Third dose of an mRNA COVID-19 vaccine for patients with multiple myeloma

Goldwater, Marissa-Skye; Stampfer, Samuel D.; Regidor, Bernard; Bujarski, Sean; Jew, Scott; Chen, Haiming; Xu, Ning; Kim, Clara; Kim, Susanna; Berenson, James R.

doi:10.1016/j.clinpr.2022.100214

Cited by 6 publications

(11 citation statements)

References 49 publications

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“…Aleman et al evaluated the immune response to booster vaccination in 261 patients with MM [ 113 ]. The booster vaccine shot (BNT162b2 or mRNA-1273) significantly increased the anti-spike RBD antibodies, including patients with antibody levels below the positivity threshold before the administration of the third dose, which is in line with other studies [ 36 – 38 , 113 – 118 ]. Enssle et al evaluated the neutralizing activity against SARS-CoV-2 variants in 100 patients with MM; the booster shot led to sufficient neutralization titers against Delta and Omicron in 64% and 29% of the patients, respectively [ 118 ].…”

Section: Methodssupporting

confidence: 89%

“…Furthermore, MM patients often show low/suboptimal rates (in terms of percentage of responders and magnitude of response) of both humoral and functional T-cell immune responses to anti-SARS-CoV-2 vaccines [ 31 – 34 ]; this further contributes to an increased risk of severe COVID-19, need of hospitalization and higher mortality rates [ 35 ]. Notably, an appropriate use of one [ 36 – 40 ] or two [ 41 , 42 ] “booster” doses may significantly improve vaccine performance, particularly among patients who failed to respond to the initial two doses with mRNA vaccines. However, several of these patients may still have vaccine failure due to severe immune impairment, particularly those who receive anti-BCMA treatments [ 39 , 41 ].…”

Section: Methodsmentioning

confidence: 99%

“…A third vaccine shot may also overcome the negative effect of anti-CD38 treatment, but not that of anti-BCMA agents [ 39 ]. Furthermore, a booster shot with mRNA-1273 may induce more robust antibody responses compared with the BNT162b2 booster [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

et al. 2023

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In the post-pandemic COVID-19 period, human activities have returned to normal and COVID-19 cases are usually mild. However, patients with multiple myeloma (MM) present an increased risk for breakthrough infections and severe COVID-19 outcomes, including hospitalization and death. The European Myeloma Network has provided an expert consensus to guide patient management in this era. Vaccination with variant-specific booster vaccines, such as the bivalent vaccine for the ancestral Wuhan strain and the Omicron BA.4/5 strains, is essential as novel strains emerge and become dominant in the community. Boosters should be administered every 6–12 months after the last vaccine shot or documented COVID-19 infection (hybrid immunity). Booster shots seem to overcome the negative effect of anti-CD38 monoclonal antibodies on humoral responses; however, anti-BCMA treatment remains an adverse predictive factor for humoral immune response. Evaluation of the immune response after vaccination may identify a particularly vulnerable subset of patients who may need additional boosters, prophylactic therapies and prevention measures. Pre-exposure prophylaxis with tixagevimab/cilgavimab is not effective against the new dominant variants and thus is no longer recommended. Oral antivirals (nirmatrelvir/ritonavir and molnupiravir) and remdesivir are effective against Omicron subvariants BA.2.12.1, BA.4, BA.5, BQ.1.1 and/or XBB.1.5 and should be administered in MM patients at the time of a positive COVID-19 test or within 5 days post symptoms onset. Convalescent plasma seems to have low value in the post-pandemic era. Prevention measures during SARS-CoV-2 outbreaks, including mask wearing and avoiding crowded places, seem prudent to continue for MM patients.

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Section: Methodssupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

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Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

et al. 2023

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“…[39][40][41] In particular, vaccinated patients with ≥2 doses showed a better OS than those unvaccinated or having receives only one dose, highlighting the need of a complete cycle of vaccination, also in individuals with MM, particularly in those with scarce immune-reaction after the first two doses. [42][43][44][45] Notwithstanding, even full vaccinations, though statistically significant at univariable analysis, did not enter into the multivariable model, where other clinical variables, in particular age, active disease, and COVID-19 severity requiring hospital/ICU admission, had a major impact. In this setting, more recent VOC, 46 reduced production of neutralizing antibodies 47,48 and impaired T-cell response, 49 as well increasing hybrid 50…”

Section: Discussionmentioning

confidence: 93%

“…Overall, OS was significantly longer in vaccinated versus unvaccinated patients, including those with scarcely controlled disease, thus suggesting the possible efficacy of vaccines even in this population of patients, despite their generally described inadequate capacity of humoral immune response 39–41 . In particular, vaccinated patients with ≥2 doses showed a better OS than those unvaccinated or having receives only one dose, highlighting the need of a complete cycle of vaccination, also in individuals with MM, particularly in those with scarce immune‐reaction after the first two doses 42–45 . Notwithstanding, even full vaccinations, though statistically significant at univariable analysis, did not enter into the multivariable model, where other clinical variables, in particular age, active disease, and COVID‐19 severity requiring hospital/ICU admission, had a major impact.…”

Section: Discussionmentioning

confidence: 97%

Survival in multiple myeloma and SARS‐COV‐2 infection through the COVID‐19 pandemic: Results from the EPICOVIDEHA registry

Musto,

Salmanton‐García,

Sgherza

et al. 2023

Hematological Oncology

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Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS‐CoV‐2) infection and subsequent coronavirus (20)19 disease (COVID‐19)‐related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID‐19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS‐CoV‐2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world. Median follow‐up was 52 days for the entire cohort and 83 days for survivors. Three‐hundred and three patients died (24%) and COVID‐19 was the primary reason for death of around 89% of them. Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus unvaccinated, while only a trend favoring vaccinated patients was observed in subjects with responsive MM. Vaccinated patients with at least 2 doses showed a better OS than those with one or no vaccine dose. Overall, according to pandemic waves, mortality rate decreased over time from 34% to 10%. In multivariable analysis, age, renal failure, active disease, hospital, and intensive care unit admission, were independently associated with a higher number of deaths, while a neutrophil count above 0.5 × 109/L was found to be protective. This data suggests that MM patients remain at risk of SARS‐CoV‐2 infection even in the vaccination era, but their clinical outcome, in terms of OS, has progressively improved throughout the different viral phases of the pandemic.

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One Year Duration of Immune Response Following a 3rd Booster Dose of mRNA Vaccine Against COVID‐19 in 292 Patients With Hematological Malignancies in University Hospital Ostrava, Czech Republic

Šušol,

Šušolová,

Klempíř

et al. 2024

Cancer Medicine

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AimsTo evaluate antibody response to mRNA vaccine, identify subgroups with poor response and to determine long‐term antibody durability in hematological patients.Materials and MethodsWe have vaccinated 292 patients with all hematological malignancies with a third dose of mRNA COMIRNATY vaccine with a 12‐month follow‐up period in our center in Ostrava, Czech Republic.ResultsAntibody response for the whole cohort exceeded 74% through the whole 12‐month follow‐up. Lowest seroconversion was observed in CLL cohort (20/41, 48.8%), patients who received anti‐CD20 therapy < 6 months before vaccination (8/30, 26.7%) and BTK inhibitors (3/6, 50.0%). On the contrary, patients with chronic myeloproliferative neoplasms and acute leukemia performed comparably with healthy population (33/33; 100% and 12/13; 92.3%, respectively). We have seen better results if the time interval between anti‐CD20 therapy and additional vaccine dose was longer than 6 months (5/8 patients achieved seroconversion on 4th booster dose after previous failure). Also, 36 patients received a 4th dose of vaccine as a booster with measurable increase in protective antibodies in 50% (18/36).ConclusionsAdditional doses show promise for a well‐timed revaccination even in poor responders. To our knowledge, no study comparable to our work in terms of follow‐up length, vaccine consistency or variety of hematological malignancies and/or treatment has been reported yet. Our findings shed more light on long‐term antibody response to mRNA vaccines against SARS‐CoV‐2 in patients with hematological cancer and bring important data for the evaluation of possible vaccine failure and scheduling of subsequent doses.

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Third dose of an mRNA COVID-19 vaccine for patients with multiple myeloma

Cited by 6 publications

References 49 publications

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

Survival in multiple myeloma and SARS‐COV‐2 infection through the COVID‐19 pandemic: Results from the EPICOVIDEHA registry

One Year Duration of Immune Response Following a 3rd Booster Dose of mRNA Vaccine Against COVID‐19 in 292 Patients With Hematological Malignancies in University Hospital Ostrava, Czech Republic

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