Humoral and cellular immune responses to BNT162B2 COVID-19 vaccination in children with cancer.

Abstract

Background: Children and adolescents undergoing cancer treatment are significantly immunocompromised and at increased risk of severe outcomes from COVID-19; including intensive care admission and death. Vaccination against SARS-CoV-2 is recommended in this group, however data regarding outcomes of vaccination are limited. <div> </div> <div> Methods: This is a prospective study of children and adolescents with haematological or solid cancers, aged 5-19 years receiving two or three doses of BNT162b2 SARS-CoV-2 vaccination. Peripheral blood was taken at baseline, post dose one, then one and three months after each subsequent dose. Vaccine response was measured by T-cell interferon- gamma production (IFN-gamma, positive >=10pg/mL), neutralising antibody titre (NAb, positive >=1:20) and binding antibody response. The primary outcome was the proportion of patients with neutralising antibody response after two vaccine doses. Patient reported outcomes (adverse events and quality of life) and safety outcomes were collected. </div> <div> </div> <div> Outcomes: Of the 113 patients enrolled, 96% were on current or had prior cytotoxic chemotherapy, most were on current or recent therapy with 16% having completed treatment more than six months prior to vaccination. Positive NAb response was seen in 52/79 (66%) with samples available after two doses, and 33/41 (80%) with samples available after 3 doses. IFN-gamma response was noted in 44/64 (59%) after 2 doses, and 25/34 (74%) after three doses. Adverse events were manageable, with fever reported by 12% after doses one and two, and 15% after dose three. No adverse event delayed cancer treatment. </div> <div> </div> <div> Interpretation: The majority of children with cancer respond to BNT162b2 COVID-19 vaccination despite intensive anti-cancer treatment, and vaccination should not be deferred until completion of chemotherapy. These data may have implications for other childhood vaccinations during cancer treatment. <div> </div> <div> Funding: This research was funded by Cancer Australia- Australian Government, The Victorian Cancer Agency, and Monash Health. </div> <div> </div> <div> Declaration of Interest: Author WR received laboratory kits from Abbott. Author SS commenced work on this study whilst employed at Queensland Institute of Medical Research Berghofer, but during manuscript preparation has commenced work at Sanofi ANZ. Author CRM has received research funding to her institution from Sanofi, book royalties from New South Press, honoraria from Sanofi, Janssen, Moderna, Seqirus and Pfizer (paid to institution), has a patent pending for EPIWATCH, participates in a Data Safety Monitoring Board for The George Institute (the PANDA trial) and has provided consulting to Bavarian Nordic, Sanofi and Seqirus (payment to institution). The remaining authors declare that they have no conflict of interest. </div> <div> </div> <div> Ethical Approval: The study was approved by the central site Human Research and Ethics Committee (Monash Health, Victoria, Australia) with institutional review board approval at satellite sites. </div> </div> Copyright © 2024, The Authors. All rights reserved.