Juárez-Salcedo LM1*, Feijóo Monroy S1, García-Herce C1, Alonso A1, Aguado B1, Ortiz J1, Figuera A1, de la Cámara JR1*.
1 Malignant Hematology Department, La Princesa University Hospital, Madrid, Spain.
* Both author equally contributed to the article.
Published: March 1, 2023
Received: January 13, 2023
Accepted: February 15, 2023
Mediterr J Hematol Infect Dis 2023, 15(1): e2023014 DOI 10.4084/MJHID.2023.014
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To the editor
s, caused high mortality in patients with some degree of
immunosuppression, like those that receive a hematopoietic progenitor
transplant. Since December 2020, several vaccines
have been developed having been key in decreasing complications and
mortality in this group of patients.[2,3] Different
articles have described the presence of thrombopenia related to the
administration of vaccines, however, data on the occurrence of
neutropenia as a side effect after administration are few.[4,5] We present several cases of neutropenia (defined as absolute neutrophil count (ANC) less than 2,000/mm3), after vaccination in hematopoietic progenitor transplant (HPT) recipients performed in our center during 2021.
conducted a retrospective study of adult patients undergoing HSCT
(allogeneic and autologous) during the year 2021 at the Hospital
Universitario de la Princesa and who received at least one dose of the
SARS-CoV2 vaccine. According to our service protocol, patients received
vaccination in the third-month post hematologic transplantation. An
analysis was made of the main demographic characteristics of the
transplanted patients, as well as the type of transplant and its
indication. Regarding vaccination data, the type of vaccine received,
the time elapsed since HSCT to vaccination, and the time of development
and degree of neutropenia were included. Early vaccination was defined
as vaccination before 100 days post-transplant.
who underwent autologous (n=16) or allogeneic (n=26) HSCT were
analyzed. 22% presented an episode of neutropenia after vaccination for
SARS-CoV2. We analyzed the group of patients who presented neutropenia
compared with the rest of the patients (Table 1).
The median age of both groups was similar (55 vs 53 years). In both
groups, the most commonly used vaccine was mRNA-1273 (Moderna),
followed by BNT162b2 (Pfizer). In our work we reviewed the
post-vaccination serology of all post-HPT patients, a total of 35.7% of
them presented positive serologies. Of the group that developed
neutropenia, 7 patients had positive serology and 2 had negative
serology. Of the 7 who presented positive serology, 6 were vaccinated
early (before 100 days) post-HPT. The median number of days between
HSCT and vaccination was similar between both groups (95 days vs. 103
days), with a higher percentage of neutropenia (78%) in the early
vaccinated population (before 100 days post-HSCT).
- Table 1. Baseline characteristics of patients included in analysis.
highest percentage of cases of neutropenia developed among patients
undergoing allogeneic HSCT, particularly in those with HLA-identical
donors. Among the group that presented neutropenia, the median number
of days between vaccination and the appearance of neutropenia was 11
days, with a median duration of 6 days. Most patients presented grade
3-4 neutropenia. 9 patients (56%) received treatment with
granulocyte-colony stimulating factor (G-CSF), with early recovery of
neutrophil numbers. Of the total of patients who developed
post-vaccination neutropenia, 3 patients were receiving low-dose
corticosteroids for the treatment of mild GVHD. None of the cases that
developed neutropenia had CMV infection.
In our series of
patients, early vaccination (administration before 100 days post-HSCT)
seems to be related to the appearance of neutropenia in a proportion of
cases, although of short duration. The percentage of patients with
neutropenia represented about 21% of the cases, of which 78% were grade
Neutropenia after SARS-CoV-2 vaccination in HSCT has been
reported in a few previous studies. Ali et al (2021), published the
results of a study of 113 allogeneic hematopoietic progenitor
transplant recipients, 13.3% of the total cases presented neutropenia
after vaccination. Similarly, the study published
by Ram et al in 2021 in which they included 80 patients, described that
12% of patients developed some cytopenia after the administration of
the first dose and 10% developed cytopenia after the second dose.
Of the total number of patients, 4 (5%) developed neutropenia, 1 of
grade 3-4. None of the studies reported whether cytopenias were related
to early administration of the vaccines.
cytopenias were also reported in healthy individuals, and are thought
to be related to the presence of preformed antibodies against certain
vaccine components or to altered hematologic cell production as part of
the systemic inflammatory response following vaccination. The latter
explanation seems the most consistent, given that most of the patients
presented a spontaneous recovery.[4,5] As early
post-HSCT vaccination (≤3 months) seems to be associated with a poor
response, and it might be complicated by transient although severe
neutropenia, it seems reasonable to postpone SARS-CoV-2 to later times
would like to thank the patients and families who participated in the
trials, and the colleagues who helped provide clinical care and
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