Biological modifications of the immune response to COVID-19 vaccine in patients treated with rituximab and immune checkpoint inhibitors

Understanding how immune-modulating therapies affect mRNA vaccine responses is essential for optimizing immunization strategies in cancer and immunocompromised patients. In this work, we investigate the immune response to the third dose of COVID-19 mRNA vaccine in cancer-free individuals, patients with non-Hodgkin lymphoma treated with rituximab (RTX), and patients with solid tumors receiving immune checkpoint inhibitors (ICIs). By integrating blood RNA sequencing, SARS-CoV-2 serology, and interferon-γ release assessment, we chart the vaccine-induced immunity over a 6-month time frame. Our findings reveal that RTX-treated patients exhibit profound immune dysfunction, characterized by a blunted type I interferon response, upregulation of transcripts pertaining to regulatory T cells, and widespread impairment of humoral immunity. In contrast, ICI-treated patients have preserved vaccine-induced immunity, displaying adaptive B cell and T cell responses akin to those of cancer-free volunteers. These results provide critical insights into immunization strategies for immunocompromised populations and may inform future vaccination protocols.