The Potential Role of Immune Alteration in the Cancer–COVID19 Equation—A Prospective Longitudinal Study

Goshen-Lago, Tal; Szwarcwort-Cohen, Moran; Benguigui, Madeleine; Almog, Ronit; Turgeman, Ilit; Zaltzman, Nelly; Halberthal, Michael; Shaked, Yuval; Ben-Aharon, Irit

SIMPLE SUMMARY: Despite lack of concrete evidence, cancer patients were considered at the onset of the COVID19 pandemic as high-risk population for COVID19 infection. However, current evidence is inconclusive and the potential role of cancer or anti-neoplastic treatments in COVID19 course remains to be elucidated. Our results may indicate that due to differential immune cell profile of cancer patients who are treated with immunomodulatory agents the host response to the SARS-COV2 may lessen symptom severity. Delineating COVID-19 infection trends in asymptomatic healthcare workers as well as a cohort of cancer patients who are on active anti-cancer treatment will lend credence to tailor future healthcare policy in the next phases of the pandemic. ABSTRACT: Background: The risk of cancer patients to develop COVID19 infection is unclear. We aimed to prospectively study cancer patients and oncology healthcare workers for COVID19 serology. In IgG+ cases, immune profile was determined to portray the pattern of immune response to SARS-CoV2. Methods: Cancer patients on active treatment and healthcare workers were enrolled. During the study period (3/2020–6/2020), demographic data and blood were collected at three time points. Expression of IgG, IgM, and IgA were assessed. In SARS-CoV-2 IgG+ cases and matched negative cases, we performed mass cytometry time of flight (CyTOF) analysis on the basis of the expression of surface markers. Results: The study included 164 cancer patients on active intravenous treatment and 107 healthcare workers at the cancer center. No symptomatic cases were reported during the study period. Serology analysis revealed four IgG+ patients (2.4%) and two IgG+ healthcare workers (1.9%)—all were asymptomatic. CyTOF analysis demonstrated substantial reduction in myeloid cells in healthcare workers who were SARS-CoV-2 IgG+ compared to those who were SARS-CoV-2 IgG-, whereas in cancer patients, the reduction was relatively milder (≈50% reduction in SARS-CoV-2 IgG+ cancer patients compared with ≈90% reduction in SARS-CoV-2 IgG+ workers). Conclusion: Our results indicate a similar rate of asymptomatic COVID19 infection in cancer patients and healthcare workers in a longitudinal study throughout the pandemic time. Due to differential immune cell profiles of cancer patients who are treated with immunomodulatory agents, the host response to the SARS-COV2 may play a role in COVID19 course and representation. The immunological perspective of cancer treatments on the risk for COVID19 infection should be further explored.