Adequate Antibody Response to COVID-19 Vaccine in Patients With Monoclonal Gammopathies and Light Chain Amyloidosis

Alan H.B. Wu, PhD; Chia-Ching Wang, MD; Chui Mei Ong, BS; Kara L. Lynch, PhD

Disclosures

Lab Med. 2022;53(3):314-319. 

In This Article

Abstract and Introduction

Abstract

Objective: Determine the COVID-19 seroconversion rate for patients with multiple myeloma receiving a COVID-19 vaccine.

Materials and Methods: After 45 patients received their second COVID-19 vaccine dose, their serum IgG antibodies were measured: 22 with monoclonal gammopathy (MG) of unknown significance, 3 with smoldering myeloma, 2 with light chain amyloidosis, and 18 with MG (9 in remission, 6 out of remission, and 3 with free light-chain gammopathy alone). A second serum specimen was retained for 16 patients with MG. Their antibody levels were compared to those of 78 uninfected healthy vaccinated control patients.

Results: Three patients with MG had low antibody levels on blood collected 98, 100, and 113 days after the initial vaccine dose (2 with MG of unknown significance and 1 with hypogammaglobulemia). The other 40 patients with MG (seroconversion rate 93%) and both patients with amyloidosis produced antibodies. Relative to days after vaccination, patients with MG had lower antibody levels than control patients.

Conclusion: After receiving a COVID-19 vaccine, most patients with MG produce anti-SARS-CoV-2 antibodies comparable to levels in uninfected vaccinated healthy control patients.

Introduction

In the past century, there have been several major pandemics caused by viral infections. The development and implementation of vaccines are among the key measures to arrest these outbreaks. Although smallpox has been eradicated and polio has largely been eliminated, influenza continues to be a major health concern, and there are no vaccines available for HIV. The release of vaccines has reduced the incidence and severity of SARS-CoV-2, the causative agent producing COVID-19. As of this report, 3 vaccines have been approved by the U.S. Food & Drug Administration under emergency use authorization. The Pfizer-BioNTech and Moderna vaccines are based on mRNA technology, and the Johnson & Johnson vaccine uses a modification of an adenovirus. Other COVID-19 vaccines are available in other parts of the world.

Multiple myeloma (MM) is a disease associated with impaired immunity, which is a manifestation of both the disease itself and the treatment given. Smoldering multiple myeloma (SMM) is a precancerous condition that is characterized by lower concentrations of myeloma proteins and the absence of symptoms. Monoclonal gammopathy of unknown significance (MGUS) is a benign condition. Both MGUS and SMM are not treated but can progress to MM over time. Amyloidosis is a disease characterized by the presence of misfolded proteins that deposit into various solid organs of the body. The most common form found in the United States is amyloid light chain (AL) amyloidosis. Many patients have excess free lambda light chains. Immunomodulatory treatment of amyloidosis[1] and medications to prevent organ transplant rejection result in immunosuppression.

The International Myeloma Working Group examined patients with myeloma who contracted COVID-19 and found significantly higher risks for death (33%) relative to individuals who had no preexisting chronic disease.[2] Therefore, vaccination against SARS-CoV-2 is recommended by many physicians.[3] There is no guarantee that a vaccination will necessarily produce adequate immune protection. In a study of a high-dose influenza vaccine, Branagan et al[4] showed that only 39% of patients with MM developed antibodies against 3 flu strains (H1N1, H3N2, and influenza B). Higher rates of antibody production were observed with administration of a booster injection, a procedure that is not routinely performed for infection prophylaxis among healthy individuals. The vaccine used in their study was an inactivated influenza virus and different in principle from 2 mRNA vaccines released in later 2019. It is not known if the mRNA vaccines are indeed more immunogenic.

The purpose of this study was to examine COVID-19 antibody levels in patients with MM (active and in remission), SMM, MGUS, and AL after administration of a COVID-19 vaccine.

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