Patients with multiple myeloma show ‘suboptimal’ responses to COVID-19 vaccination
Patients with multiple myeloma mounted suboptimal and variable antibody responses to the messenger RNA COVID-19 vaccines, according to study results published in Cancer Cell.
Additionally, patients who had not contracted COVID-19 before messenger RNA (mRNA) vaccination were more likely to have delayed and suboptimal vaccine responses, and those on active cancer treatment had significantly lower antibody levels after both vaccine doses.
“COVID-19 vaccines are highly effective in preventing severe infections or death, but patients with multiple myeloma are immunocompromised and often on immunosuppressive therapy. In addition, preliminary reports showed the vaccines evoked a lower and delayed response among those with multiple myeloma compared with healthy individuals,” Samir Parekh, MD, MBBS, professor of medicine and oncological sciences and director of translational research in myeloma at Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, told Healio. “This study was the first to analyze a large group of patients with multiple myeloma after completing both doses of vaccination and sought to compare their antibody response to a control group of healthy individuals.”
Parekh and colleagues assessed SARS-CoV-2 spike-binding immunoglobulin G antibody levels of 320 patients with multiple myeloma who received both doses of the mRNA vaccines in early 2021 (69.1% BNT162b2 [Pfizer/BioNTech]; 27.2% mRNA-1273, [Moderna]; 3.8% unknown).
Overall, 18.8% of patients had COVID-19 before receiving either vaccine dose.
Most patients (81.3%) had their IgG antibody levels measured at least 10 days (median, 51) after their second vaccine dose.
The majority (84.2%) of fully vaccinated patients had measurable IgG antibody levels of varying magnitude, with a median level of 149 AU/mL, and 15.8% of patients had undetectable IgG antibody levels after vaccination.
Conversely, the median antibody level after vaccination among a control group of 67 otherwise healthy health care workers was 300 AU/mL, and none of them had antibody levels less than the level of detection, according to Parekh and colleagues.
More than half (58.5%) of patients with multiple myeloma and undetectable IgG antibody levels were on active treatment with anti-CD38 antibody-containing therapy at the time of vaccination, 31.7% were on anti-BCMA bispecific antibody therapy and 9.8% underwent anti-BCMA chimeric antigen receptor T-cell therapy more than 3 months before vaccination.
Ten patients who received at least one dose of the vaccine developed COVID-19, four patients required hospitalization and one patient died.
“Repeat antibody measurements from before patients’ first vaccine dose until 60 days after the second vaccination showed delayed and suboptimal responses,” Parekh said. “Preliminary data from our research lab efforts suggest that patients with low antibody titers may have low or absent T-cell responses and this is now an area of active investigation. Research into strategies to boost immune responses, such as third/booster vaccines or passive antibody infusions, is urgently needed.”
For more information:
Samir Parekh, MD, MBBS, can be reached at Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1128, New York, NY 10029; email: samir.parekh@mssm.edu.
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