Implications of findings for COVID-19 vaccination guidelines
| Condition . | Advice . |
|---|---|
| Myeloid malignancies | Do not postpone vaccination during chemotherapy or therapy with TKI |
| Antibody responses are less during hypomethylating or ruxolitinib therapy | |
| Lymphoid malignancies | Do not postpone vaccination during active treatment of multiple myeloma |
| Effective B-cell–depleting therapy precludes generation of antibody responses, although B-cell numbers do not need to be normalized to generate sufficient antibody concentrations | |
| Do not interrupt B-cell–depleting therapy for vaccination as B-cell reconstitution to levels sufficient for the generation of antibody responses takes at least 8 mo | |
| Ibrutinib and venetoclax hamper potent antibody responses | |
| Autologous HCT | Multiple myeloma: vaccination is immunogenic immediately after autologous HCT |
| B-NHL: sufficient antibody responses cannot be generated<8 mo after autologous HCT | |
| Allogeneic HCT | Vaccination can be immunogenic as early as 4 mo after allogeneic HCT |
| Vaccination is immunogenic in most patients with cGVHD | |
| CAR T-cell therapy | Effective B-cell–depleting therapy precludes generation of antibody responses |
| Sickle cell disease | Vaccination is immunogenic despite functional asplenia and the use of hydroxyurea |
| Determinants of response | IgG4 concentration, B- and NK-cell numbers, number of immunosuppressants used |
| Condition . | Advice . |
|---|---|
| Myeloid malignancies | Do not postpone vaccination during chemotherapy or therapy with TKI |
| Antibody responses are less during hypomethylating or ruxolitinib therapy | |
| Lymphoid malignancies | Do not postpone vaccination during active treatment of multiple myeloma |
| Effective B-cell–depleting therapy precludes generation of antibody responses, although B-cell numbers do not need to be normalized to generate sufficient antibody concentrations | |
| Do not interrupt B-cell–depleting therapy for vaccination as B-cell reconstitution to levels sufficient for the generation of antibody responses takes at least 8 mo | |
| Ibrutinib and venetoclax hamper potent antibody responses | |
| Autologous HCT | Multiple myeloma: vaccination is immunogenic immediately after autologous HCT |
| B-NHL: sufficient antibody responses cannot be generated<8 mo after autologous HCT | |
| Allogeneic HCT | Vaccination can be immunogenic as early as 4 mo after allogeneic HCT |
| Vaccination is immunogenic in most patients with cGVHD | |
| CAR T-cell therapy | Effective B-cell–depleting therapy precludes generation of antibody responses |
| Sickle cell disease | Vaccination is immunogenic despite functional asplenia and the use of hydroxyurea |
| Determinants of response | IgG4 concentration, B- and NK-cell numbers, number of immunosuppressants used |
Conclusions are based on S1 IgG concentrations obtained 4 wk after the standard 2-dose mRNA-1273 vaccination schedule given 28 d apart. Other markers of immunogenicity, such as antigen-specific T-cell responses, are not taken into consideration here.