SARS-CoV-2 antibody formation in patients with chronic lymphoproliferative diseases

Patients with chronic lymphoproliferative diseases (CLLD) are at increased risk of developing severe COVID-19 due to the immune dysfunction underlying CLLD and the significant hematologic toxicity of systemic cytostatic therapy. The humoral immune response plays an important role in protection against severe COVID-19. The aim of our study was to determine the factors that negatively influence antibody formation to SARS-CoV-2 virus in patients with CLPD. The examined group included 59 patients with CLPD aged 33–86 years (median – 64 years), of whom 20 – females and 29 males. 36 patients received therapy using monoclonal antibodies (mAbs), chemotherapy – 20, without treatment – 3 subjects. Event that triggered the immune response: COVID-19 disease – 27; Sputnik V vaccination – 10; COVID-19 disease and Sputnik V vaccination – 22 cases. IgG class antibodies (Abs) to SARS-CoV-2 were determined by ELISA (Vector-Best, Russia). Criteria for assessing antibody levels (BAU/ml): 150 – low, 150 to 500 – protective, >500 – elevated level. Statistical analysis was performed using the Statistics 10 program, Fisher's two-sided exact test and logistic regression method. Multivariate analysis performed with age, sex, immunizing event, type of CLPD, and therapy for CLPD (chemotherapy, therapy with specific mAbs) established trends of negative effect on Abs formation to SARS-CoV-2 of daratumumab [OR 2.01; 95% CI 0.99-4.11; p=0.05] and patient age [OR 0.95; 95% CI 0.89-1.00; p=0.06]. When planning the timing of vaccination of CLPD patients treated with daratumumab, it is necessary to take into account the negative effect of the drug on the level of gamma-globulins and NK-cells and the period required to restore these indicators after discontinuation of daratumumab.