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Some Myeloma Patients Get No Protection From COVID-19 Vaccines

By Ernie Mundell and Cara Murez HealthDay Reporters

WEDNESDAY, June 30, 2021 (HealthDay News) -- Because they're often given drugs that suppress their immune systems, people battling a blood cancer known as multiple myeloma have varying responses to the COVID-19 vaccine, new research shows.

Some patients had no evidence at all of COVID-fighting antibody production after getting two doses of vaccine, the new study found.

In a minority of cases, fully vaccinated myeloma patients went on to develop sometimes serious cases of COVID-19, according to the team of New York City researchers.

All of this "underscores the need for routine blood tests on multiple myeloma patients after vaccination to understand their risk and potential need to continue wearing masks and socially distance until the pandemic wanes," said study co-lead author Dr. Samir Parekh. He directs translational research in multiple myeloma at The Tisch Cancer Institute at Mount Sinai.

In the study, the Mount Sinai team analyzed the antibody levels of 320 multiple myeloma patients, including 260 patients who received two doses of COVID-19 vaccinations (either Pfizer-BioNTech or Moderna). The researchers reported that about one in every six patients (about 16%) had undetectable antibodies to SARS-CoV-2.

Multiple myeloma patients who had experienced a prior infection with the COVID-19 virus before their vaccination showed immune responses that were 10 times higher than those who had not, the team noted in a Mount Sinai news release.

In addition, about 10 study participants who received at least one dose of COVID-19 vaccine did develop the illness during the study period, the findings showed. In four cases, the illness was so severe that patients needed to be hospitalized, and one patient died.

The researchers repeated antibody measurements from before patients' first vaccine dose until 60 days after the second vaccination. These typically showed delayed and suboptimal responses, according to the study, particularly in patients with multiple myeloma who had not contracted COVID-19 before their vaccinations.

Cancer treatment status seemed to matter, too: Patients on active cancer treatment had significantly lower antibody levels after two vaccine doses compared to those who weren't being treated at the time of vaccination, the researchers said.

The new data "also calls for clinical trials to study the use of prophylactic therapies, like monoclonal antibodies, to mitigate COVID-19 risk or use of different vaccines or booster vaccinations in these patients," said Parekh, who is also professor of medicine (hematology and medical oncology) at the Icahn School of Medicine at Mount Sinai in New York City.

Study co-lead author Dr. Ania Wajnberg is director of clinical antibody testing at The Mount Sinai Hospital. "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," Wajnberg said in the news release.

Speaking in an interview with HealthDay Now, Dr. Joshua Richter, assistant professor of medicine at Tisch, said that, in general, blood cancer patients "don't have the same robustness of their protection as people without hematological malignancies."

Richter, who wasn't involved in the new study, stressed that the human immune system has many components, and the immune response to COVID-19 vaccines for these patients is not an "all or none" situation.

"A lot of people are measuring their antibody levels, which kind of shows their [immune system] B-cell response," Richter explained. "Some of the researchers at my institution are actually doing studies looking into the T-cell response. So even those people that show no antibody production may still have some protection against COVID."

There might also be ways to "bump up" the immune response to vaccination, he noted.

"One of them may be giving them an extra dose of the vaccine, like a booster. There's some recent data presented for solid organ transplant recipients [who also take immune-lowering drugs] about how they've been benefiting from that strategy," Richter said.

"Another strategy that's under investigation is using some of the commercially available antibody drugs to treat COVID, like the Regeneron drug, which may be worthwhile to give to some of these patients to provide extra protection against COVID," Richter added.

The study authors said they are continuing to study the response of myeloma patients to COVID-19 vaccines. They believe that patients who mount low-to-modest antibody responses may lose protection more rapidly than those who mount a high response.

The findings were published online June 29 in Cancer Cell. They may be relevant to other cancer patients undergoing treatment and to immunocompromised patients, the researchers said.

More information

The U.S. Centers for Disease Control and Prevention has more information on COVID-19.

SOURCES: HealthDay Now, June 28, 2021, interview with Joshua Richter, MD, assistant professor of medicine, The Tisch Cancer Institute at Mount Sinai, New York City; Mount Sinai School of Medicine, news release, June 28, 2021

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