![]() ![]() Those who could not provide all three sera samples within the designated timepoints were excluded. Healthy subjects were not known to be immunocompromised or currently receiving immunosuppressive therapy. Participants in the trial included MM patients from a single clinic specializing in their care, and age-matched healthy controls contemporaneous with the MM study group or prior to the existence of COVID-19. We also tested serum from healthy subjects obtained prior to COVID-19. Serum samples were obtained from all individuals at baseline and following their first and second doses, and we evaluated their antibody responses using an anti-spike IgG assay developed in our laboratory. In this observational trial, we evaluated the antibody responses to the two mRNA vaccines against COVID-19, mRNA-1273 and BNT162b2, of 103 patients with MM compared to age-matched healthy subjects. In larger, unselected populations, phase III trial results for mRNA-1273 and BNT162b2 COVID-19 vaccines showed an efficacy of 94–95% against even mild COVID-19, but this may be lower in immunocompromised MM patients. Reactivity against the spike antigen encompasses the entirety of the vaccine-induced immune response against SARS-CoV-2. The first mRNA vaccines for COVID-19, mRNA-1273 and BNT162b2, consist of mRNA encoding prefusion-stabilized SARS-CoV-2 spike ectodomain packaged in a lipid nanoparticle. While MM patients were targeted early for COVID-19 vaccination, the efficacy of this intervention is unknown. Factors known to play a role in their higher risk of infection include impaired renal function, low uninvolved immunoglobulin (Ig) levels, diminished T-cell responses, reduced neutrophil and lymphocyte counts, immunosuppressive treatments including frequent use of corticosteroids, and disease status. They develop more frequent infections, and it is a leading cause of death. Unfortunately, the same mechanisms that impede MM patients’ ability to fend off infections also reduce their capability to generate immunity from vaccination, as demonstrated by their diminished responses to vaccines for multiple respiratory illnesses. Thus, these patients received early vaccination with the hope of providing them protection. Multiple myeloma (MM) patients are immunocompromised, often elderly, and more likely to develop more severe COVID-19 complications. The highly effective mRNA vaccines for COVID-19 (BNT162b2 from Pfizer/BioNTech and mRNA-1273 from Moderna) were made available first to these vulnerable populations to achieve the greatest impact on survival per vaccination in this at-risk population. The elderly and immunocompromised are particularly vulnerable, experiencing much higher rates of mortality. Thus, most MM patients have impaired responses to mRNA vaccination against COVID-19, and specific clinical and myeloma-related characteristics predict vaccine responsiveness.ĬOVID-19 has already killed 0.05% of the world population, with the true tally likely much higher. Patients who received mRNA-1273 vaccine had higher anti-spike antibody levels than those who were vaccinated with BNT162b2. ![]() We stratified patients into clinically relevant responders (>250 IU/mL), partial responders (50–250 IU/mL, which was above pre-COVID-19 background), and nonresponders ( second line of treatment, and among those not in complete remission. Using an ELISA-based assay that detects IgG antibodies to SARS-CoV-2 spike protein, we determined serum antibody levels prior to immunization and 12–21 and 14–21 days following the first and second vaccinations, respectively, with mRNA-1273 (Moderna) or BNT162b2 (Pfizer/BioNTech) among 103 MM patients (96 and 7 with active and smoldering disease, respectively). Thus, we analyzed responses to mRNA vaccination against COVID-19 among these patients. Their mRNA vaccination response against SARS-CoV-2 is unknown. Multiple myeloma (MM) patients are at higher risk for severe COVID-19.
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