"Abstract
B-cell lymphomas are neoplastic diseases occasionally associated with chronic inflammation. mRNA vaccines for coronavirus disease 2019 (COVID-19) induce inflammatory responses, which often lead to fever and lymphadenopathies indistinguishable from lymphomas. Although both lymphadenopathies and lymphomas can be influential, the correlation between them is unclear. Herein, we present the first case of marginal zone B-cell lymphoma [MZL] following mRNA COVID-19 vaccination...
Introduction
During the coronavirus disease 2019 (COVID-19) pandemic, the mRNA COVID-19 vaccines, BNT162b2 and mRNA-1273, were administered worldwide. The clinical trials of the mRNA COVID-19 vaccines reported them as safe for administration, and their relationship with malignant diseases was rare...
In the abovementioned clinical trials, the incidence of lymphadenopathy after the administration of the BNT162b2 vaccine was 0.3%, while the incidence of lymphadenopathy after the administration of the mRNA-1273 vaccine was 6.1–11.6%...
Discussion
... In our case, the same mechanism by which T-cell lymphomas are induced by the COVID-19 vaccine could be considered for the pathogenesis of MZL. mRNA COVID-19 vaccines are reported to induce T follicular helper cells with a Th1 functional profile, which is associated with selective generation of neutralizing antibodies, and stimulate germinal center B-cells, long-lived plasma cells, and memory B-cells. Therefore, these vaccines induce a stronger germinal center reaction than recombinant protein vaccines. However, the continuous stimulation of T- and B-cells by mRNA COVID-19 vaccines can trigger aberrant inflammatory responses, leading to lymphoma or accelerating its progression...
This is the first report of a malignant lymphoma of B-cell lineage that developed after COVID-19 vaccination. Lymphadenopathy induced by mRNA COVID-19 vaccination is not rare; therefore, clinicians should be aware of the atypical features of lymphadenopathy to prevent delayed diagnosis during monitoring of the signs and symptoms listed above. We suggest that malignant lymphoma may be differentiated from benign lymphadenopathy if there are >11 enlarged lymph nodes, lymph nodes with short-axis diameters >15 mm, and lymphadenopathy contralateral to the vaccination site and/or in a region other than the axial and supraclavicular regions. Attention should be paid to the development of lymphoma within 4–6 weeks after COVID-19 vaccination. Moreover, care should be taken to avoid overlooking relatively benign, slowly progressing lymphomas, such as MZLs, after 4–6 weeks of follow-up."
© 2022 Sekizawa, Hashimoto, Kobayashi, Kozono, Kobayashi, Kawamura, Kimata, Fujita, Ono, Obuchi and Tanaka.
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