Immune response to COVID-19 vaccination is attenuated by poor disease control and antimyeloma therapy with vaccine driven divergent T cell response
Background: Myeloma patients frequently respond poorly to bacterial and viral vaccination. Small number of studies have reported poor humoral immune responses in myeloma patients to COVID-19 vaccination. Methods: Using a prospective study of a myeloma and smouldering myeloma patients within the UK rudystudy cohort, we assessed humoral and cellular immune responses to COVID-19 vaccination post second COVID-19 vaccine administration. Findings: We report data from 214 adults with myeloma (n=204) or smouldering myeloma (n=10) who provided blood samples at least 3 weeks after second vaccine dose.Positive Anti-S antibody levels (> 50 IU/ml) were detected in 188/203 (92.5%), positive IGRA responses were seen in 102/167 (61.7%). Only 9/167 patients were identified to have both a negative IGRA and negative Anti-S protein antibody response. 100/167 (59.8%) patients produced positive results for both S protein serology and IGRA. After adjusting for disease severity and myeloma therapy, poor humoral immune response was predicted by male gender. Predictors of poor IGRA included antiCD38/ BCMA therapy and Pfizer-BioNTech vaccination.. Interpretation: A significant majority of myeloma patients elicit Anti-S protein antibody responses to COVID-19 vaccine with approximately half of myeloma patients show both positive COVID serology, and cellular responses via IGRA. Predictors of a poor immune response included male gender, myeloma therapy regimen and vaccination with Pfizer-BioNTech vaccination. Further work is needed to understand the clinical significance of patients discordant for humoral and cellular responses.