Immunogenicity of SARS-CoV-2 vaccines in patients with multiple myeloma: a systematic review and meta-analysis

• Published in: Blood advances 2022-12, Vol.6 (24), p.6198-6207
• Main Authors: Chuleerarux, Nipat, Manothummetha, Kasama, Moonla, Chatphatai, Sanguankeo, Anawin, Kates, Olivia S., Hirankarn, Nattiya, Phongkhun, Kasidis, Thanakitcharu, Jaedvara, Leksuwankun, Surachai, Meejun, Tanaporn, Thongkam, Achitpol, Mongkolkaew, Thanuthong, Dioverti, M. Veronica, Torvorapanit, Pattama, Langsiri, Nattapong, Worasilchai, Navaporn, Plongla, Rongpong, Chindamporn, Ariya, Gopinath, Shilpa, Nissaisorakarn, Pitchaphon, Thaniyavarn, Tany, Nematollahi, Saman, Permpalung, Nitipong
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal; COVID-19 - prevention & control; COVID-19 Vaccines - therapeutic use; Humans; Multiple Myeloma; SARS-CoV-2; Systematic Review
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2022008530

Patients with multiple myeloma (MM) have a diminished immune response to coronavirus disease 2019 (COVID-19) vaccines. Risk factors for an impaired immune response are yet to be determined. We aimed to summarize the COVID-19 vaccine immunogenicity and to identify factors that influence the humoral immune response in patients with MM. Two reviewers independently conducted a literature search in MEDLINE, Embase, ISI Web of Science, Cochrane library, and Clinicaltrials.gov from existence until 24 May 24 2022. (PROSPERO: CRD42021277005). A total of 15 studies were included in the systematic review and 5 were included in the meta-analysis. The average rate (range) of positive functional T-lymphocyte response was 44.2% (34.2%-48.5%) after 2 doses of messenger RNA (mRNA) COVID-19 vaccines. The average antispike antibody response rates (range) were 42.7% (20.8%-88.5%) and 78.2% (55.8%-94.2%) after 1 and 2 doses of mRNA COVID-19 vaccines, respectively. The average neutralizing antibody response rates (range) were 25% (1 study) and 62.7% (53.3%-68.6%) after 1 and 2 doses of mRNA COVID-19 vaccines, respectively. Patients with high-risk cytogenetics or receiving anti-CD38 therapy were less likely to have a humoral immune response with pooled odds ratios of 0.36 (95% confidence interval [95% CI], 0.18, 0.69), I2 = 0% and 0.42 (95% CI, 0.22, 0.79), I2 = 14%, respectively. Patients who were not on active MM treatment were more likely to respond with pooled odds ratio of 2.42 (95% CI, 1.10, 5.33), I2 = 7%. Patients with MM had low rates of humoral and cellular immune responses to the mRNA COVID-19 vaccines. Further studies are needed to determine the optimal doses of vaccines and evaluate the use of monoclonal antibodies for pre-exposure prophylaxis in this population.