Dept. of Urology, Hirosaki University Graduate School of Medicine
Introduction: Patients with cancer and solid organ transplantation are at risk for immune dysregulation related to underlying malignant disease and immunomodulatory therapy. There is a great concern for protective immune response to SARS-CoV-2vaccination in those patients. We aimed to evaluate rates of anti-spike antibody response to a BNT162b2 vaccine in patients with urological cancers, kidney transplantation, and healthy controls in a single tertiary referral hospital in Japan.
Methods: This retrospective study included 280 adult patients with urological cancers, 93 adult patients with kidney transplantation, and 60 healthcare workers (controls) who received the second dose of the BNT162b2 vaccine at least 7 days before evaluation. The study was conducted between June 21, 2021, and November 1, 2021, at Hirosaki University Hospital (Hirosaki, Japan). Blood samples were cross-sectionally obtained from the study participants. Serum samples were analyzed and the titers of the IgG antibodies against the SARS-CoV-2 spike receptor-binding domain were determined using the Elecsys Anti-SARS-CoV-2 S RUO (Roche-diagnostics). Seropositivity was defined as >15 Unit/mL (sufficient for the presence of neutralizing antibodies). The primary outcome was the rate of seropositivity (>15 Unit/mL). Secondary outcomes included the decay of IgG titers over time and identifying factors that were associated with seropositivity using multivariable logistic regression analyses.
Results: The analysis included 195 patients with prostate cancer (PC) (median age 75 years), 57 patients with urothelial cancer (UC) (median age 73 years), 28 patients with renal cell carcinoma (RCC) (median age 72 years), 93 patients with kidney transplantation (KT) (median age 55 years), and 60 controls (median age 36 years). Of 433, we observed seropositive in 341 (79%) participants. The rate of seropositive for SARS-CoV-2 anti-spike IgG antibodies after the second vaccine in the patients with KT, PC, UC, RCC, and Ctrl were 23%, 94%, 88%, 96%, and 100%, respectively. The antibody titers were elevated 1 week after the second dose of the BNT162b2 vaccine. Multivariable analysis showed that age (HR 0.95, P=0.002), metastatic disease (HR0.25, P=0.021), and immunosuppression (HR 0.003, P<0.01) were significantly associated with seropositivity. A minimum dose of steroids or immune-checkpoint inhibitors was not significantly associated with seropositivity.
Conclusions: We observed a remarkably lower rate of seropositive in KT patients, while approximately 90% of patients with cancer exhibited adequate antibody response to the BNT162b2 vaccine. Further research is required for the durability and protective activity of lower titers for breakthrough infections.
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