Abstract
Recent data suggest a suboptimal antibody response to COVID-19 vaccination in patients with hematological malignancies. Neutralizing antibodies (NAbs) against SARS-CoV-2 were evaluated in 276 patients with plasma cell neoplasms after vaccination with either the BNT162b2 or the AZD1222 vaccine, on days 1 (before the first vaccine shot), 22, and 50. Patients with MM (n = 213), SMM (n = 38), and MGUS (n = 25) and 226 healthy controls were enrolled in the study (NCT04743388). Vaccination with either two doses of the BNT162b2 or one dose of the AZD1222 vaccine leads to lower production of NAbs in patients with MM compared with controls both on day 22 and on day 50 (p < 0.001 for all comparisons). Furthermore, MM patients showed an inferior NAb response compared with MGUS on day 22 (p = 0.009) and on day 50 (p = 0.003). Importantly, active treatment with either anti-CD38 monoclonal antibodies (Mabs) or belantamab mafodotin and lymphopenia at the time of vaccination were independent prognostic factors for suboptimal antibody response following vaccination. In conclusion, MM patients have low humoral response following SARS-CoV-2 vaccination, especially under treatment with anti-CD38 or belamaf. This underlines the need for timely vaccination, possibly during a treatment-free period, and for continuous vigilance on infection control measures in non-responders.
Highlights
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic and has become a major global health concern
We report here the development of neutralizing antibodies (NAbs) against SARS-CoV-2 in patients with plasma cell neoplasms after vaccination with either the mRNA BNT162b2 or viral vector AZD1222 vaccine, up to day 50 post their first vaccine dose, and we evaluate possible correlations with clinical characteristics of patients as well as with treatment data
Baseline characteristics of patients and controls Study population included 276 patients with plasma cell neoplasms (213 symptomatic MM, 38 smoldering myeloma (SMM), 25 monoclonal gammopathy of undetermined significance (MGUS)) (151 males/125 females; median age: 74 years, interquartile range (IQR): 62–80 years) and 226 controls matched for age and gender who were vaccinated during the same period, at the same vaccination center (Alexandra Hospital, Athens, Greece)
Summary
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic and has become a major global health concern. Patients with MM may present a decreased antibody response following vaccination [23, 24] This is attributed to defects in immune effector cells, associated with the B-cell disorder and the use of anti-myeloma regimens [14]. The BNT162b2 mRNA and the AZD1222 viral vector vaccines against SARS-CoV-2 have shown significant efficacy in. Regarding ChAdOx1 nCoV-19 vaccine (AZD1222), no data on its efficacy among patients with solid and hematological malignancies are currently available In this context, we report here the development of neutralizing antibodies (NAbs) against SARS-CoV-2 in patients with plasma cell neoplasms after vaccination with either the mRNA BNT162b2 or viral vector AZD1222 vaccine, up to day 50 post their first vaccine dose, and we evaluate possible correlations with clinical characteristics of patients as well as with treatment data
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