Development of antibody response to SARS‐CoV‐2 following asymptomatic infection in patients with plasma cell disorders on immunomodulatory therapy

Chan, Wei Yee; Sanchez, Emilie; Chavda, Selina J; Lecat, Catherine; Ainley, Louise; Xu, Ke; Wisniowski, Brendan; Mahmood, Shameem; Papanikolaou, Xenofon; Kyriakou, Charalampia; Sive, Jonathan; Wechalekar, Ashutosh; Popat, Rakesh; Rabin, Neil; Lee, Lydia; Nastouli, Eleni; Yong, Kwee

doi:10.1111/bjh.17441

Cited by 3 publications

(3 citation statements)

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“…A clinical audit was conducted at University College London Hospitals between December 2020 and July 2021 of anti‐spike protein antibody testing in patients with PCDs after each vaccine dose. Some had routine nucleocapsid antibody monitoring, 7 those receiving chemo‐immunotherapy (CIT) have 4‐weekly routine swabs. Patient and treatment characteristics were retrieved from medical records (Table SI ).…”

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confidence: 99%

Serological response to the BNT162b2 mRNA or ChAdOx1 nCoV‐19 COVID‐19 vaccine after first and second doses in patients with plasma cell disorders: influence of host and disease factors

et al. 2021

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confidence: 99%

Serological response to the BNT162b2 mRNA or ChAdOx1 nCoV‐19 COVID‐19 vaccine after first and second doses in patients with plasma cell disorders: influence of host and disease factors

et al. 2021

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“…The breadth of immune response against SARS-CoV-2 variants is also wider following infection than after vaccination [ 129 ]. Studies have shown mixed results regarding the serological response following COVID-19 in patients with plasma cell dyscrasias [ 130 , 131 ]. Interestingly, SARS-CoV-2 infection may induce superior humoral responses compared to the initial two-dose vaccination scheme in patients with MM on active treatment [ 132 ].…”

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confidence: 99%

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

et al. 2023

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In the post-pandemic COVID-19 period, human activities have returned to normal and COVID-19 cases are usually mild. However, patients with multiple myeloma (MM) present an increased risk for breakthrough infections and severe COVID-19 outcomes, including hospitalization and death. The European Myeloma Network has provided an expert consensus to guide patient management in this era. Vaccination with variant-specific booster vaccines, such as the bivalent vaccine for the ancestral Wuhan strain and the Omicron BA.4/5 strains, is essential as novel strains emerge and become dominant in the community. Boosters should be administered every 6–12 months after the last vaccine shot or documented COVID-19 infection (hybrid immunity). Booster shots seem to overcome the negative effect of anti-CD38 monoclonal antibodies on humoral responses; however, anti-BCMA treatment remains an adverse predictive factor for humoral immune response. Evaluation of the immune response after vaccination may identify a particularly vulnerable subset of patients who may need additional boosters, prophylactic therapies and prevention measures. Pre-exposure prophylaxis with tixagevimab/cilgavimab is not effective against the new dominant variants and thus is no longer recommended. Oral antivirals (nirmatrelvir/ritonavir and molnupiravir) and remdesivir are effective against Omicron subvariants BA.2.12.1, BA.4, BA.5, BQ.1.1 and/or XBB.1.5 and should be administered in MM patients at the time of a positive COVID-19 test or within 5 days post symptoms onset. Convalescent plasma seems to have low value in the post-pandemic era. Prevention measures during SARS-CoV-2 outbreaks, including mask wearing and avoiding crowded places, seem prudent to continue for MM patients.

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“…Cancer patients, including those with hematological malignancies [ 2 , 3 ] such as multiple myeloma (MM) and other plasma cell disorders (PCD) [ 4 ], have a higher risk for a severe outcome following infection with SARS-CoV-2 [ 5 – 7 ].…”

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confidence: 99%

Anti-RBD IgG antibodies and neutralizing antibody levels after the second BNT162b2 dose in patients with plasma cell disorders

et al. 2023

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Patients with plasma cell disorders (PCD) are at an increased risk for severe morbidity and mortality due to COVID-19. Recent data have suggested that patients with hematological malignancies, including those with PCD, have suboptimal antibody response to COVID-19 vaccination. We compared the antibody titers of 213 patients with PCD to those of 213 immunocompetent healthcare workers after the second vaccine dose of the BNT162b2 mRNA vaccine. Blood samples were taken 2–4 weeks after the second vaccination and analyzed for anti-receptor binding-domain immunoglobulin G (RBD-IgG) antibodies and neutralizing antibodies (NA). At a median of 20 days after the second vaccine dose, 172 patients (80.8%) developed anti-RBD-IgG antibodies with a geometric mean titer (GMT) of 2.7 (95% confidence interval [CI], 2.4–3.1). In the control group 210 (98.9%) developed anti-RBD-IgG antibodies after a median of 21 days, with a GMT of 5.17 (95%CI, 4.8–5.6), p<0.0001. NA were observed in 151 patients with MM (70.9%) and in 210 controls (98.9%). The GMT of NA in patients with MM and controls was 84.4 (95% CI, 59.0–120.6), and 420.2 (95% CI, 341.4–517.1), respectively (p<0.0001). Multivariable logistic regression revealed that the number of prior therapy lines and age were significant predictors of poor humoral response among patients with MM. Injection site reaction, headache and fatigue were the most common adverse events after vaccination. Adverse events were less common in patients with MM than in controls. In conclusion, a significant percentage of patients with MM developed protecting NA to the BNT162b2 mRNA vaccine, which appears to be safe in this patient population.

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Development of antibody response to SARS‐CoV‐2 following asymptomatic infection in patients with plasma cell disorders on immunomodulatory therapy

Cited by 3 publications

References 13 publications

Serological response to the BNT162b2 mRNA or ChAdOx1 nCoV‐19 COVID‐19 vaccine after first and second doses in patients with plasma cell disorders: influence of host and disease factors

Serological response to the BNT162b2 mRNA or ChAdOx1 nCoV‐19 COVID‐19 vaccine after first and second doses in patients with plasma cell disorders: influence of host and disease factors

Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

Anti-RBD IgG antibodies and neutralizing antibody levels after the second BNT162b2 dose in patients with plasma cell disorders

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