There are currently three Covid-19 vaccines (Pfizer/BioNTech, Moderna, Johnson & Johnson) approved by the US Food and Drug Administration for emergency use against the spread of Covid-19. There has been some recent literature indicating that healthy patients are better protected than myeloma patients. The question arises then as to how effective these vaccines are for us.
An article, titled “Humoral response rate and predictors of response to BNT162b2 mRNA COVID19 vaccine in patients with multiple myeloma”, published in the most recent issue of the British Haematology Journal provides the answer for the Pfizer/BioNTech vaccine (though, unfortunately for some of us, not for either the Moderna or J&J vaccines). At this point you may wonder what on earth a “humoral response” is. “Humor” is a medieval term for body fluid, and a “humoral response” (also called an antibody mediated response) involves B cells that recognize antigens or pathogens that are circulating in the lymph [fluid in the lymph nodes] or blood.
The article states the importance of understanding the efficacy of the Covid-19 vaccine in myeloma patients:
“Patients diagnosed with multiple myeloma (MM) were found to be at high risk for significant complications [from Covid-19 infection], with mortality approaching 33% . Moreover, recent data suggest that immunocompromised patients often experience a prolonged disease course and may serve as ‘continuous viral reservoirs’, thereby supporting the development of new viral mutations. Prevention of infections, or at least reducing disease severity, is therefore warranted.”
And, also good to know :
“… considering the relatively low response rates reported in multiple myeloma patients that were vaccinated with anti-influenza or pneumococci vaccines approaching 20%–30% only.”
The study was performed in Tel Aviv, Israel and included a cohort of 171 patients (159 active myeloma patients and 12 smoldering myeloma patients) and 64 age compatible healthy volunteers. The active myeloma patient pool characteristics can be summarized as follows:
|Characteristic||% of Patients|
|Median Age||70 years|
|Standard Risk Cytogenetics||74%|
|High Risk Cytogenetics||26%|
|Patients Receiving IVIG Therapy||16%|
|Treatment Regimen at time of vaccination includes:|
|Immunomodulator (e.g. Revlimid)||
|Proteasome inhibitor (e.g. Velcade)||46%|
|Immunomodulator + proteasome inhibitor||20%|
|Number of Lines of Therapy:|
|3 or greater||37%|
|Prior stem cell transplant||60%|
|Time since transplant (median)||36 months|
|Myeloma treatment response at time of vaccination||72%|
|Very good partial response or better||86%|
Patients were vaccinated 21 days apart, consistent with the manufacturer’s vaccination guidelines. The “best time” to vaccinate the myeloma patients was decided to be:
Key results can be summarized as follows:
|Median Antibody Response||U/mL|
|All active myeloma||91|
|Active myeloma that responded to the vaccine||218|
With respect to the large difference to the antibody titer levels between MM patients that responded to the vaccine and the healthy patients, the researchers specifically state:
“There are currently no sufficient data regarding the clinical significance of achieving a high- versus a low-antibody titer following vaccination and the antibody titer cut-off that predicts an efficient and durable immunity is not yet determined. However, achievement of a higher antibody titer may theoretically predict a longer immunity (as reported for some other vaccines)” [emphasis added]
In other words, medical science does not yet know at which antibody level a patient has solid immunity against Covid exposure following vaccination, though it seems reasonable to assume that “the higher, the better."
Response to the vaccine seems to be impacted by several factors:
The researchers conclude:
”…, considering the poor outcome of MM patients infected with COVID19, together with the high seropositivity rate to BNT162b2 mRNA COVID19 vaccine, we recommend to vaccinate all MM patients with mRNA anti-COVID vaccine.”
I highly recommend that you read the article referenced above and provided in the link. It is written in very plain, easy to understand English. The full article will not only provide you with some additional knowledge and understanding but will also give you some additional nuances that I was not able to capture in this summary post.
about the author
I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find successful treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and two grandsons who are the ‘lights of our lives’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs. I am a firm believer that staying mentally active, physically fit, compliant to our treatment regimen and taking an active interest in our disease are keys to successful treatment outcomes.