ABSTRACT
Immunocompromised individuals were not included in formal trials of SARS-CoV-2 mRNA vaccines. Subsequent studies in patients with hematologic malignancies and solid organ transplantation recipients suggest inferior responses to vaccination. We determined antibody responses to a single dose of vaccines in one of the most vulnerable patient groups, allogeneic hematopoietic cell transplantation (allo-HCT) recipients. Pfizer-BioNTech (PB) or AstraZeneca (AZ) SARS-CoV-2 vaccines were administered at least 3 months post-transplantation to 55 adult allo-HCT recipients. We found that older age and concurrent use of immunosuppressive medications were significantly associated with lack of antibody response to vaccination. Only 21% of patients on systemic immunosuppression mounted a response, compared with 58% of patients not on immunosuppression (P = .006). We also show that responses to the AZ vaccine may be superior to responses to the PB vaccine in this cohort. These findings highlight the need for novel immunogenic vaccine formulations and schedules in these highest-risk patients, as well as continued public healthy safety measures to protect the most vulnerable members of our society.
Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Aged , Antibodies, Viral , COVID-19 Vaccines , Humans , Immunogenicity, Vaccine , SARS-CoV-2 , VaccinationABSTRACT
OBJECTIVE: A pilot study to compare the use of a combination dialysate (7.5% icodextrin/1.36% glucose) versus icodextrin 7.5% alone for the long dwell in patients on peritoneal dialysis (PD). DESIGN: A 4-week, prospective, randomized crossover study. SETTING: A large regional renal unit providing treatment for a population of 1.7 million. PATIENTS: Five patients on continuous ambulatory PD (CAPD) and 3 patients on automated PD. MAIN OUTCOME MEASUREMENTS: Long-dwell and 24-hour ultrafiltration volumes, body weight, 24-hour ambulatory blood pressure, and antihypertensive/diuretic tablet count. RESULTS: The use of the combination dialysate resulted in an increase in the median (interquartile range) long-dwell ultrafiltration, from 750 (650-828) mL to 1000 (889-1100) mL (p < 0.001), and 24-hour ultrafiltration, from 739 (400-1623) mL to 956 (700-1750) mL (p < 0.001). Weight, blood pressure, and tablet count remained unchanged. CONCLUSIONS: The use of the novel combination dialysate resulted in a 33% increase in long-dwell ultrafiltration and a 29% increase in 24-hour ultrafiltration.