Source: Myeloma – Hematology Advisor

A recent analysis of vaccination response against SARS-CoV-2 in patients with multiple myeloma (MM) receiving mRNA vaccines revealed that 45% of patients with active MM reportedly showed an adequate response to vaccination. The study findings were reported in the journal Leukemia.

The study was conducted at a single clinic specializing in MM care, and in addition to patients with MM, the study included age-matched healthy control individuals for analysis. Vaccines used in these participants included the mRNA-based COVID-19 vaccines BNT162b2 and mRNA-1273. Vaccine response was based on quantitative enzyme-linked immunosorbent assay (ELISA) measuring anti-SARS-CoV-2 spike-protein antibody levels, with samples taken at baseline, 12 to 21 days after the first vaccine dose, and 14 to 21 days after the second dose. In analyses, patients were categorized based on vaccine response as clinically relevant responders (>250 IU/mL), partial responders (50-250 IU/mL), and nonresponders (<50 IU/mL).

The study included 103 patients with MM for comparison with results for 31 control individuals without MM, all of whom had been given 2 doses of their respective vaccine. Of the patients with MM, 96 had active disease, while 7 patients had smoldering disease. Median baseline anti-spike antibody levels were 7.3 IU/mL for patients with MM and 30.5 IU/mL for healthy individuals.

Patients with smoldering MM showed full vaccine responses, with a median anti-spike antibody level of 555.8 IU/mL, compared with a median of 173.7 IU/mL for patients with active MM and a median of 893.6 IU/mL for healthy individuals.

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Of the patients with active MM, 45% were considered to have an adequate vaccine response after 2 doses, and 22% were partial responders. Clinically significant immunity was identified after just a single vaccine dose in 2% of patients with active MM, and 19% showed partial antibody after a single dose. Analyses of factors related to variation in antibody response were limited to patients with active MM.

Factors that appeared associated with a lower anti-spike antibody response included older age, renal impairment, low lymphocyte count, reduced levels of uninvolved immunoglobulins, being on a second or higher line of therapy, and the lack of complete remission. Additionally, spike-binding antibody levels were higher in patients given the mRNA-1273 vaccine, compared with the BNT162b2 vaccine. MM treatment type did not generally appear to show a correlation with vaccine response, although use of steroids appeared associated with lower antibody response (P =.035).

Many factors linked to antibody response were noted to be interdependent and associated with immune function. In a sample of 88 patients, a multivariate analysis based on stepwise variable selection suggested that low immunoglobulin M (P <.001) and receipt of mRNA-1273 vaccine (P =.014) were predictive of vaccine response.

“Overall, 55% of MM patients failed to fully respond to COVID-19 vaccination,” the researchers concluded in their report. They suggested that adherence to social distancing protocols after vaccination may be useful for patients with MM. They also noted that measurement of vaccine response may have a role in considerations around revaccination and/or use of antibody prophylaxis.

Stampfer SD, Goldwater MS, Jew S, et al. Response to mRNA vaccination for COVID-19 among patients with multiple myeloma. Leukemia. Published online July 29, 2021. doi:10.1038/s41375-021-01354-7

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