Response to COVID-19 Vaccines Varies Widely in Blood Cancer Patients
Some of these patients had undetectable antibodies after mRNA vaccines, showing need for monitoring or continued precautions
Patients with a type of blood cancer called multiple myeloma had a widely variable response to COVID-19 vaccines—in some cases, no detectable response—pointing to the need for antibody testing and precautions for these patients after vaccination, according to a study published in Cancer Cell in June.
Mount Sinai researchers found that multiple myeloma patients mount variable and sometimes suboptimal responses after receiving the Pfizer-BioNTech or Moderna COVID-19 vaccines. Almost 16 percent of these patients developed no detectible antibodies after both vaccine doses. These findings may be relevant to other cancer patients undergoing treatment and to immunocompromised patients.
“This study 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 co-lead author Samir Parekh, MD, Director of Translational Research in Multiple Myeloma at The Tisch Cancer Institute at Mount Sinai and Professor of Medicine (Hematology and Medical Oncology), and Oncological Sciences, at the Icahn School of Medicine at Mount Sinai. “This also calls for clinical trials to study the use of prophylactic therapies, like monoclonal antibodies, to mitigate COVID-19 risk or to use of different vaccines or booster vaccinations in these patients.”
COVID-19 vaccines are highly effective in preventing severe infections or death, but patients with multiple myeloma are immunocompromised and often on immunosuppressive therapy, and preliminary reports showed that the vaccines evoked a lower and delayed response in them compared to healthy people. This study was the first to analyze a large group of patients with multiple myeloma after completing both doses of vaccination and to compare their antibody response to a control group of healthy people.
“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,” said co-lead author Ania Wajnberg, MD, Director of Clinical Antibody Testing at The Mount Sinai Hospital.
Repeat antibody measurements from before patients’ first vaccine dose until 60 days after the second vaccination showed delayed and suboptimal responses, particularly in patients with multiple myeloma who had not contracted COVID-19 before their vaccinations. Patients on active cancer treatment had significantly lower antibody levels after two vaccine doses than multiple myeloma patients who were not on treatment at the time of vaccination.
Researchers analyzed the antibody levels of 320 multiple myeloma patients, 260 of whom received two doses of COVID-19 vaccinations, and found that 15.8 percent had undetectable antibodies. The multiple myeloma patients who had had COVID-19 before vaccination showed immune responses that were 10 times higher than those who had not.
Pointing to the importance of the study, 10 multiple myeloma patients who received at least one dose of COVID-19 vaccine developed COVID-19 during the study period. Four needed to be hospitalized with severe symptoms and one of them died.
The team of Mount Sinai researchers continue to study the response of these patients to COVID-19 vaccines and believe that it may be possible that patients who mount low to modest antibody responses will lose protection more rapidly than those who mount a high response.
The study was performed in collaboration with the Precision Virology/Seronet team including Viviana Simon, MD, PhD, Professor of Microbiology, and clinical and research staff at the Center of Excellence for Multiple Myeloma at Mount Sinai.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai advances medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture ambulatory surgery centers; more than 415 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. The Mount Sinai Hospital is ranked on U.S. News & World Report's "Honor Roll" of the top 20 U.S. hospitals and is top in the nation by specialty: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. Mount Sinai Kravis Children's Hospital is ranked in U.S. News & World Report’s “Best Children’s Hospitals” among the country’s best in four out of 10 pediatric specialties. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and No. 14 in the nation for National Institutes of Health funding. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.