报道称，血液恶性肿瘤患者的新型冠状病毒肺炎（COVID-19）病情较重，并对疫苗反应性较低。本前瞻性研究的目的是评估台湾血液恶性肿瘤患者对COVID-19加强疫苗的血清反应，并确定有效中和免疫的潜在预测标志物。该研究纳入了68例血液恶性肿瘤患者和68例与之年龄和性别匹配的健康对照受试者，他们在2022年1月1日至2022年10月31日期间接种了三剂严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗。使用Abbott检测方法测量SARS-CoV-2免疫球蛋白G（IgG）刺突抗体水平。有效的中和能力定义为抗刺突抗体水平≥4160 AU/mL。在68例血液恶性肿瘤患者中，89.7%在接种加强剂后实现血清转换。7例正在积极治疗淋巴瘤的患者保持血清阴性，并在不同类型血液恶性肿瘤患者中具有最低的体液应答。尽管患者和健康个体之间的抗体滴度相当，但在血液恶性肿瘤患者中，有效中和率（66.2% vs. 86.8%，p = 0.005）显著降低。多变量分析显示，6个月内未接受B细胞靶向药物治疗（比值比为15.2；95%可信区间为2.7-84.2；p = 0.002）和免疫球蛋白水平较高（比值比为4.4；95%可信区间为1.3-14.7；p = 0.017）是有效中和的独立预测因子。综上所述，大多数血液恶性肿瘤患者在接种加强剂疫苗后实现血清转换。正在进行B细胞耗竭和低免疫球蛋白血症治疗的患者被发现具有不良预测标志物，不能有效中和。

Patients with hematologic malignancies are reported to have a more severe course of coronavirus disease 2019 (COVID-19) and be less responsive to vaccination. In this prospective study, we aimed to evaluate the serological responses to booster COVID-19 vaccines of Taiwanese patients with hematologic malignancies and identify potential predictive markers for effective neutralizing immunity. This study enrolled 68 patients with hematologic malignancies and 68 age- and gender-matched healthy control subjects who received three doses of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 1 January 2022 to 31 October 2022. The SARS-CoV-2 immunoglobulin G (IgG) spike antibody level was measured with the Abbott assay. The effective neutralization capacity was defined as an anti-spike IgG level of ≥4160 AU/mL. Among the 68 patients with hematologic malignancies, 89.7% achieved seroconversion after booster doses. Seven patients with actively treated lymphoma remained seronegative and had the lowest humoral responses among patients with different types of hematologic malignancies. Despite comparable antibody titers between patients and healthy individuals, rates of effective neutralization (66.2% vs. 86.8%, respectively; p = 0.005) were significantly reduced in patients with hematologic malignancies. In a multivariate analysis, the independent predictors for effective neutralization were a lack of B-cell-targeted agents within six months of vaccination (odds ratio, 15.2; 95% confidence interval, 2.7-84.2; p = 0.002) and higher immunoglobulin levels (odds ratio, 4.4; 95% confidence interval, 1.3-14.7; p = 0.017). In conclusion, the majority of patients with hematologic malignancies achieved seroconversion after booster vaccination. Patients with ongoing B-cell depletion and hypogammaglobinemia were identified as having negative predictive markers for effective neutralization.