# The quantity and quality of B-cell immunity against SARS-CoV-2 in children with cancer and hematological diseases

## TL;DR

This study examines how children with cancer or blood disorders respond to SARS-CoV-2 infection or vaccination, finding that most can develop antibody responses, though immunosuppressed children may have weaker B-cell immunity.

## Contribution

The study provides new insights into SARS-CoV-2 B-cell immunity in immunosuppressed pediatric patients, highlighting age-related variability and risks in those with severe immunosuppression.

## Key findings

- Most pediatric oncological and hematological patients can mount a broad antibody response to SARS-CoV-2.
- Children on immunosuppression had significantly lower RBD IgG-secreting memory B-cell responses.
- Antigen-specific MBC responses were elevated in older children but blunted in immunosuppressed patients.

## Abstract

Our understanding of protective immunity after natural viral infections in children with cancer and hematological diseases is restricted. Current cancer treatments cause significant immunosuppression, affecting both innate and adaptive immunity which leads to reduced B-cell and antibody responses. The aim of this study was to characterize SARS-CoV-2 immune response in children with cancer or hematological disease.

A single-center study was conducted from June 2020 to June 2023, including 135 patients and 14 healthy siblings. Blood samples were obtained for serological analysis and cell-based assays. SARS-CoV-2 IgG and IgA responses were quantified using suspension multiplex immunoassay (SMIA) and enzyme-linked immunosorbent assay (IgG ELISA) while neutralizing antibody (nAb) responses were assessed by plaque reduction neutralization tests (PRNT). The memory B-cell (MBC) population was evaluated through flow cytometry and MBC responses through FluoroSpot, respectively.

In total, 78 patients seroconverted in response to SARS-Co-V-2 but neither immunosuppression nor cancer diagnosis significantly affected seroconversion. SARS-CoV-2 IgG and IgA levels correlated positively with increasing age, and IgA seroconversion was significantly associated with the presence of nAbs. Antigen-specific MBC responses against both spike and receptor-binding domain (RBD) were elevated in older children, while children on immunosuppression had significantly lower RBD IgG-secreting cells.

Our results show that most pediatric oncological and hematological patients can mount a broad antibody response upon SARS-CoV-2 natural infection or vaccination, although there is a variability in their responses influenced by increasing age. MBC responses in children with immunosuppression were blunted with fewer RBD IgG-secreting cells. Essentially, our findings underscore that young children with severe treatment-related immunosuppression are at risk for less effective B-cell responses upon viral infection.