Shields, Adrian M.Venkatachalam, SrinivasanShafeek, SalimPaneesha, ShankaraFord, MarkSheeran, ThomasKelly, MelanieQureshi, ImanSalhan, BeenaKarim, FarheenDe Silva, NeelakshiStones, JacquelineLee, SophieKhawaja, JahanzebKumar Kaudlay, PraveenWhitmill, RichardNabi Kakepoto, GhulamParry, Helen M.Moss, PaulFaustini, SianRichter, Alex G.Drayson, MarkBasu, Supratik2021-11-112021-11-112021-11-30Shields, A.M., Venkatachalam, S., Shafeek, S. et al. (2021) SARS-CoV-2 vaccine responses following CD20-depletion treatment in patients with haematological and rheumatological disease: a West Midlands Research Consortium study. Clinical and Experimental Immunology, 207(1), pp. 3–10, https://doi.org/10.1093/cei/uxab0180009-910410.1093/cei/uxab018http://hdl.handle.net/2436/624441© 2021 The Authors. Published by Oxford Academic. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1093/cei/uxab018B cell depleting agents are amongst the most commonly used drugs to treat haemato-oncological and autoimmune diseases. They rapidly induce a state of peripheral B cell aplasia with the potential to interfere with nascent vaccine responses, particularly to novel antigens. We have examined the relationship between B cell reconstitution and SARS-CoV-2 vaccine responses in two cohorts of patients previously exposed to B cell depleting agents: a cohort of patients treated for haematological B cell malignancy and another treated for rheumatological disease. B cell depletion severely impairs vaccine responsiveness in the first 6 months after administration: SARS-CoV-2 antibody seroprevalence was 42.2% and 33.3% in the haemato-oncological patients and rheumatology patients respectively and 22.7% in patients vaccinated while actively receiving anti-lymphoma chemotherapy. After the first 6 months, vaccine responsiveness significantly improved during early B cell reconstitution, however, the kinetics of reconstitution was significantly faster in haemato-oncology patients. The AstraZeneca ChAdOx1 nCoV-19 vaccine and the Pfizer BioNTech 162b vaccine induced equivalent vaccine responses, however shorter intervals between vaccine doses (<1m) improved the magnitude of the antibody response in haeamto-oncology patients. In a subgroup of haemato-oncology patients, with historic exposure to B cell depleting agents (>36m previously) vaccine non-responsiveness was independent of peripheral B cell reconstitution. The findings have important implications for primary vaccination and booster vaccination strategies in individuals clinically vulnerable to SARS-CoV-2.application/pdfenSARS-CoV-2vaccinationrituximabCD20 depletionhaematological malignancyrheumatoid arthritisJournal articleClinical and Experimental Immunology2021-11-10