{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T09:15:00Z","timestamp":1762074900541,"version":"build-2065373602"},"reference-count":73,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Two-dose COVID-19 vaccination often results in poor humoral response rates in patients with hematologic malignancies (HMs); yet responses to COVID-19 booster vaccines and the risk of COVID-19 infection post-booster are mostly uncertain. Methods: We included 200 outpatients with HMs and predominantly lymphoid neoplasms (96%, 191\/200) in our academic center and reported on the humoral responses, which were assessed by measurement of anti-spike IgG antibodies in peripheral blood as early as 14 days after mRNA-based prime-boost vaccination, as well as factors hampering booster efficacy. Previous basic (double) immunization was applied according to the local recommendations with mRNA- and\/or vector-based vaccines. We also report on post-booster COVID-19 breakthrough infections that emerged in the Omicron era and the prophylaxis strategies that were applied to poor and non-responders to booster vaccines. Results: A total of 55% (110\/200) of the patients achieved seroconversion (i.e., anti-spike protein IgG antibody titer &gt; 100 AU\/mL assessed in median 48 days after prime-boost vaccination) after prime-boost vaccination. Multivariable analyses revealed age, lymphocytopenia, ongoing treatment and prior anti-CD20 B-cell depletion to be independent predictors for booster failure. With each month between anti-CD20-mediated B-cell depletion and booster vaccination, the probability of seroconversion increased by approximately 4% (p &lt; 0.001) and serum\u2013antibody titer (S-AbT) levels increased by 90 AU\/mL (p = 0.011). Notably, obinutuzumab treatment was associated with an 85% lower probability for seroconversion after prime-boost vaccination compared to rituximab (p = 0.002). Of poor or non-responders to prime-boost vaccination, 41% (47\/114) underwent a second booster and 73% (83\/114) underwent passive immunization. COVID-19 breakthrough infections were observed in 15% (29\/200) of patients after prime-boost vaccination with predominantly mild courses (93%). Next to seroconversion, passive immunization was associated with a significantly lower risk of COVID-19 breakthrough infections after booster, even in vaccine non-responders (all p &lt; 0.05). In a small proportion of analyzed patients with myeloid neoplasms (9\/200), the seroconversion rate was higher compared to those with lymphoid ones (78% vs. 54%, accordingly), while the incidence rate of COVID-19 breakthrough infections was similar (22% vs. 14%, respectively). Following the low frequency of myeloid neoplasms in this study, the results may not be automatically applied to a larger cohort. Conclusions: Patients with HMs are at a high risk of COVID-19 booster vaccine failure; yet COVID-19 breakthrough infections after prime-boost vaccination are predominantly mild. Booster failure can likely be overcome by passive immunization, thereby providing immune protection against COVID-19 and attenuating the severity of COVID-19 courses. Further sophistication of clinical algorithms for preventing post-vaccination COVID-19 breakthrough infections is urgently needed.<\/jats:p>","DOI":"10.3390\/cancers14225512","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T02:07:48Z","timestamp":1668046068000},"page":"5512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy of COVID-19 Booster Vaccines in Patients with Hematologic Malignancies: Experiences in a Real-World Scenario"],"prefix":"10.3390","volume":"14","author":[{"given":"Carolin","family":"Krekeler","sequence":"first","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea","family":"Reitnauer","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8771-947X","authenticated-orcid":false,"given":"Ulrike","family":"Bacher","sequence":"additional","affiliation":[{"name":"Central Hematology Laboratory, Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4655-6269","authenticated-orcid":false,"given":"Cyrus","family":"Khandanpour","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"},{"name":"Department for Hematology and Oncology, University Hospital Schleswig-Holstein, 23564 Luebeck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leander","family":"Steger","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6ran Ramin","family":"Boeckel","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 Muenster, Germany"},{"name":"Department of Medicine D for Nephrology and Rheumatology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Klosner","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2757-4755","authenticated-orcid":false,"given":"Phil-Robin","family":"Tepasse","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-5297","authenticated-orcid":false,"given":"Marcel","family":"Kemper","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc Tim","family":"Hennies","sequence":"additional","affiliation":[{"name":"Institute of Virology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rolf","family":"Mesters","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Stelljes","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Kerkhoff","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Schliemann","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan-Henrik","family":"Mikesch","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Hematology and Medical Oncology, University Medicine G\u00f6ttingen (UMG), 37077 Goettingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annalen","family":"Bleckmann","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0178-1729","authenticated-orcid":false,"given":"Evgenii","family":"Shumilov","sequence":"additional","affiliation":[{"name":"Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital M\u00fcnster, 48149 Muenster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1182\/blood.2021013445","article-title":"Humoral and Cellular Responses after COVID-19 Vaccination in Anti-CD20-Treated Lymphoma Patients","volume":"139","author":"Liebers","year":"2022","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3384","DOI":"10.1080\/10428194.2021.1966782","article-title":"COVID-19 among Patients with Hematological Malignancies: A National Israeli Retrospective Analysis with Special Emphasis on Treatment and Outcome","volume":"62","author":"Levy","year":"2021","journal-title":"Leuk. 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