Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
Int J Hematol. 2022 May;115(5):737-747. doi: 10.1007/s12185-022-03300-4. Epub 2022 Feb 21.
We conducted a prospective, three-center, observational study in Japan to evaluate the prevalence of seropositivity and clinically protective titer after coronavirus disease 2019 vaccination in patients with plasma cell dyscrasia(PCD). Two-hundred sixty-nine patients with PCD [206 symptomatic multiple myeloma (MM)] were evaluated. Seropositivity was observed in 88.7% and a clinically protective titer in 38.3% of MM patients, both of which were significantly lower than those of healthy controls. Patients receiving anti-CD38 antibodies had much lower antibody titers, but antibody titers recovered in those who underwent a wash-out period before vaccine administration. Older age (≥65), anti-CD38 antibody administration, immunomodulatory drugs use, lymphopenia (<1000/μL), and lower polyclonal IgG (<550 mg/dL) had a negative impact for the sufficient antibody production according to multivariate analysis. Patients with clinically protective titer had a significantly higher number of CD19+ lymphocytes than those with lower antibody responses (114 vs. 35/μL, p = 0.016). Our results suggested that patients with PCD should be vaccinated, and that the ideal protocol is to temporarily interrupt anti-CD38 antibody therapy for a "wash-out" period of a few months, followed by a (booster) vaccine after the B-cells have recovery.
我们在日本进行了一项前瞻性、三中心、观察性研究，以评估浆细胞疾病（PCD）患者在感染 2019 冠状病毒病（COVID-19）后的血清阳性率和临床保护滴度。共评估了 269 例 PCD 患者[206 例有症状多发性骨髓瘤（MM）]。MM 患者的血清阳性率为 88.7%，临床保护滴度为 38.3%，均显著低于健康对照组。接受抗 CD38 抗体治疗的患者抗体滴度明显较低，但在疫苗接种前进行冲洗期后，抗体滴度恢复。根据多变量分析，年龄较大（≥65 岁）、使用抗 CD38 抗体、免疫调节剂、淋巴细胞减少症（<1000/μL）和较低的多克隆 IgG（<550mg/dL）对产生足够的抗体产生有负面影响。具有临床保护滴度的患者的 CD19+淋巴细胞数量明显高于抗体反应较低的患者（114 与 35/μL，p=0.016）。我们的研究结果表明，PCD 患者应进行接种，理想的方案是暂时中断抗 CD38 抗体治疗几个月的“冲洗”期，然后在 B 细胞恢复后进行（加强）疫苗接种。
