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COSTEM 2021 | The optimal time of vaccination for allogeneic stem cell transplant patients

Rafael de la Cámara, MD, Hospital de la Princesa, Madrid, Spain, discusses the question of timing of vaccination in transplant patients, highlighting data from clinical studies. Dr Cámara explains that in the general population, studies have shown that patients who do not develop antibodies after receiving the vaccine still have a 50% protection rate against COVID-19. Thus, Dr Cámara emphasizes that studies which focus on investigating the optimal timing of vaccination to minimize the risk of disease, and not those that focus on maximizing the rate of immunological response, need to be conducted for transplant patients. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.

Transcript (edited for clarity)

The question of the time of vaccination is very important, of course, and we all agree that the best time will be that time that offers the best benefit for the patient. We know that later we administered any vaccine in the transplant, we obtain a better response to the vaccine if we measure with antibody response. But the thing is not when we are going to obtain this better immunological response...

The question of the time of vaccination is very important, of course, and we all agree that the best time will be that time that offers the best benefit for the patient. We know that later we administered any vaccine in the transplant, we obtain a better response to the vaccine if we measure with antibody response. But the thing is not when we are going to obtain this better immunological response. The question is, when we have to give the vaccine to the most benefit to the patient.

And we now know that based on the Moderna Phase III trial, that even the patients that don’t develop antibodies, they have a 50% protection against COVID. So, serology response is not equal to protection, even if you have a response or even if you have no antibody response. So, based on this, and also in other clinical evidence that shows that patients that had a previous COVID infection and disease, but that haven’t any antibody response to the virus, if they get infected again, they develop less disease.

So, depending on the result of the ongoing studies in transplant patient, of course, I will administer the vaccine, as early as we can. That is after the third month, we can expect responses in these patients. And if the epidemiology situation in the area where the patient is living is good, we can wait until the sixth month. So, I think that the question is not if early or late, we have to find the time that benefit more the patient in order to minimize the risk of COVID disease, not to maximize the rate of immunological response. So, these are apparently contradictory end points, but for the first, the protection for COVID, we need clinical study that show that the vaccination protect for. This is even if the patient has no antibody response. We have not that information yet for transplant patients. We have some of this information from the general population.

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