Antibody Responses to COVID-19 Vaccination in Patients with Monoclonal Gammopathies and Light Chain Amyloidosis

Patients with monoclonal gammopathies (MG) have a higher risk for infections than healthy people due to both the disease itself and therapy. They may also have poor responses to vaccination. To determine whether patients with MG respond to COVID-19 vaccines, a new study examined COVID-19 antibody levels after vaccination in these individuals.

The study included patients with several related diseases. There were 45 patients in the study: 22 with MG of unknown significance, 3 with smoldering multiple myeloma, 18 with multiple myeloma, and 2 with light chain amyloidosis. Of the patients with multiple myeloma, 3 had free light chain gammopathy only and 6 had hypogammaglobulinemia.

Blood samples used in the study were collected for routine disease monitoring. The investigators tried to rule out previous COVID-19 infection by examining medical records for SARS-CoV-2 polymerase chain reaction test results. They also measured antibodies specific to nucleocapsid protein to distinguish infection from vaccination. This screening step was important because the assay for IgG antibodies against COVID-19 that the investigators used to measure vaccine response cannot distinguish between antibodies produced in response to natural infection and those produced in response to vaccination. Four patients were included whom had no history of infection but not enough sample volume to measure antinucleocapsid protein antibodies.

One patient was vaccinated with the Johnson & Johnson vaccine, 28 with the Moderna vaccine, and 16 with the Pfizer vaccine.

Controls were 78 healthcare workers who had not been infected with COVID-19. Of the control group, 37 received the Moderna vaccine, 41 received the Pfizer vaccine, and none received the Johnson & Johnson vaccine.

The investigators found that 42 of 45 patients with MG had IgG antibodies to COVID-19 above the cutoff for a positive response except for 3 patients whose samples were taken at least 94 days after the first vaccination dose. Of the 3 patients who did not respond to vaccination, 1 had MG with hypogammaglobulinemia and 2 had MG of unknown significance. Both patients with amyloidosis developed antibody responses to vaccination.

The seroconversion rate was 93% in patients with MG compared with 99% in the control group. These results showed that almost all patients were able to generate a response to COVID-19 vaccination.

These results are similar to those of other recent reports of COVID-19 vaccine responses in patients with multiple myeloma. The investigators noted that 93% seroconversion in patients with MG is a much higher response rate than other studies have found in patients who are taking immunosuppressive therapies after solid organ transplant.

Finally, the investigators wrote that their findings suggest that patients with multiple myeloma should be screened for vaccine response to identify the few who may be nonresponders.

Source: Wu AHB, Wang CC, Ong CM, Lynch KL. Adequate antibody response to COVID-19 vaccine in patients with monoclonal gammopathies and light chain amyloidosis. Lab Med. 2022;lmab113.

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