Immunogenicity and persistence of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) in patients with untreated Smoldering Multiple Myeloma (SMM): A pilot study.
Immunogenicity and persistence of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) in patients with untreated Smoldering Multiple Myeloma (SMM): A pilot study.
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DOI：
10.1016/j.heliyon.2017.e00441
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发表时间：
2017-11
期刊：
影响因子：
4
通讯作者：
Fermand JP
中科院分区：
文献类型：
--
作者：
Bahuaud M;Bodilis H;Malphettes M;Maugard Landre A;Matondo C;Bouscary D;Batteux F;Launay O;Fermand JP
郁积型多发性骨髓瘤（SMM）是一种无症状的克隆性浆细胞疾病，经常进展为多发性骨髓瘤（MM），一种肺炎球菌感染的高风险疾病。此外，如果多糖疫苗在MM中的免疫原性差，则13价缀合疫苗从未在克隆性浆细胞疾病中进行过测试。我们在20例年龄≥ 50岁的郁积型多发性骨髓瘤（SMM）患者中评价了PCV 13常规接种前后7种血清型的免疫原性。通过标准化ELISA和调理吞噬试验（OPA），在基线、接种后1、6和12个月测量7种血清型特异性IgG浓度。主要终点是在1个月时通过ELISA对7种血清型中至少5种血清型应答的患者比例。在疫苗接种后1个月，12名患者（60%）通过ELISA检测为应答者，其中8名患者也通过OPA检测为应答者。在6个月时，12名应答者中有6名（占总数的30%）具有持续免疫力，在12个月时仅2名（占总数的10%）。这些结果表明，在该人群中出现部分应答，并且在接种疫苗的头几个月抗体水平迅速下降。虽然13价肺炎球菌结合疫苗的一次注射在某些SMM患者中具有免疫原性，但应答是短暂的。可能需要重复注射以获得有效和持续的保护。
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder that frequently progress to multiple myeloma (MM), a disease at high risk of pneumococcal infections. Moreover, if the polysaccharide vaccine is poorly immunogenic in MM, the 13-valent conjugated vaccine has never been tested in clonal plasma cell disorders. We evaluated its immunogenicity for 7 serotypes in 20 patients ≥ 50 years of age with smoldering multiple myeloma (SMM) pre and post routine-vaccination with PCV13. Concentrations of IgG specific for 7 serotypes were measured at baseline, 1, 6, and 12 months after vaccination by standardized ELISA and an Opsonophagocytic Assay (OPA). The primary endpoint was the proportion of patients responding to at least 5 of the 7 serotypes by ELISA at one month. At 1 month post vaccination, 12 patients (60%) were responders by ELISA, among whom 8 were also responders by OPA. At 6 months, 6 (30% of total) of the 12 responders had persistent immunity, and only 2 (10% of total) at 12 months. These results suggested a partial response in this population and a rapid decrease in antibody levels in the first months of vaccination. Although one injection of the 13-valent pneumococcal conjugate vaccine is immunogenic in some patients with SMM, the response is transient. Repeated injections are likely to be needed for effective and sustained protection.