Response to first vaccination against SARS-CoV-2 in patients with multiple myeloma.
Response to first vaccination against SARS-CoV-2 in patients with multiple myeloma.
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DOI：
10.1016/s2352-3026(21)00110-1
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Boyd K
中科院分区：
文献类型：
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作者：
Bird S;Panopoulou A;Shea RL;Tsui M;Saso R;Sud A;West S;Smith K;Barwood J;Kaczmarek E;Panlaqui C;Kaiser M;Stern S;Pawlyn C;Boyd K
多发性骨髓瘤是浆细胞恶性肿瘤，与免疫抑制密切相关。与此一致，多发性骨髓瘤患者感染COVID-19的结局报告显示，严重疾病的发生率高于一般人群。1，2保护这一弱势患者群体免受COVID-19感染至关重要，但多发性骨髓瘤患者对新疫苗的反应尚不清楚。最近的一份报告显示，癌症患者对辉瑞疫苗的抗SARS-CoV-2 IgG反应较低，其中包括38名血液恶性肿瘤患者（9名多发性骨髓瘤患者），反应率仅为13%，这引起了人们对多发性骨髓瘤可能与减弱的疫苗反应有关的担忧。3在英国，辉瑞和阿斯利康疫苗的第一次和第二次接种间隔为12周。我们回顾性评估了我们中心多发性骨髓瘤患者首次接种SARS-CoV-2疫苗后的血清学反应。如果患者在接种疫苗后21天或更长时间内诊断为多发性骨髓瘤并获得抗SARS-CoV-2刺突蛋白S1 IgG抗体结果，则符合条件。实验室检测和数据分析详情见附录（第1-2页）。数据收集和分析由皇家马斯登临床研究委员会批准。所纳入的93例患者的临床特征见表和附录第2页。患者接受了中位1线（IQR 1-2，范围0-8）既往治疗，66例（71%）患者在接种疫苗时正在接受治疗。48例（52%）患者在接种疫苗时完全缓解或非常好的部分缓解，而16例（17%）患者部分缓解，27例（29%）患者疾病稳定或疾病进展。在43例（46%）患者中确定了免疫轻瘫。在接种后33天（IQR 28-38，范围21-61）的中位数时进行抗体状态分析。在93名患者中，52名（56%[95%CI 46-66]）在接种疫苗后21天或更长时间进行的血液检测中检测出SARS-CoV-2 IgG抗体阳性。接受辉瑞和阿斯利康疫苗的患者之间阳性结果的百分比没有差异（表）。在亚组分析中，基于年龄、性别、疾病同种型、白细胞减少症或从接种疫苗到抗体检测的时间的血清阳性率没有差异（表）。然而，良好缓解（完全缓解或非常好的部分缓解）或部分缓解患者与疾病稳定或疾病进展患者之间的血清阳性率不同（表1，附录p3）。其他功能，
Multiple myeloma is a malignancy of plasma cells, which is highly associated with immune suppression. Consistent with this, reports of outcomes of COVID-19 infection in patients with multiple myeloma show higher rates of severe disease than in the general population. 1, 2 Protection of this vulnerable patient group from COVID-19 infection is crucial but response to the new vaccines in patients with multiple myeloma is unknown. A recent report showing low anti-SARS-CoV-2 IgG response to the Pfizer vaccine in patients with cancer included 38 patients with haematological malignancies (nine patients with multiple myeloma) and showed only a 13% response rate, raising concerns that multiple myeloma might be associated with attenuated vaccine response. 3 In the UK, both Pfizer and AstraZeneca vaccines have been used with spacing of 12 weeks between the first and second doses. We retrospectively assessed serological response following the first SARS-CoV-2 vaccine dose in patients with multiple myeloma in our centre. Patients were eligible if they had a diagnosis of multiple myeloma and an anti-SARS-CoV-2 spike protein S1 IgG antibody result 21 days or more postvaccination. Details of the laboratory testing and data analysis are in the appendix (pp 1–2). Data collection and analysis was approved by the Royal Marsden Committee for Clinical Research.Clinical characteristics of the 93 patients included are shown (table and appendix p 2). Patients had received a median of one (IQR 1–2, range 0–8) previous line of therapy and 66 (71%) patients were on therapy at the time of vaccination. 48 (52%) patients were in a complete response or very good partial response at the time of vaccination compared with 16 (17%) patients in partial response and 27 (29%) patients with stable disease or progressive disease. Immunoparesis was identified in 43 (46%) patients. Analysis of antibody status occurred at a median of 33 days (IQR 28–38, range 21–61) following vaccination. Of the 93 patients, 52 (56%[95% CI 46–66]) tested positive for SARS-CoV-2 IgG antibodies on a blood test taken 21 days or more post-vaccination. There was no difference in the percentage of patients with a positive result between those who received the Pfizer and AstraZeneca vaccines (table). On subgroup analysis there was no difference in seropositive rates based on age, sex, disease isotype, leucopenia, or time from vaccination to antibody test (table). However, seropositive rates were different between patients with a good response (complete response or very good partial response) or partial response and those with stable disease or progressive disease (table 1, appendix p 3). Other features with a