key: cord-0721042-0wtatqfx
authors: Lockmer, Sandra; Uttervall, Katarina; Kashif, Muhammad; Svärd, Carina; Malmsten, Katarina; Fletcher‐Torres, Evellyn; Alici, Evren; Lund, Johan; Nahi, Hareth
title: Antibody response to COVID‐19 mRNA vaccine (Comirnaty) in myeloma patients treated with high‐dose melphalan and/or immunotherapy
date: 2021-09-22
journal: Am J Hematol
DOI: 10.1002/ajh.26348
sha: 590b72c865036a40d825694587fff3d7d5ee5c09
doc_id: 721042
cord_uid: 0wtatqfx

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Additional supporting information may be found in the online version of the article at the publisher's website. Received We categorized the patients, on the basis of their current treatment status, into non-ongoing (n = 31), and ongoing (n = 62) treatment groups. Patients with non-ongoing treatment showed significantly higher SP levels (p = 0.002) than patients with ongoing treatment (see Table 1 ). Importantly (n = 7) also had a significant reduction in SP (p = 0.01) (see Table 1 ).

Machine learning using an ensemble method random-forest ranked daratumumab (more than once per month), anti-BCMA and dexamethasone as top three important variables in predicting the categories of SP response. This study illustrates the safety and tolerability of BNT162b2 vaccine. It highlights the benefit in patients with MM previously treated with ASCT regardless when the vaccine was given from the ASCT date, but also patients on antibody treatment whose response was inadequate. Our findings suggest that this type of vaccine can induce an antibody response while maintaining a tolerable safety profile, which is of great importance in this population.

In an earlier study by Avivi et al., 5 the BNT162b2 vaccine was found to be safe and to provide a high seropositivity rate after two T A B L E 1 Effect of treatments and clinical parameters on the levels of spike proteins in the NT162b2 vaccinated patients (n = 93) In this study, we found that anti-BCMA, daratumumab (more than once per month) and dexamethasone treatments are strongly associated with lower SP levels, results that are well in line with those reported by Oekelen et al. 7 It had already been shown that 6 daratumumab treatment tended towards reduced response, but the association was not significant for any agent included in a combination regimen.

In this study we did not monitor the T-cell immunity as a response to the vaccination and thus the results need to be interpreted with caution. None of the patients reported a serious unexpected adverse event.

In conclusion, the BNT162b2 mRNA vaccine against SARS CoV-2

virus was found to be safe and often efficient (73% responded) in inducing an antibody response in patients with MM. Response to vaccination seems to be affected more by the type of ongoing treatment than by the current presentation of disease. In our study anti-BCMA therapy and frequent administration of daratumumab (more than once per month) were the strongest predictors of a reduced response.

Future randomized trials will be needed to validate if withholding of the ongoing antibody/dexamethasone treatment promotes better responses to COVID-19 vaccination.

This work was supported by Cancerfonden, grant number 190190 Pj01.

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