Response to first vaccination against SARS-CoV-2 in patients with multiple myeloma

Bird, Sarah; Panopoulou, Aikaterini; Shea, Robyn; Tsui, Micky; Sašo, Radovan; Sud, Amit; West, Sharon; Smith, Katy; Barwood, John; Kaczmarek, Ewa; Panlaqui, Carmela; Kaiser, Martin; Stern, Simon; Pawlyn, Charlotte; Boyd, Kevin

doi:10.1016/s2352-3026(21)00110-1

Cited by 127 publications

(131 citation statements)

References 6 publications

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“…After the first mRNA vaccine dose, we observed only 2% of MM patients with spike antibody levels of >250 IU/mL, and just 19% of patients at levels above background (>50 IU/mL). This contrasts with an earlier report, which indicated that 56% of myeloma patients had positive IgG levels 21 days after a single vaccine dose [ 24 ]. This difference is unlikely to be due to patient sera being drawn earlier, as another study demonstrated that patients sampled at 13–16 days after the first dose of mRNA vaccines had 78% of the antibody levels as those sampled at 21–28 days [ 25 ].…”

Section: Discussioncontrasting

confidence: 99%

“…This difference is unlikely to be due to patient sera being drawn earlier, as another study demonstrated that patients sampled at 13–16 days after the first dose of mRNA vaccines had 78% of the antibody levels as those sampled at 21–28 days [ 25 ]. Rather, this is more likely due to a different cutoff selection in the commercial IgG assay used by Bird et al [ 24 ]. The phase III clinical trials for both mRNA vaccines demonstrated that there was clinically significant protection from COVID-19 as early as 14 days after the first dose [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Response to mRNA vaccination for COVID-19 among patients with multiple myeloma

et al. 2021

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Multiple myeloma (MM) patients are at higher risk for severe COVID-19. Their mRNA vaccination response against SARS-CoV-2 is unknown. Thus, we analyzed responses to mRNA vaccination against COVID-19 among these patients. Using an ELISA-based assay that detects IgG antibodies to SARS-CoV-2 spike protein, we determined serum antibody levels prior to immunization and 12–21 and 14–21 days following the first and second vaccinations, respectively, with mRNA-1273 (Moderna) or BNT162b2 (Pfizer/BioNTech) among 103 MM patients (96 and 7 with active and smoldering disease, respectively). We stratified patients into clinically relevant responders (>250 IU/mL), partial responders (50–250 IU/mL, which was above pre-COVID-19 background), and nonresponders (<50 IU/mL). Smoldering MM patients responded better than those with active disease. Only 45% of active MM patients developed an adequate response, while 22% had a partial response. Lower spike antibody levels were associated with older age, impaired renal function, low lymphocyte counts, reduced uninvolved immunoglobulin levels, > second line of treatment, and among those not in complete remission. Patients who received mRNA-1273 vaccine had higher anti-spike antibody levels than those who were vaccinated with BNT162b2. Thus, most MM patients have impaired responses to mRNA vaccination against COVID-19, and specific clinical and myeloma-related characteristics predict vaccine responsiveness.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Response to mRNA vaccination for COVID-19 among patients with multiple myeloma

et al. 2021

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“…A study by Bird and colleagues 24 showed that patients with multiple myeloma with active disease, active treatment, or immunoparesis had inferior serological responses to a single dose of ChAdOx1 or BNT162b2 vaccines; however, no associations between serological response and multiple myeloma treatment type were detected. Treatment and disease-related immunoparesis in patients with multiple myeloma are difficult to disentangle because treatment regimens include combinations of drugs from different classes administered in multiple treatment lines.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study

Maneikis

Šablauskas

Ringelevičiūtė

et al. 2021

The Lancet Haematology

232

296

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Background Haematological malignancies and their treatments are likely to affect SARS-CoV-2 vaccine efficacy. We aimed to evaluate serological response to BNT162b2 vaccine in patients with haematological malignancies by type of treatment. Methods Our national prospective cohort study was done in Lithuania and assessed serological response to one and two BNT162b2 (Comirnaty, Pfizer-BioNTech) vaccine doses in healthy health-care workers and in patients with haematological malignancies. Eligible participants were aged 18 years or older, had received both vaccine doses, and had available biobanked blood samples from before vaccination and after the second dose. Biobanked samples and health data were obtained from Vilnius University Hospital Santaros Klinikos Biobank. Abbott Architect SARS-CoV-2 IgG Quant II chemiluminescent microparticle assay was used to quantify serum anti-SARS-CoV-2-S1 IgG antibody (anti-S1 IgG antibody) concentrations 0–10 days before the first BNT162b2 vaccine, on the day of second immunisation (around day 21), and 7 to 21 days after the second immunisation. Adverse events were assessed by a standardised questionnaire. Breakthrough infections were characterised clinically and by SARS-CoV-2 genotyping whenever possible. This study is registered with ClinicalTrials.gov , NCT04871165 . Findings Between Jan 8 and April 21, 2021, 885 participants with haematological malignancies were included in the study. 857 patients were anti-S1 IgG seronegative at timepoint 0 and constituted the main analysis cohort. The age-matched comparison was made between 315 patients with haematological malignancies who were aged 18–60 years and 67 healthy health-care workers in the same age group. Patients aged 18–60 years with haematological malignancies had lower median anti-S1 IgG antibody responses after two BNT162b2 vaccine doses than did health-care workers of the same age group (median 6961 AU/mL [IQR 1292–20 672] vs 21 395 AU/mL [14 831–33 553]; p<0·0001). Compared with untreated patients with haematological malignancies (n=53; median 5761 AU/mL [629–16 141]), patients actively treated with Bruton tyrosine kinase inhibitors (BTKIs; n=44; 0 AU/mL [0–7]; p<0·0001), ruxolitinib (n=16; 10 AU/mL [0–45]; p<0·0001), venetoclax (n=10; 4 AU/mL [0–1218]; p=0·0005), or anti-CD20 antibody therapy (n=87; 17 AU/mL [1–2319]; p<0·0001) showed particularly poor anti-S1 IgG antibody responses following two BNT162b2 doses. Patients being treated with tyrosine kinase inhibitors (n=41; 10 537 AU/mL [IQR 2335–19 388]) or patients who received autologous haematopoietic stem-cell transplantation (HSCT; n=192; 6203 AU/mL [1451–16 834]) or allogeneic HSCT (n=122; 6304 AU/mL [1120–16 913]) were among the subgroups with the highest numerical responses. Nine SARS-CoV-2 infections and three COVID-19 deaths were observed among fully vaccinated patients with haematological malignancies. ...

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“…Recently, one study reported that the first dose of a COVID-19 vaccine (either Pfizer-BioNTech or Oxford-AstraZeneca) was able to induce an immune response in around 70% of patients with multiple myeloma. Yet, patients with worse remission status (SD/PD) and suppression of polyclonal (physiologic) immunoglobulins were more likely to lack a seropositive response following a vaccination [30]. Even though the initial clinical studies of the COVID-19 vaccines did not include cancer patients, the European Society for Medical Oncology (ESMO), the Society for Immunotherapy of Cancer (SITC) and the National Comprehensive Cancer Network (NCCN) COVID-19 Vaccination Advisory Committee have recently released their preliminary recommendations supporting vaccination of all patients with cancer, including those receiving active therapy [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic, Clinical and Post-SARS-CoV-2 Scenarios in Cancer Patients with SARS-CoV-2: Retrospective Analysis in Three German Cancer Centers

Shumilov

Hoffknecht

Koch

et al. 2021

Cancers

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Oncologists face challenges in the management of SARS-CoV-2 infections and post-SARS-CoV-2 cancer treatment. We analyzed diagnostic, clinical and post-SARS-CoV-2 scenarios in patients from three German cancer centers with RT-PCR confirmed SARS-CoV-2 infection. Sixty-three patients with SARS-CoV-2 and hematologic or solid neoplasms were included. Thirty patients were initially asymptomatic, 10 of whom developed COVID-19 symptoms subsequently. Altogether 20 (32%) patients were asymptomatic, 18 (29%) had mild, 12 (19%) severe and 13 (20%) critical courses. Lymphocytopenia increased risk of severe/critical COVID-19 three-fold (p = 0.015). Asymptomatic course was not associated with age, remission status, therapies or co-morbidities. Secondary bacterial infection accompanied more than one third of critical COVID-19 cases. Treatment was delayed post-SARS-CoV-2 in 46 patients, 9 of whom developed progressive disease (PD). Cancer therapy was modified in 8 SARS-CoV-2 survivors because of deteriorating performance or PD. At the last follow-up, 17 patients had died from COVID-19 (n = 8) or PD (n = 9) giving an estimated 73% four-month overall survival rate. SARS-CoV-2 infection has a heterogenous course in cancer patients. Lymphocytopenia carries a significant risk of severe/critical COVID-19. SARS-CoV-2 disruption of therapy is as serious as SARS-CoV-2 infection itself. Careful surveillance will allow early restart of the anti-cancer treatment.

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Response to first vaccination against SARS-CoV-2 in patients with multiple myeloma

Cited by 127 publications

References 6 publications

Response to mRNA vaccination for COVID-19 among patients with multiple myeloma

Response to mRNA vaccination for COVID-19 among patients with multiple myeloma

Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study

Diagnostic, Clinical and Post-SARS-CoV-2 Scenarios in Cancer Patients with SARS-CoV-2: Retrospective Analysis in Three German Cancer Centers

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