Response to pneumococcal vaccination in multiple myeloma

Abstract

Background Streptococcus pneumoniae infection causes morbidity and mortality in multiple myeloma patients. Pneumococcal vaccination is commonly given to immunocompromised myeloma patients; however response data are sparse. Here, we present longitudinal response data to pneumococcal vaccination in multiple myeloma patients. Method Twenty‐eight multiple myeloma patients were included, 25 of whom were newly diagnosed. All the patients received two vaccines Prevnar13® and Pneumo23®. Serotype‐specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline, and then sequentially at different time points postvaccination until treatment ended. Response to vaccination is available for 20 patients. The primary endpoint was the incidence rate of patients who obtained an isotype response serum concentration after vaccination. Secondary endpoints included detailed isotype increase, time to first increase, further assessment of a decreased anti‐pneumococcal serum concentrations following treatment including autologous stem cell transplantation (ASCT), rate of infection with a special attention to pneumococcal infection. Results The median age was 66 years and the male to female ratio was 0.6. Anti‐pneumococcal capsular polysaccharide (anti‐PCP23) IgG, IgG2, IgA, and IgM responses were detected within 1 week postvaccination. Response to at least one subtype of antibody was obtained in 85% (n = 17) of patients, for at least two subtypes in 65% (n = 13), for at least three subtypes in 55% (n = 11), and 2 patients responded to all four subtypes. The median increase in the concentration of anti‐PCP23 isotypes was threefold following vaccination, with the highest increase observed when Pneumo23® was given more than 30 days after Prevnar13®. The anti‐pneumococcal geometric mean concentration decreased significantly for all subtypes over time independently of treatment approaches. Conclusion Myeloma has the ability to demonstrate a response to pneumococcal vaccine, independently of preexisting hypogammaglobulinemia and possibly of treatment‐induced immunodepression. We also observed a drop in the serum response overtime and following autologous transplantation. Further studies in larger sample are needed to understand the benefit of vaccination strategies in these patients.

Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network

“… No SAEs observed Poor antibody response was associated with higher sepsis risk Robertson et al [ 21 ] PCV13 and PPV23 MM: 20 pts scheduled for induction TX Median time between both vaccinations: 21 days One dose of PCV13 and PPV23 each Protective IgG response in 60% antipneumococcal serum levels of IgG. IgG2, IgM, and IgA increased by 5.1-, 5.9-, 1.5-, and 3.8-fold Not reported Antibody levels decreased significantly at follow-up (28–502 days) in pts without ASCT but was even more pronounced in those receiving ASCT Renaud et al [ 72 ] Haemophilus influenzae Haemophilus influenza type B MM: 52 patients 16 had chemotherapy <1 week and 7 had high-dose TX + ASCT <6 months prior to vaccination. 21 were on interferon α TIW One dose Pre-vaccination protective ab titers: 45% Postvaccination: 75%, fourfold increase in ab titers in 41 No SAEs reported by patients Receiving high-dose therapy and ASCT <6 months prior to vaccination correlated with poor response Robertson et al [ 21 ] …”

“…Antibodies for various pathogens including pneumococci, haemophilus, and measles are significantly reduced after autologous [ 71 , 72 ] and more so after allogeneic stem cell transplantation [ 73 ]. Transplanted patients have a higher risk for virus reactivation and develop a more severe course of viral infections [ 74 ].…”

More than Meets the Eye: Bacteremic Pneumococcal Pneumonia as the Initial Presentation of Multiple Myeloma

“…In case of S. pneumoniae infection, antibody-dependent humoral immunity is crucial [ 12 ]. Strategies to prevent infections with S. pneumoniae therefore include administration of pneumococcal vaccines and intravenous immunoglobulin replacement [ 13 ], although vaccine responses may be impaired [ 14 ] and the benefit of intravenous immunoglobulin may be confined to patients with stable MM and recurrent serious infections or specific antibody deficiencies [ 15 ].…”

Clinical and Immunological Aspects of Pneumococcal Vaccination in Patients with Multiple Myeloma

“…L. Renaud и соавт. в своем исследовании установили, что пациенты с ММ способны продемонстрировать адекватный ответ на пневмококковую вакцинацию независимо от имеющейся гипогаммаглобулинемии, с ожидаемым снижением антител непосредственно после аутологичной трансплантации ГСК [39]. В обоих приведённых в обсуждении исследованиях отсутствовали клинические данные о влиянии вакцинации на развитие пневмонии у пациентов с ММ, в то время как считается, что пневмония во многом определяет эффективность профилактической меры в реальных условиях.…”