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

• Type of Material: Article
• Authors: Samuel Stampfer, Emory University; Marissa-Skye Goldwater, Institute for Myeloma and Bone Cancer Research; Scott Jew, Institute for Myeloma and Bone Cancer Research; Sean Bujarski, Institute for Myeloma and Bone Cancer Research; Bernard Regidor, Berenson Cancer Center; David Daniely, Institute for Myeloma and Bone Cancer Research; Haiming Chen, Institute for Myeloma and Bone Cancer Research; Ning Xu, Institute for Myeloma and Bone Cancer Research; Mingjie Li, Institute for Myeloma and Bone Cancer Research; Tracy Green, Berenson Cancer Center; Eddie Fung, Berenson Cancer Center; Elias Aquino, Berenson Cancer Center; Regina Swift, Berenson Cancer Center; Shahrooz Eshaghian, Cedars Sinai Medical Center; Kurt Preugschat, KP BIOSTATS LLC; Aaron J Feinstein, Providence Cedars-Sinai Tarzana Medical Center; Tanya M Spektor, ONCOtherapeutics; James R Berenson, Institute for Myeloma and Bone Cancer Research
• Language: English
• Date: 2021-07-29
• Publisher: SPRINGERNATURE
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s), under exclusive licence to Springer Nature Limited 2021
• Final Published Version (URL): http://dx.doi.org/10.1038/s41375-021-01354-7
• Title of Journal or Parent Work: LEUKEMIA
• Volume: 35
• Issue: 12
• Start Page: 3534
• End Page: 3541
• Grant/Funding Information: This publication was supported by the National Institute of Allergy and Infectious Diseases under award T32AI074492 and Institute for Myeloma and Bone Cancer Research.
• Keywords: Hematology; Life Sciences & Biomedicine; INFECTION; Science & Technology; RISK; Oncology; SARS-COV-2
• Research Categories: Health Sciences, Oncology

Abstract

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.