Eur J Nucl Med Mol Imaging：血液系统恶性肿瘤患者Covid-19疫苗相关高代谢淋巴结病与体液免疫有关

2021-05-20 MedSci原创 MedSci原创

血液恶性肿瘤患者[18F]FDG PET-CT所示的VAHL可能反映了BNT162b2疫苗诱导的GC B细胞增殖和有效的体液反应。

关于抗SARS-CoV-2疫苗引起的免疫反应的数据正在不同的患者队列中积累。Polack等人研究了BNT162b2 mRNA Covid-19疫苗在健康成人或慢性稳定疾病患者中的安全性和有效性，不包括接受免疫抑制治疗或诊断为免疫损害疾病的患者。后来观察到，在免疫功能低下的患者中，Covid-19 mRNA疫苗诱导的免疫应答减少。Boyarsky等人在一项对346名实体器官移植受者的研究中发现了较差的体液反应。Monin-Aldama等研究表明，在实体癌患者中，BNT162b2接种后免疫效果显著较低，在血液恶性肿瘤患者中更低。

虽然过去VAHL是在接种其它疫苗之后才被报道的，接种BNT162b2后经常在[¹⁸F]FDG PET-CT上观察到疫苗相关的高代谢性淋巴结病(VAHL)。但目前还没有关于VAHL与免疫原性之间的相关性的资料。最近的数据表明，mRNA疫苗在引流淋巴结中引起了显著的B细胞生发中心(GC)反应。因此， Einat Even-Sapir等在European Journal of Nuclear Medicine and Molecular Imaging杂志撰文对此进行了研究。

这项研究针对血液系统恶性肿瘤患者。目的是通过疫苗接种后血清学检测来探讨VAHL与体液免疫之间的相关性，并通过比较最近接受B细胞耗尽治疗的淋巴瘤患者与未接受B细胞耗尽治疗的淋巴瘤患者之间VAHL的发生率。

137例接种疫苗后行[¹⁸F]FDG PET-CT检查的血液系统恶性肿瘤患者纳入All-PET组，86例患者在成像前接受两种疫苗剂量(PET-2组)。记录患者VAHL状态及影像学分级。102例淋巴瘤患者中，34例(33.3%)在接种疫苗前一年接受了含抗CD20抗体治疗。54名患者在接种第二剂疫苗后2-3周进行了血清检测，并记录其抗刺突滴度和分级。

骨髓瘤和淋巴瘤患者中疫苗相关的高代谢淋巴结病发生率。下面一行显示最近使用含抗CD20抗体治疗的淋巴瘤患者VAHL率显著降低。All-PET 组是指所有使用BNT162b2后接受[¹⁸F]FDG PET-CT检查的血液系统恶性肿瘤患者。PET-1组包括仅在成像前接受第一剂疫苗的患者，而PET-2组还包括接受加强剂的患者。a:两组间无VAHL率差异有统计学意义;b:两组间1-2级VAHL率差异有统计学意义;c:两组间3-4级VAHL率差异有统计学意义;tx,治疗。

上排:血清学组中疫苗相关的高代谢淋巴结病发生率。血清学阴性患者中VAHL的发生率低。下排:在影像学上注意到VAHL患者的血清学阳性率显著升高。a:血清学阴性组与低滴度组之间无VAHL率有统计学差异;b:血清学阴性组与高滴度组之间无VAHL率有统计学差异;c:低滴度组与高滴度组之间无VAHL率有统计学差异;d:血清学阴性组与高滴度组1-2级VAHL率有统计学差异;e: 1-2级VAHL率在低滴度组和高滴度组之间有统计学差异。

基于血清学和基于 VAHL级别之间的相关性

血液系统恶性肿瘤患者VAHL的总发生率为31.4%。与所有其他淋巴瘤患者相比，34例接种前一年接受含抗CD20抗体治疗的淋巴瘤患者的VAHL的发生率显著降低(All-PET组， 41.2% VS 8.8%，Pv<0.01)。血清学阴性的患者中VAHL发病率为10%，在抗刺突抗体滴度低的患者中为31.3%，在抗刺突抗体滴度高的患者中为72.2%。在all-PET和PET-2患者中VAHL的阳性预测值分别为90%和93.3%。在All-PET组患者中，VAHL与血清秩呈正相关(r_s = 0.530, Pv <0.001)，而PET-2组显示了更强的正相关(r_s= 0.642, Pv< 0.001)。

[¹⁸F]FDG PET-CT检测到的血液系统恶性肿瘤患者VAHL与抗体介导的Covid-19疫苗免疫应答呈正相关，而在接种疫苗前的一年接受含抗CD20抗体治疗的患者中几乎没有观察到。血液恶性肿瘤患者[¹⁸F]FDG PET-CT所示的VAHL可能反映了BNT162b2疫苗诱导的GC B细胞增殖和有效的体液反应。

原文出处

Cohen, D., Hazut Krauthammer, S., Cohen, Y.C. et al. Correlation between BNT162b2 mRNA Covid-19 vaccine-associated hypermetabolic lymphadenopathy and humoral immunity in patients with hematologic malignancy. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05389-x

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2021-09-29 旅苦化文_208

#血液系统#

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有意义

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2021-05-22 sodoo

#淋巴结#

74 0
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2021-05-22 limedical1974

#血液系统恶性肿瘤#

111 0
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2021-05-22 lanyan20020087

#肿瘤患者#

76 0
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2021-05-22 ms3994565386320060

#Med#

59 0
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2021-05-20 1e1e4967m20(暂无匿称)

学习了

99 0
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2021-05-20 ms5000000023660064

热点

92 0
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2021-05-20 jyzxjiangqin

好文章！

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