Ariel Jones

Cancer Nursing Today nonprod

According to a poster presented at the 2021 ASH Annual Meeting by Andrew R. Branagan, MD, PhD, and colleagues, patients with myeloma and Waldenstr&ouml;m macroglobulinemia show impaired functional humoral responses following COVID-19 vaccines. Dr. Branagan, from the Center for Multiple Myeloma at Massachusetts General Hospital Cancer Center in Boston, and researchers noted that patients with Waldenstr&ouml;m macroglobulinemia, in particular, have more severe impairment of COVID-19 spike protein (S) antibody (Ab) responses.Multiple myeloma and Waldenstr&ouml;m macroglobulinemia are two malignancies associated with significant immunoparesis, making patients with these conditions susceptible to adverse consequences of COVID-19 infection. However, it is unclear whether these patient populations can mount a sufficient response to COVID-19 vaccines.To help answer this question, researchers evaluated S antibody levels and T-cell responses in patients with multiple myeloma and Waldenstr&ouml;m macroglobulinemia who were vaccinated with one of the three available COVID-19 vaccines in a prospective clinical trial.The primary endpoint was S Ab levels at 28 days after final vaccination, and secondary endpoints included functional serologic assessments and T-cell responses at 28 days, 6 months, 9 months, and 12 months following vaccination. An S Ab level of 0.80 U/mL was defined as positive and titers &gt;250 U/mL were considered stronger correlates of neutralization.As of the study presentation, 137 patients (91 with multiple myeloma and 46 with Waldenstr&ouml;m macroglobulinemia) had an S Ab assessment available. Median Ab titers were 178.0 (interquartile range [IQR] = 16.10-1,166.0) for multiple myeloma and 3.92 for Waldenstr&ouml;m macroglobulinemia (IQR = 0-278.9). Eighty-three patients with multiple myeloma (91%) achieved an S Ab response, while 27 patients with Waldenstr&ouml;m macroglobulinemia (56%) had a response.However, the rate of patients achieving S Ab &gt;250 U/mL were 47.3% (43/91) in the myeloma group and 26.1% (12/46) in the Waldenstr&ouml;m macroglobulinemia group. Vaccine-specific S Ab responses &gt;250 u/mL differed with the three vaccine products, and for multiple myeloma and Waldenstr&ouml;m macroglobulinemia:<ul>
<li>Moderna: 67.6% (23/34; p &lt; 0.05) for myeloma and 50.0% (8/16; p &lt; 0.05) for Waldenstr&ouml;m macroglobulinemia</li>
<li>Pfizer: 38.3% (18/47; p = not significant) and 14.8% (4/27; p &lt; 0.05) for Waldenstr&ouml;m macroglobulinemia</li>
<li>Johnson &amp; Johnson: 20% (2/10; p = not significant) and 0% (0/3; p = not significant) for Waldenstr&ouml;m macroglobulinemia</li>
</ul>Multiple myeloma patients who underwent autologous stem cell transplant within 12 months of vaccination demonstrated 100% (5/5; p&lt;0.05) S Ab responses, however, only 38.9% (14/36) of those actively receiving an anti-CD38 monoclonal antibody and 50.9% (28/55) of those receiving an immunomodulatory drug, had S Ab response.As evidenced by functional Ab studies performed on 14 patients with myeloma, 14 with Waldenstr&ouml;m macroglobulinemia, and 14 healthy donors, the patients with B-cell malignancies showed increased IgA and IgM S Ab production as well as increased FcgR2A binding following a second vaccine, compared with the healthy controls.Overall, patients with Waldenstr&ouml;m macroglobulinemia showed more severe impairment of COVID-19 S Ab responses. &ldquo;Most previously untreated Waldenstr&ouml;m macroglobulinemia patients achieved S Ab responses, however the most significant reduction in S Ab responses were seen in Waldenstr&ouml;m macroglobulinemia patients who received rituximab within 12 months or active BTK inhibitors,&rdquo; the authors reported. For patients with multiple myeloma, however, disease in remission was associated with improved S Ab response. &ldquo;Further understanding of the immunological response to COVID-19 vaccination is needed to clarify patients risks, and necessity for booster or alternative protective measures against COVID-19,&rdquo; they concluded.

Multiple Myeloma and Waldenström Macroglobulinemia Patients Have Impaired COVID-19 Vaccine Responsiveness

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Both are malignancies associated with significant immunoparesis.