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

• Published in: Leukemia Vol. 35; no. 12; pp. 3534 - 3541
• Main Authors: Stampfer, Samuel D., Goldwater, Marissa-Skye, Jew, Scott, Bujarski, Sean, Regidor, Bernard, Daniely, David, Chen, Haiming, Xu, Ning, Li, Mingjie, Green, Tracy, Fung, Eddie, Aquino, Elias, Swift, Regina, Eshaghian, Shahrooz, Preugschat, Kurt, Feinstein, Aaron J., Spektor, Tanya M., Berenson, James R.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2021; Nature Publishing Group
• Subjects: 2019-nCoV Vaccine mRNA-1273 - administration & dosage; 2019-nCoV Vaccine mRNA-1273 - immunology; 631/67/1990/804; 692/700/478; Adult; Aged; Aged, 80 and over; Antibodies; Antibodies, Viral - blood; Antibodies, Viral - immunology; BNT162 Vaccine - administration & dosage; BNT162 Vaccine - immunology; Cancer Research; Coronaviruses; COVID-19; COVID-19 - epidemiology; COVID-19 - therapy; COVID-19 - virology; COVID-19 vaccines; Critical Care Medicine; Enzyme-linked immunosorbent assay; Female; Hematology; Humans; Immunization; Immunoglobulin G; Immunoglobulin G - blood; Immunoglobulin G - immunology; Intensive; Internal Medicine; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; mRNA; Multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - immunology; Multiple Myeloma - virology; Oncology; Patients; Physiological aspects; Remission; Renal function; SARS-CoV-2 - immunology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Smoldering; Spike Glycoprotein, Coronavirus - immunology; Spike protein; Vaccination; Vaccines; United States
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/s41375-021-01354-7

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.