Robust T-Cell Responses in Anti-CD20-Treated Patients Following COVID-19 Vaccination: A Prospective Cohort Study

Clin Infect Dis. 2022 Aug 24;75(1):e1037-e1045. doi: 10.1093/cid/ciab954.


Background: Patients treated with anti-CD20 therapy are particularly at risk of developing severe coronavirus disease 2019 (COVID-19); however, little is known regarding COVID-19 vaccine effectiveness in this population.

Methods: This prospective observational cohort study assesses humoral and T-cell responses after vaccination with 2 doses of mRNA-based COVID-19 vaccines in patients treated with rituximab for rheumatic diseases or ocrelizumab for multiple sclerosis (n = 37), compared to immunocompetent individuals (n = 22).

Results: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies were detectable in only 69.4% of patients and at levels that were significantly lower compared to controls who all seroconverted. In contrast to antibodies, Spike (S)-specific CD4 T cells were equally detected in immunocompetent and anti-CD20 treated patients (85-90%) and mostly of a Th1 phenotype. Response rates of S-specific CD8 T cells were higher in ocrelizumab (96.2%) and rituximab-treated patients (81.8%) as compared to controls (66.7%). S-specific CD4 and CD8 T cells were polyfunctional but expressed more effector molecules in patients than in controls. During follow-up, 3 MS patients without SARS-CoV-2-specific antibody response had a mild breakthrough infection. One of them had no detectable S-specific T cells after vaccination.

Conclusions: Our study suggests that patients on anti-CD20 treatment are able to mount potent T-cell responses to mRNA COVID-19 vaccines, despite impaired humoral responses. This could play an important role in the reduction of complications of severe COVID-19.

Keywords: COVID-19 vaccination; T-cell response; anti-CD20; multiple sclerosis; rheumatoid arthritis.

Publication types

  • Observational Study

MeSH terms

  • Antibodies, Viral
  • COVID-19 Vaccines
  • COVID-19* / drug therapy
  • COVID-19* / prevention & control
  • Humans
  • Prospective Studies
  • RNA, Messenger
  • Rituximab
  • SARS-CoV-2
  • Vaccination
  • Viral Vaccines*


  • Antibodies, Viral
  • COVID-19 Vaccines
  • RNA, Messenger
  • Viral Vaccines
  • Rituximab