Abstract
Simple SummaryThe global impact of the current COVID-19 pandemic has led to the impressively rapid development of multiple anti-SARS-CoV-2 vaccines. However, only few data are available regarding the efficacy of anti-SARS-CoV-2 vaccines in patients with hematological malignancies, and, in particular, plasma cell neoplasia. This ongoing observational study aimed to describe the level of post-vaccination anti-SARS-CoV-2-antibodies depending on multiple clinical factors including B lymphocyte count and current therapy of 82 patients with multiple myeloma and related plasma cell neoplasia, after the first dose of anti-SARS-CoV-2 vaccination. A positive SARS-CoV-2 spike protein antibody titer (SP-AbT) was detected in 23% of assessable patients. SARS-CoV-2 SP-AbT was significantly higher in patients with higher CD19+ B lymphocyte counts and current treatment with anti-CD38-antibodies has led to significantly reduced SP-AbT titers. Based on our results, the majority of myeloma patients respond poorly after receiving the first dose of any anti-SARS-CoV-2 vaccination and need booster vaccination.Few data are available regarding the efficacy of anti-SARS-CoV-2 vaccines in patients with hematological malignancies, and particular, plasma cell neoplasia. This ongoing single-center study aimed to describe the level of post-vaccination anti-SARS-CoV-2-antibodies depending on B lymphocyte count, current therapy, and remission status of patients with multiple myeloma and related plasma cell dyscrasia, after the first dose of anti-SARS-CoV-2 vaccination. The 82 patients included in this study received SARS-CoV-2 vaccines (including mRNA- and vector-based vaccines) as a routine measure. After the first vaccination, a positive SARS-CoV-2 spike protein antibody titer (SP-AbT) was detected in 23% of assessable patients. SARS-CoV-2 SP-AbT was significantly higher in patients with higher CD19+ B lymphocyte counts. A cut-off value of ≥30 CD19+ B cells/µL was significantly positive correlating with higher SARS-CoV-2 SP-AbT. In contrast, current treatment with anti-CD38-antibodies has led to significantly reduced SP-AbT titers. Furthermore, in multivariable linear regression, higher age and insufficiently controlled disease significantly correlated negatively with SARS-CoV-2 SP-AbT. Conversely, treatment with immunomodulatory drugs did not harm the development of antibody titers. Based on our results, the majority of myeloma patients respond poorly after receiving the first dose of any anti-SARS-CoV-2 vaccination and need booster vaccination.
Highlights
Infections, regardless of whether they are bacterial or viral in origin, pose a major threat to patients with multiple myeloma (MM), due to plasma cell dysfunction-related immunodeficiency [1]
In this observational single-center study patients aged 18 years and older with a confirmed diagnosis of MM, monoclonal gammopathies of clinical significance (MGCS), or AL according to the 2014 updated diagnostic criteria of the international myeloma working group (IMWG) and who were vaccinated according to national prioritization strategy and eligible for Anti-SARS-CoV-2 vaccination according to International Myeloma Society (IMS) recommendations were included [18,19]
To the best of our knowledge, this is the first analysis of SARS-CoV-2 spike protein antibody titer (SP-AbT) in patients with plasma-cell-related neoplasia with a systematic assessment of immune status including CD19+ B lymphocyte counts
Summary
Infections, regardless of whether they are bacterial or viral in origin, pose a major threat to patients with multiple myeloma (MM), due to plasma cell dysfunction-related immunodeficiency [1]. Anti-myeloma treatments, and in particular the use of anti-CD38-monoclonal antibodies like daratumumab and isatuximab, are associated with impaired immune response. Treatment with anti-CD38-monoclonal antibodies leads to long and sustained suppression of CD38+ plasma cells [6]. The expression of CD38+ is not limited to plasma cells and found on various immune cells including B lymphocytes [7,8]. B lymphocyte precursor cells show high expression of CD38 and are being targeted by anti-CD38-directed treatment [8,9]
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