Variable Antibody Response Found Following mRNA COVID-19 Vaccination

Multiple myeloma patients had a variable response to mRNA COVID-19 vaccines pointing to the need for antibody testing and precautions for these blood cancer patients after vaccination, according to a study published in Cancer Cell on June 29, 2021.

New York City-based Mount Sinai researchers found that multiple myeloma patients mount variable and sometimes suboptimal responses after receiving either the Pfizer-BioNTech or Moderna COVID-19 vaccines.

These researchers analyzed the antibody levels of 320 multiple myeloma patients, 260 of whom received two doses of mRNA COVID-19 vaccinations, and found that 15.8% had undetectable antibodies. 

This study was the first to analyze a large group of patients with multiple myeloma after completing both vaccination doses and comparing their antibody response to a control group of healthy people.

These new findings may be relevant to other cancer patients undergoing treatment and to immunocompromised patients.

"This study underscores the need for routine blood tests on multiple myeloma patients after vaccination to understand their risk and the potential need to continue wearing masks and socially distance until the pandemic wanes," stated co-lead author Samir Parekh, MD, Director of Translational Research in Multiple Myeloma at The Tisch Cancer Institute at Mount Sinai and Professor of Medicine, and Oncological Sciences, at the Icahn School of Medicine at Mount Sinai, in a press release.

"This also calls for clinical trials to study the use of prophylactic therapies, like monoclonal antibodies, to mitigate COVID-19 risk or to use of different vaccines or booster vaccinations in these patients."

COVID-19 vaccines are highly effective in preventing severe infections or death. Still, patients with multiple myeloma are immunocompromised and often on immunosuppressive therapy.

Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Healthy plasma cells help you fight infections by making antibodies that recognize and attack germs, says Cancer.org. In multiple myeloma, cancerous plasma cells accumulate in the bone marrow and crowd out healthy blood cells.

Preliminary reports showed that the vaccines evoked a lower and delayed response compared to healthy people.

"As we continue to reopen the country, it is important for people with immune system disorders, including multiple myeloma, to work with their doctors and to understand their response to their COVID-19 vaccines due to the varied antibody responses to the vaccines we see in this study," said co-lead author Ania Wajnberg, MD, Director of Clinical Antibody Testing at The Mount Sinai Hospital.

Repeat antibody measurements before patients' first vaccine dose until 60 days after the second vaccination showed delayed and suboptimal responses, particularly in patients with multiple myeloma who had not contracted COVID-19 before their vaccinations. 

Patients on active cancer treatment had significantly lower antibody levels after two vaccine doses than numerous myeloma patients who were not on treatment at the time of vaccination.

The multiple myeloma patients who had had COVID-19 before vaccination showed immune responses ten times higher than those who had not.

Pointing to the importance of the study, ten multiple myeloma patients who received at least one dose of the COVID-19 vaccine developed COVID-19 during the study period. Four needed to be hospitalized with severe symptoms, and one of them died.

The team of Mount Sinai researchers continues to study the response of these patients to COVID-19 vaccines and believe that it may be possible that patients who mount low to modest antibody responses will lose protection more rapidly than those who mount a high response.

The study was performed in collaboration with the Precision Virology/Seronet team, including Viviana Simon, MD, Ph.D., Professor of Microbiology, and clinical and research staff at the Center of Excellence for Multiple Myeloma at Mount Sinai.

The Mount Sinai Health System is New York City's most extensive academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region.

PrecisionVaccinations publishes research-based vaccine news.