Regular Humoral and Cellular Immune Responses in Individuals with Chronic Myeloid Leukemia Who Received a Full Vaccination Schedule against COVID-19

SIMPLE SUMMARY: Individuals with chronic myeloid leukemia (CML) are different from other individuals with oncohematological disease (OHD) because they receive treatment with drugs that may modulate the activity of cells from the immune system, causing an increase in their activity against the cancerous cells. This activity may also be effective against cells infected with virus. Although people with OHD usually have a reduced response to viral infections, individuals with CML present low risk of infection. Therefore, we hypothesized that people with CML may develop a better response after vaccination against COVID-19 than other individuals with OHD. We confirmed that there was no difference between people with CML and healthy donors in the formation of antibodies against SARS-CoV-2 with capacity to neutralize the virus after receiving vaccination. Similar results were also observed between both groups in the cellular immunity. In conclusion, individuals with CML developed immunity that was comparable to healthy donors after COVID-19 vaccination, although it was better in people with CML who was still on treatment against their cancer disease than in those who had discontinued treatment due to great improvement in the CML. And although the vaccination did not impede completely infections with SARS-CoV-2 in individuals with CML, it prevented the development of severe or critical illness. ABSTRACT: Individuals with chronic myeloid leukemia (CML) constitute a unique group within individuals with oncohematological disease (OHD). They receive treatment with tyrosine kinase inhibitors (TKIs) that present immunomodulatory properties, and they may eventually be candidates for treatment discontinuation under certain conditions despite the chronic nature of the disease. In addition, these individuals present a lower risk of infection than other immunocompromised patients. For this study, we recruited a cohort of 29 individuals with CML in deep molecular response who were on treatment with TKIs (n = 23) or were on treatment-free remission (TFR) (n = 6), and compared both humoral and cellular immune responses with 20 healthy donors after receiving the complete vaccination schedule against SARS-CoV-2. All participants were followed up for 17 months to record the development of COVID-19 due to breakthrough infections. All CML individuals developed an increased humoral response, with similar seroconversion rates and neutralizing titers to healthy donors, despite the presence of high levels of immature B cells. On the whole, the cellular immune response was also comparable to that of healthy donors, although the antibody dependent cytotoxic activity (ADCC) was significantly reduced. Similar rates of mild breakthrough infections were observed between groups, although the proportion was higher in the CML individuals on TFR, most likely due to the immunomodulatory effect of these drugs. In conclusion, as with the healthy donors, the vaccination did not impede breakthrough infections completely in individuals with CML, although it prevented the development of severe or critical illness in this special population of individuals with OHD.