Monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL) are clonal B-cell disorders associated with an increased risk of infections and impaired vaccination responses. We investigated the immunogenicity of recombinant zoster vaccine (RZV) in these patients. Individuals with MBL/untreated CLL and Bruton tyrosine kinase inhibitor (BTKi)-treated CLL patients were given two doses of RZV separated by 2 months. Responses assessed at 3 and 12 months from the first dose of RZV by an anti-glycoprotein E ELISA antibody assay and by dual-color Interferon-γ and Interleukin-2FLUOROSPOT assays were compared to historic controls matched by age and sex. About 62 patients (37 MBL/untreated CLL and 25 BTKi-treated CLL) were enrolled with a median age of 68 years at vaccination. An antibody response at 3 months was seen in 45% of participants, which was significantly lower compared to historic controls (63%, p = .03). The antibody response did not significantly differ between MBL/untreated CLL and BTKi-treated CLL (51% vs. 36%, respectively, p = .23). The CD4+ T-cell response to vaccination was significantly lower in study participants compared to controls (54% vs. 96%, p < .001), mainly due to lower responses among BTKi-treated patients compared to untreated MBL/CLL (32% vs. 73%, p = .008). Overall, only 29% of participants achieved combined antibody and cellular responses to RZV. Among participants with response assessment at 12 months (n = 47), 24% had antibody titers below the response threshold. Hypogammaglobulinemia and BTKi therapy were associated with reduced T-cell responses in a univariate analysis. Strategies to improve vaccine response to RZV among MBL/CLL patients are needed.

中文翻译：

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慢性淋巴细胞白血病和单克隆 B 细胞淋巴细胞增多症患者对重组带状疱疹疫苗的体液和细胞免疫反应

单克隆 B 细胞淋巴细胞增多症 (MBL) 和慢性淋巴细胞白血病 (CLL) 是与感染风险增加和疫苗接种反应受损相关的克隆性 B 细胞疾病。我们研究了重组带状疱疹疫苗 (RZV) 在这些患者中的免疫原性。MBL/未治疗的 CLL 患者和接受布鲁顿酪氨酸激酶抑制剂 (BTKi) 治疗的 CLL 患者被给予两剂 RZV，间隔 2 个月。将通过抗糖蛋白 E 酶联免疫吸附试验抗体测定法和双色干扰素-γ 和白细胞介素-2FLUOROSPOT 测定法在首次接种 RZV 后 3 个月和 12 个月评估的反应与按年龄和性别匹配的历史对照进行比较。大约 62 名患者（37 名 MBL/未治疗的 CLL 和 25 名 BTKi 治疗的 CLL）在接种疫苗时的中位年龄为 68 岁。45% 的参与者在 3 个月时出现抗体反应，p  = .03）。MBL/未治疗的 CLL 和 BTKi 治疗的 CLL 之间的抗体反应没有显着差异（分别为 51% 和 36%，p  = .23）。与对照组相比，研究参与者对疫苗接种的 CD4+ T 细胞反应明显较低（54% 对 96%，p  < .001），这主要是因为与未治疗的 MBL/CLL (32%) 相比，接受 BTKi 治疗的患者的反应较低对比 73%，p  = .008）。总体而言，只有 29% 的参与者实现了对 RZV 的抗体和细胞联合反应。在 12 个月时进行反应评估的参与者中（n = 47), 24% 的抗体滴度低于反应阈值。在单变量分析中，低丙种球蛋白血症和 BTKi 治疗与 T 细胞反应降低相关。需要提高 MBL/CLL 患者对 RZV 疫苗反应的策略。