B Cell Depletion and SARS-CoV-2 Vaccine Responses in Neuroimmunologic Patients

Ann Neurol. 2022 Mar;91(3):342-352. doi: 10.1002/ana.26309. Epub 2022 Feb 8.


Objective: The study was undertaken to assess the impact of B cell depletion on humoral and cellular immune responses to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccination in patients with various neuroimmunologic disorders on anti-CD20 therapy. This included an analysis of the T cell vaccine response to the SARS-CoV-2 Delta variant.

Methods: We investigated prospectively humoral and cellular responses to SARS-CoV-2 mRNA vaccination in 82 patients with neuroimmunologic disorders on anti-CD20 therapy and 82 age- and sex-matched healthy controls. For quantification of antibodies, the Elecsys anti-SARS-CoV-2 viral spike (S) immunoassay against the receptor-binding domain (RBD) was used. IFN-gamma enzyme-linked immunosorbent spot assays were performed to assess T cell responses against the SARS-CoV-2 Wuhan strain and the Delta variant.

Results: SARS-CoV-2-specific antibodies were found less frequently in patients (70% [57/82]) compared with controls (82/82 [100%], p < 0.001). In patients without detectable B cells (<1 B cell/mcl), seroconversion rates and antibody levels were lower compared to nondepleted (≥1 B cell/mcl) patients (p < 0.001). B cell levels ≥1 cell/mcl were sufficient to induce seroconversion in our cohort of anti-CD20 treated patients. In contrast to the antibody response, the T-cell response against the Wuhan strain and the Delta variant was more pronounced in frequency (p < 0.05) and magnitude (p < 0.01) in B-cell depleted compared to nondepleted patients.

Interpretation: Antibody responses to SARS-CoV-2 mRNA vaccinnation can be attained in patients on anti-CD20 therapy by the onset of B cell repopulation. In the absence of B cells, a strong T cell response is generated which may help to protect against severe coronavirus disease 2019 (COVID-19) in this high-risk population. ANN NEUROL 2022;91:342-352.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Autoimmune Diseases of the Nervous System / blood
  • Autoimmune Diseases of the Nervous System / epidemiology
  • Autoimmune Diseases of the Nervous System / immunology*
  • B-Lymphocytes / immunology*
  • B-Lymphocytes / metabolism
  • COVID-19 / epidemiology
  • COVID-19 / prevention & control
  • COVID-19 Vaccines / administration & dosage*
  • Cohort Studies
  • Female
  • Humans
  • Immunity, Cellular / immunology*
  • Immunity, Humoral / immunology*
  • Male
  • Middle Aged
  • Neuroimmunomodulation / immunology
  • Prospective Studies
  • SARS-CoV-2 / immunology*
  • SARS-CoV-2 / metabolism


  • COVID-19 Vaccines