This single-center, retrospective study analyzed vaccine responses in patients who received post-Chimeric Antigen Receptor (CAR) T-cell therapy vaccination between 2018 and 2024. Vaccinations were administered according to EBMT/CIBMTR recommendations and pathogen-specific IgG responses to 12 vaccine-preventable infections were assessed. Seroprotection was defined by established cut-offs or a significant fold increase in titers. A total of 73 patients that had not received intravenous immunoglobulins within the eight weeks prior to pre- or post titer were included. The median time to vaccination initiation was 13 months (range 6–66) post-CAR T. Pre and post-vaccination titers were available for 49 patients. Pre-vaccination seroprotection was high (> 85%) for tetanus and poliovirus. Among patients not seroprotected prior to vaccination, vaccine response rates were high for tetanus and polio (100%), moderate for diphtheria (75%) and haemophilus influenzae type b (62%), and lower for pertussis (48%), hepatitis A (43%), hepatitis B (44%), and pneumococcal disease (33%). CD19 CAR T recipients had higher pre-vaccination seroprotection rates than BCMA recipients, but vaccine responses did not differ significantly between groups. Pre-vaccination IgA levels were significantly associated with vaccine response, and absolute B-cell counts trended higher among responders (p = 0.054). Our findings highlight the importance of immune reconstitution in vaccine responses post-CAR T.
这项单中心回顾性研究分析了2018年至2024年间接受嵌合抗原受体（CAR）T细胞治疗后疫苗接种患者的免疫应答。疫苗接种遵循欧洲血液与骨髓移植学会（EBMT）/国际血液与骨髓移植研究中心（CIBMTR）指南，并评估了针对12种疫苗可预防感染的病原体特异性IgG抗体应答。血清保护率依据既定阈值或抗体滴度显著倍增进行定义。共纳入73名在抗体检测前/后八周内未接受静脉注射免疫球蛋白的患者。开始疫苗接种的中位时间为CAR-T治疗后13个月（范围6-66个月）。49名患者提供了疫苗接种前后的抗体滴度数据。破伤风与脊髓灰质炎的疫苗接种前血清保护率较高（>85%）。在接种前未具血清保护的患者中，破伤风与脊髓灰质炎的疫苗应答率最高（100%），白喉（75%）和b型流感嗜血杆菌（62%）次之，百日咳（48%）、甲型肝炎（43%）、乙型肝炎（44%）及肺炎球菌疾病（33%）的应答率较低。CD19 CAR-T接受者的疫苗接种前血清保护率高于BCMA CAR-T接受者，但两组间疫苗应答率无显著差异。疫苗接种前IgA水平与疫苗应答显著相关，应答者的绝对B细胞计数呈更高趋势（p=0.054）。本研究结果凸显了免疫重建在CAR-T治疗后疫苗应答中的重要性。
肿瘤(癌症)患者之家