Most patients with multiple myeloma demonstrated antibody responses after administration of 2 different pneumococcal vaccines administered an average of 30 days apart; however, these responses diminished over time. The findings from this small prospective study were published in Cancer Medicine.
Infections, including pneumococcal infection with Streptococcus pneumoniae, are a major cause of morbidity and mortality in patients with multiple myeloma. This is likely due, at least in part, to the presence of hypogammaglobulinemia, resulting from infiltration of tumor plasma cells into the bone marrow and the subsequent replacement of gamma globulin-producing plasma cells. Although infection prophylaxis with vaccines (in addition to antibiotic prophylaxis and administration of immunoglobulins) is a common approach for patients with multiple myeloma, humoral (ie, antibody-mediated) and cellular immune responses to vaccination have not been well characterized in this setting.
In this study, 2 pneumococcal vaccines (Prevar 13, a 13-valent conjugated vaccine, and Pneumo 23, a 23-valent polysaccharide vaccine) were administered an average of 30 days apart (range, 0‐119 days) to patients with multiple myeloma by their primary care provider. Blood specimens were obtained at baseline prior to vaccination and on day 1 of every treatment cycle. Specific immunoglobulin isotype levels were measured for antipneumococcal capsular polysaccharide for 23 serotypes (anti-PCP23) using an enzyme-linked immunosorbent assay.
Primary end point was incidence of isotype response serum concentration after administration of the 2 vaccines. Secondary end points included detailed isotype increase; time to first increase; further assessment of a decreased antipneumococcal serum concentration following treatment, including autologous stem cell transplantation (ASCT); and rate of infection with special attention to pneumococcal infection, the study authors noted.
Of the 28 patients included in the study, 25 patients had newly diagnosed multiple myeloma. Twenty-seven patients had hypogammaglobulinemia at baseline. Patients with new diagnoses received induction therapy with triplet therapy, including a proteasome inhibitor, and 10 patients underwent ASCT. Induction therapy could be administered after first and prior to second vaccination. Of the 3 patients who did not have newly diagnosed disease, 2 were in a first relapse and 1 was in a second relapse. Data related to immune response to vaccination were available for 20 patients.
A central finding of this study was that immune responses were observed within 1 week of vaccination for most patients, and at least 1 anti-PCP23 isotype (eg, IgG, IgG2, IgM, and IgA) was measured in 85% of vaccinated patients, with at least 2 antibody isotypes against PCP23 observed in 65% of patients and 3 observed in 55% of patients. In addition, levels of PCP23 isotypes were highest when the interval between vaccinations was more than 30 days.
With a median follow-up of 224 days, a decline in all antibodies against PCP23 was observed over time, and this decrease was particularly notable following ASCT.
“These data tend to confirm that multiple myeloma can respond to vaccination at diagnosis and relapse, but tend[s] to lose this response overtime, especially if further immunocompromised with a myeloablative treatment approach,” the study authors commented.
Although severe infections developed in 18% of patients, no patients developed pneumococcal infection.
Limitations of this study noted by the authors include its small size, as well as the wide range in the period between first and second vaccination.
“A response to pneumococcal vaccine, independently of preexisting hypogammaglobulinemia and disease response and possibly of treatment-induced immunodepression, with an expected drop of response over time and immediately following autologous transplantation [was demonstrated]. This response tends to be associated with protection against pneumococcal infection,” the study authors stated in their conclusion.
Renaud L, Schraen S, Fouquet G, et al. Response to pneumococcal vaccination in multiple myeloma [published online May 30, 2019]. Cancer Med. doi: 10.1002/cam4.2253