Comparison of patient, disease, and treatment characteristics by vaccine response in auto-HCT, allo-HCT, and CAR T-cell therapy
| . | Vaccine response . | . | |
|---|---|---|---|
| Positive . | Negative . | P . | |
| Total patients (N = 130) | 79 (60) | 51 (40) | NA |
| Vaccine type | .38 | ||
| Pfizer | 43 (56) | 34 (44) | |
| Moderna | 32 (68) | 15 (32) | |
| Johnson & Johnson | 4 (67) | 2 (34) | |
| Auto-HCT (n = 45) | |||
| All patients | 27 (60) | 18 (40) | NA |
| Median (range) age, y | 65 (48-70) | 65 (45-75) | .50 |
| Interval between auto-HCT and vaccination, mo | .20 | ||
| <12 | 11 (73) | 4 (27) | |
| ≥12 | 16 (53) | 14 (47) | |
| Auto-HCT indication | .52 | ||
| Lymphoma | 8 (53) | 7 (47) | |
| Myeloma | 19 (63) | 11 (37) | |
| Patients on maintenance therapy* | 8 (67) | 4 (33) | .58 |
| Disease relapse before vaccine | 8 (47) | 9 (53) | .18 |
| Prior COVID infection | 1 | 1 | — |
| Patients with IgG <400 mg/dL | 8 (57) | 6 (43) | .79 |
| Median (range) time from auto-HCT to vaccine, mo | 30 (3-173) | 30 (2-96) | .50 |
| Median (range) IgG level per mg/dL | 474 (146- 1481) | 429 (40-990) | .29 |
| Allo-HCT (n = 71) | |||
| All patients | 49 (69) | 22 (31) | NA |
| Median (range) age, y | 64 (25-70) | 68.5 (37-77) | .07 |
| Interval between allo-HCT and vaccination, mo | .22 | ||
| <12 | 11 (58) | 8 (42) | |
| ≥12 | 38 (73) | 14 (27) | |
| IST status | .69 | ||
| Off IST | 18 (72) | 7 (28) | |
| Ongoing IST drugs† | 31 (67) | 15 (33) | |
| GVHD status‡ | .99 | ||
| No active GVHD | 20 (69) | 9 (31) | |
| Active GVHD | 29 (69) | 13 (31) | |
| Active chronic GVHD‡ | 23 (65) | 12 (34) | .55 |
| Disease relapse before vaccine | 4 (57) | 3 (43) | .47 |
| Positive patients with either CD4 <100/μL or CD8 <100/μL and/or IgG <400 mg/dL | 12 (55) | 10 (45) | .08 |
| Median (range) time from allo-HCT to vaccine, mo | 26 (4-154) | 25 (3-155) | .68 |
| Prednisone use at time of vaccination | 4 (31) | 9 (69) | .001 |
| Prior COVID infection | 3 | 0 | |
| Median (range) CD4 count, per μL | 327 (44-1165) | 274 (56- 576) | .10 |
| Median (range) CD8 count, per μL | 278 (46-1739) | 276 (34-1440) | .73 |
| Median (range) IgG level, per mg/dL | 577 (189-2090) | 408 (153-1187) | .01 |
| CAR T-cell therapy (n = 14) | |||
| All patients | 3 (21) | 11 (79) | NA |
| Prior COVID infection | 1 | 0 | — |
| Median (range) time from CAR T-cell therapy to vaccine, mo | 24 (8-31) | 6 (3-37) | .09 |
| Disease relapse before vaccine | 0 | 1 | .59 |
| Median (range) IgG level, per mg/dL | 535 (191-1562) | 535 (191-4843) | — |
| . | Vaccine response . | . | |
|---|---|---|---|
| Positive . | Negative . | P . | |
| Total patients (N = 130) | 79 (60) | 51 (40) | NA |
| Vaccine type | .38 | ||
| Pfizer | 43 (56) | 34 (44) | |
| Moderna | 32 (68) | 15 (32) | |
| Johnson & Johnson | 4 (67) | 2 (34) | |
| Auto-HCT (n = 45) | |||
| All patients | 27 (60) | 18 (40) | NA |
| Median (range) age, y | 65 (48-70) | 65 (45-75) | .50 |
| Interval between auto-HCT and vaccination, mo | .20 | ||
| <12 | 11 (73) | 4 (27) | |
| ≥12 | 16 (53) | 14 (47) | |
| Auto-HCT indication | .52 | ||
| Lymphoma | 8 (53) | 7 (47) | |
| Myeloma | 19 (63) | 11 (37) | |
| Patients on maintenance therapy* | 8 (67) | 4 (33) | .58 |
| Disease relapse before vaccine | 8 (47) | 9 (53) | .18 |
| Prior COVID infection | 1 | 1 | — |
| Patients with IgG <400 mg/dL | 8 (57) | 6 (43) | .79 |
| Median (range) time from auto-HCT to vaccine, mo | 30 (3-173) | 30 (2-96) | .50 |
| Median (range) IgG level per mg/dL | 474 (146- 1481) | 429 (40-990) | .29 |
| Allo-HCT (n = 71) | |||
| All patients | 49 (69) | 22 (31) | NA |
| Median (range) age, y | 64 (25-70) | 68.5 (37-77) | .07 |
| Interval between allo-HCT and vaccination, mo | .22 | ||
| <12 | 11 (58) | 8 (42) | |
| ≥12 | 38 (73) | 14 (27) | |
| IST status | .69 | ||
| Off IST | 18 (72) | 7 (28) | |
| Ongoing IST drugs† | 31 (67) | 15 (33) | |
| GVHD status‡ | .99 | ||
| No active GVHD | 20 (69) | 9 (31) | |
| Active GVHD | 29 (69) | 13 (31) | |
| Active chronic GVHD‡ | 23 (65) | 12 (34) | .55 |
| Disease relapse before vaccine | 4 (57) | 3 (43) | .47 |
| Positive patients with either CD4 <100/μL or CD8 <100/μL and/or IgG <400 mg/dL | 12 (55) | 10 (45) | .08 |
| Median (range) time from allo-HCT to vaccine, mo | 26 (4-154) | 25 (3-155) | .68 |
| Prednisone use at time of vaccination | 4 (31) | 9 (69) | .001 |
| Prior COVID infection | 3 | 0 | |
| Median (range) CD4 count, per μL | 327 (44-1165) | 274 (56- 576) | .10 |
| Median (range) CD8 count, per μL | 278 (46-1739) | 276 (34-1440) | .73 |
| Median (range) IgG level, per mg/dL | 577 (189-2090) | 408 (153-1187) | .01 |
| CAR T-cell therapy (n = 14) | |||
| All patients | 3 (21) | 11 (79) | NA |
| Prior COVID infection | 1 | 0 | — |
| Median (range) time from CAR T-cell therapy to vaccine, mo | 24 (8-31) | 6 (3-37) | .09 |
| Disease relapse before vaccine | 0 | 1 | .59 |
| Median (range) IgG level, per mg/dL | 535 (191-1562) | 535 (191-4843) | — |
Data presented as n (%) unless otherwise indicated.
GVHD, graft-versus-host disease; IST, immunosuppressive therapy; NA, not applicable.
Maintenance therapy included lenalidomide ± other drugs (n = 9), rituximab (n = 2), or nivolumab (n = 1).
IST in vaccine responders (n = 29 [ruxolitinib ± other drugs, n = 16; sirolimus ± other drugs, n = 5; mycophenolate moefetil, n = 3; tacrolimus, n = 2; prednisone, n = 2; and ibrutinib, n = 1]) and nonresponders (n = 14 [ruxolitinib ± other drugs, n = 6; mycophenolate moefetil, n = 4; tacrolimus, n = 3; and prednisone, n = 1]).
Active acute or chronic GVHD defined as either active signs or symptoms of GVHD or ongoing IST drugs used to treat GVHD. Ongoing use of GVHD prophylaxis in the absence of signs or symptoms of GVHD was not considered active GVHD. Group off IST consisted of patients off all systemic medications to treat or prevent GVHD for ≥2 weeks.