incomplete immune reconstitution, there is a high likelihood of a limited response to vaccination. Regarding the SARS-CoV-2/COVID-19 vaccine, T-cell-induced protection is relatively significant. Therefore, B-cell aplasia is not a contraindication for vaccination in CAR-T patients. The consensus of European Society of Blood and Marrow Transplantation/European Hematology Association experts is that vaccination after CAR-T therapy is beneficial in order to reduce the rates of infection, and eventually to improve clinical course.
Keywords
CAR-T, vaccination, acute lymphoblastic leukemia, non-Hodgkin lymphoma, multiple myeloma, SARS-CoV-2, COVID-19, influenza
About this articleTitle
Vaccinations following CAR-T cell therapy: summary of reported cases and state-of-the-art review of current recommendations
Journal
Issue
Article type
Original research article
Pages
207-214
Published online
2022-06-06
Page views
1984
Article views/downloads
291
DOI
10.5603/AHP.a2022.0025
Bibliographic record
Acta Haematol Pol 2022;53(3):207-214.
Keywords
CAR-T
vaccination
acute lymphoblastic leukemia
non-Hodgkin lymphoma
multiple myeloma
SARS-CoV-2
COVID-19
influenza
Authors
Jan Styczyński
Tomasz Styczyński
Jagoda Sadlok
Magdalena Woźniak
Dorota Rutkowska
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