Humoral Immune Responses to Vaccines in Patients with Hematologic Malignancies Following Chimeric Antigen Receptor (CAR) T-Cell Therapy
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Infectious complications significantly burden patients after CAR T-cell therapy and vaccinations are recommended to reduce infection-related morbidity. Here we report vaccine responses among CD19 and BCMA CAR T-cell recipients. Methods This is a single-center, retrospective analysis of vaccine responses among patients receiving vaccination between 2018 and 2024 post CAR T. Patients who received at least one vaccination of interest with a baseline titer were included, see Table 1 for patient demographics. Seroprotection was defined by a set cut-off or by an appropriate fold increase between pre and post-vaccine series titer. Titers were drawn before the first vaccine and after a median of 3 doses (range 1-5). Patients receiving immunoglobulin therapy within 4 weeks of sampling were excluded. Pathogen-specific IgG antibodies against 12 vaccine-preventable infections were assessed. Results Seventy-eight adult patients (median age 66, range 30-85) met the study criteria. In the BCMA group, 81% of patients had prior hematopoietic stem cell transplant , compared to 19% in the CD19 group. The median time to vaccination start was 13 months (range 6-66) post CAR T. Table 2 lists vaccines administered, while Table 3 shows baseline seroprotection and vaccine response rates. High baseline seroprotection rates were observed for diphtheria , tetanus , and poliovirus (over 70%). Tetanus and polio achieved a 100% vaccine response rate. Lower baseline seroprotection and vaccine response rates were noted for pertussis , hepatitis A, hepatitis B, and pneumococcus . CD19 group showed better baseline seroprotection against most tested pathogens compared to the BCMA group. Conclusion Baseline seroprotection and vaccine response rates varied by vaccine antigen and CAR T target. Most vaccines improved seroprotection, with the CD19 group showing better baseline protection. These results highlight the need for tailored vaccination strategies, especially for pathogens with low baseline seroprotection and suboptimal post-vaccination responses.
Authors: Sigrun Einarsdottir, Stephanie M. Lobaugh, Padmapriya Subramanian, Sean Devlin, David J. Chung, Parastoo B Dahi, Lorenzo Falchi, Sergio A. Giralt, Heather J. Landau, Alexander M. Lesokhin, Dr. Richard J. Lin, Jennifer K Lue, Sham Mailankody, M. Lia Palomba, Jae H Park, Gilles Salles, Michael Scordo, Saad Z. Usmani, Miguel Angel Perales, Gunjan L Shah, Zainab Shahid
Institution: Memorial Sloan Kettering Cancer Center
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W4407974863