Patients with multiple myeloma (MM) and Waldenström macroglobulinemia (WM) often have impaired immune responses, raising concerns about the effectiveness and durability of COVID-19 vaccines in these populations. Researchers of a prospective clinical trial (NCT04830046) assessed the response to mRNA-1273 (Moderna), BNT162b2 mRNA (Pfizer/BioNTech), and JNJ-78436735 (Johnson & Johnson) vaccines in 148 patients (98 MM and 50 WM). After the primary vaccination series, the median SARS-CoV-2 spike protein (S) antibody titer was 178 U/mL for MM and 2.38 U/mL for WM. S antibody response rates were 91.7% in MM and 57.1% in WM, with adequate response rates (>250 U/mL) of 45.8% in MM and 26.5% in WM. Booster doses significantly improved these rates, with second boosters achieving 90.6% in MM and 88.8% in WM. At 12 months, 84.8% of patients with MM and 86.8% of patients with WM maintained S antibody levels >250 U/mL.

During the study, 15% of patients experienced SARS-CoV-2 infections, with severe cases in 2.7% of patients, all in the MM group. A higher risk of infection was noted among non-Caucasian participants. The study highlights that optimal protection was achieved with at least four vaccine doses, showing that booster vaccinations are crucial for maintaining adequate antibody levels in patients with MM and patients with WM.

Reference: Branagan AR, Lei MM, Mo CC, et al. Clinical Effectiveness and Long-Term Serologic Responses of COVID-19 Vaccination in Patients with Multiple Myeloma and Waldenström Macroglobulinemia. Blood. 2022;140:10094–6. doi: 10.1182/blood-2022-167899.