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Immunotherapy Impairs SARS-CoV-2 Vaccine Response in Multiple Myeloma Patients

The humoral and cellular responses were analysed after administration of two doses of BNT162b2 (Pfizer-BioNTech) mRNA vaccine in 72 multiple myeloma (MM) patients of which 11 had been infected with SARS-CoV-2 virus more than three months before vaccination and compared with the control group (n=20). SARS-CoV-2 specific IgG and IgA antibodies were lower in MM patients after one month and three month respectively when compared with the control cohort. IgG levels were further decreased in MM patients receiving anti-CD38 immunotherapy. However, IgA levels were similar for MM patients with and without anti-CD38 therapy.

Moreover, neutralizing antibodies (Nabs) against alpha and delta variants were significantly low in MM patients and much lower in MM patients undergoing anti-CD 38 immunotherapy. Only 51% and 41% of MM patients developed Nabs against alpha and delta variants respectively. Post-vaccine, production of SARS-CoV-2 Nabs was significantly impaired in patients with longer disease evolution and undergoing anti-CD 38 immunotherapy for a longer period when compared to patients in the first line of treatment. The IFN-γ and circulating T-cells response to spike SARS-CoV-2 antigens S1 and S2 were weaker in MM patients. It was also revealed that immune response achieved after administration of BNT162b2 vaccine is lower when compared to that achieved after SARS-CoV-2 infection in immunocompromised MM patients. Investigation in hospitals from January 2020 to July 2021 showed that COVID-19 associated mortality rate among vaccinated MM patients without anti-CD38 therapy decreased but remained stable in MM patients undergoing anti-CD38 therapy.

In conclusion, MM patients vaccinated with BNT162b2 had a delayed seroconversion, decreased Nabs and impaired cellular immune response. This was more significant in MM patients undergoing anti-CD38 therapy. This suggests that alternative strategies are required for planning the vaccine booster doses for MM immunocompromised patients. 

Ref Link: MedRxiV



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