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Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines
Mehmet Emin Adin1, Edvin Isufi2, Jennifer Wu1
1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, .
Objective:
To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria.
Methods:
In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity.
Results:
Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL ( P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters).
Conclusion:
RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.
Insights
mRNA vaccines like Pfizer and Moderna showed higher rates of reactive axillary lymph nodes (RAL) compared to whole-virus vaccines. This nodal reactivity, assessed by PET-CT, was more prolonged with Moderna than Pfizer vaccines.
Area of Science:
- Oncology
- Immunology
- Radiology
Background:
- Reactive axillary lymph nodes (RAL) can be a side effect of vaccination.
- Differentiating vaccine-induced lymphadenopathy from malignancy is crucial in oncological patients.
- PET-CT imaging with Deauville criteria is used to assess lymph node activity.
Purpose of the Study:
- To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines.
- To evaluate the predictive value of clinical parameters for PET positivity in RAL.
Main Methods:
- A multi-institutional PET-CT study included 522 oncological patients who received various vaccines (Pfizer-BioNTech, Moderna, Sinovac, Janssen).
- Standardized Deauville scaling system was used to assess RAL.
- Univariate and multivariate analyses evaluated clinical parameters (ANC, platelets, age, sex, tumor type, vaccine-to-PET interval) for PET positivity.
Main Results:
- mRNA vaccines (Pfizer, Moderna) showed similar initial RAL incidence (44% within 10 days).
- Moderna recipients had significantly higher RAL incidence after 20 days (15% vs. 4% for Pfizer, P < 0.001), lasting up to 9 weeks.
- No RAL was observed with J&J or Sinovac vaccines. Younger age was associated with increased RAL likelihood.
Conclusions:
- Reactive axillary lymph nodes (RAL) were observed with mRNA vaccines but not with attenuated whole-virus vaccines.
- This finding aligns with the higher immunogenicity and protection offered by mRNA vaccines.
- Strict PET criteria are essential for assessing vaccine-related lymphadenopathy.
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