Patients with Castleman disease report mild COVID-19 symptoms and mount a humoral response to SARS-CoV-2 vaccination

Blood Neoplasia Pub Date : 2024-03-01 DOI:10.1016/j.bneo.2024.100002

Saishravan Shyamsundar , Sheila K. Pierson , Caoilfhionn M. Connolly , Mayan Teles , Dorry L. Segev , William A. Werbel , Frits van Rhee , Corey Casper , Joshua D. Brandstadter , Ariela Noy , David C. Fajgenbaum

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Abstract

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in increased morbidity and mortality in patients with impaired immunity, hematologic malignancies, and on immunosuppressive regimens. COVID-19 can cause a cytokine storm with some patients benefiting from blockade of the proinflammatory cytokine, interleukin 6 (IL-6). Because Castleman disease (CD) is an atypical lymphoproliferative disorder that can involve a cytokine storm and often requires immunosuppressive therapies, including IL-6 inhibition, we sought to evaluate outcomes after COVID-19 and SARS-CoV-2 vaccination in patients with CD. We administered a survey in April 2021 to characterize experiences with COVID-19 and SARS-CoV-2 vaccination among 300 patients enrolled in ACCELERATE, a CD natural history registry. Among 128 respondents, the prevalence of SARS-CoV-2 infection (16/95, 17%), severe disease (1/16, 6%), vaccination rates (112/128, 88%), and vaccine adverse effects after dose 1 (62/112, 55%) were comparable with that of the general US population. Although there were 2 cases of CD flares occurring shortly after SARS-CoV-2 infection (n = 1) and vaccination (n = 1), >100 patients that were infected and/or vaccinated did not experience CD flares. Among patients with CD, the median antispike titer 6 months after the second vaccine dose was comparable to that of individuals with other immune-related diseases and healthy populations. Despite being on immunosuppressive therapies, patients with CD do not appear to be at increased risk of poor COVID-19 outcomes and can mount a humoral response to SARS-CoV-2 vaccination. This study was registered at www.ClinicalTrials.gov as #NCT02817997.

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卡斯特曼病患者出现轻微的 COVID-19 症状，并对接种 SARS-CoV-2 疫苗产生体液反应

摘要严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）感染引起的冠状病毒病 2019（COVID-19）导致免疫力低下、血液系统恶性肿瘤和接受免疫抑制治疗的患者发病率和死亡率增加。COVID-19 可引起细胞因子风暴，一些患者可从阻断促炎细胞因子白细胞介素 6（IL-6）中获益。由于卡斯特曼病（CD）是一种非典型淋巴细胞增生性疾病，可引起细胞因子风暴，通常需要采用免疫抑制疗法，包括抑制 IL-6，因此我们试图评估 CD 患者接种 COVID-19 和 SARS-CoV-2 疫苗后的疗效。我们于 2021 年 4 月进行了一项调查，以了解 CD 自然病史登记系统 ACCELERATE 的 300 名登记患者接种 COVID-19 和 SARS-CoV-2 疫苗后的经历。在128名受访者中，SARS-CoV-2感染率（16/95，17%）、重症率（1/16，6%）、疫苗接种率（112/128，88%）和第一剂后疫苗不良反应（62/112，55%）与美国普通人群相当。虽然有 2 例 CD 病例在感染 SARS-CoV-2 （1 例）和接种疫苗（1 例）后不久复发，但 100 例感染和/或接种疫苗的患者均未出现 CD 复发。在 CD 患者中，第二剂疫苗接种 6 个月后的抗梭形细胞滴度中位数与其他免疫相关疾病患者和健康人群相当。尽管CD患者正在接受免疫抑制疗法，但COVID-19不良后果的风险似乎并没有增加，而且他们还能对SARS-CoV-2疫苗接种产生体液反应。该研究已在 www.ClinicalTrials.gov 注册，注册号为 #NCT02817997。

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Blood Neoplasia

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