Impaired booster-induced SARS-CoV-2 antibody responses in rituximab-treated B-cell lymphoma patients despite peripheral B-Cell Recovery Cover

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Impaired booster-induced SARS-CoV-2 antibody responses in rituximab-treated B-cell lymphoma patients despite peripheral B-Cell Recovery

Radiology and Oncology

Volume 60 (2026): Issue 1 (March 2026)

By: Tomaz Jurca, Lucka Boltezar, Miha Orazem, Kristina Fujs Komlos, Katka Pohar, Sara Jevnikar, Mario Poljak, Denis Mlakar Mastnak, Nada Rotovnik Kozjek, Bor Vratanar, Janja Ocvirk and Alojz Ihan

Open Access

|Mar 2026

Figures & Tables

The timeline of vaccinations and laboratory analyses. Time points of sample collection are indicated as follows: a0 – baseline measurement and first vaccination (second dose administered 21 days later); a1 – 14 days after the second vaccination; a2 – 3 months after the first vaccination; a3 – 6 months after the first vaccination (corresponding to b0 in cancer patients); b0 – before the third vaccination; b1 – 14 days after the third vaccination; b2 – 3 months after the third vaccination.

Relationship between time since last rituximab and lymphocyte B-cell count Each point represents a single patient’s measurement. Patients with B-cell counts of 0, 0–0.1, and > 0.1 × 109 cells/L are represented as red, orange, and blue dots, respectively. The solid line shows the fitted linear regression based solely on subjects who have stopped receiving rituximab (i.e., time > 0), and the shaded region indicates the 95% confidence interval for the fitted regression line.

Geometric mean anti-S antibody concentrations in three patient subgroups and healthy volunteers following primary and booster vaccinations Patient subgroups with B-cell counts of 0, 0–0.1, and > 0.1 × 109 cells/L, and healthy volunteers are shown in red, orange, blue, and green, respectively. The mean estimates and their 95% confidence intervals were calculated on the log-transformed scale due to the skewed distribution of the original data, then back-transformed for display. Confidence intervals for the B = 0 and 0 < B < 0.1 groups were omitted because of the limited sample size and the high concentration of zeros.

Demographic characteristics of the patient and volunteer groups

Characteristic	Overall N = 66	Patients N = 25	Volunteers N = 41	p-value¹
Sex: n (%)				0.039
male	17 (26%)	10 (40%)	7 (17%)
female	49 (74%)	15 (60%)	34 (83%)
Age: mean (Q1, Q3)	51 (39, 62)	65 (56, 68)	42 (36, 53)	< 0.001

Welch’s t-test results for log-transformed anti-S antibody concentrations (U/mL), comparing the B > 0_1 × 109 cells/L group with the volunteer group at 14 days post-primary and post-booster vaccination

Measurement	Group	Geometric mean (SD)	Welch’s t-test
a1	control	1 510 (650)	t (df = 6.8) = 0.05
a1	B ≥ 0.1	1 482 (1 079)	p = 0.963
b1	control	20 442 (3 572)	t (df = 3.1) = 3.62
b1	B ≥ 0.1	3 617 (2 510)	p = 0.035

Linear regression model results of the relationship between B-cell count and time post last rituximab

Term	Estimate	SE	t	df	p	CI lower	CI upper
(Intercept)	-0.03	0.08	-0.37	9	0.718	-0.20	0.14
Years post rituximab	0.10	0.03	3.32	9	0.009	0.03	0.18

DOI: https://doi.org/10.2478/raon-2026-0014 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 76 - 85

Submitted on: Feb 16, 2026

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Accepted on: Feb 24, 2026

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Published on: Mar 24, 2026

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

COVID-19 vaccines,

humoral immunity,

Related subjects:

Clinical medicine,

Internal medicine,

Haematology, oncology,

© 2026 Tomaz Jurca, Lucka Boltezar, Miha Orazem, Kristina Fujs Komlos, Katka Pohar, Sara Jevnikar, Mario Poljak, Denis Mlakar Mastnak, Nada Rotovnik Kozjek, Bor Vratanar, Janja Ocvirk, Alojz Ihan, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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