Contributions
Abstract: PB2154
Type: Publication Only
Background
Patients with myeloma are at increased risk of infective complications and current international guidelines recommend the use of immunization against S. pneumoniae, H. influenzae and influenza A and B. Prior studies assessing response to influenza vaccine have demonstrated poor rates of seroconversion. Modern myeloma therapy is based around combinations of immunosuppressive proteasome inhibitors (PI) and immunomodulatory (IMiD) agents.
Aims
We sought to assess the rate of seroconversion in patients with myeloma receiving different treatment regimens.
Methods
This study was conducted as a pilot study. Patients had serological assessment for the pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F prior to vaccination with the 23-valent purified polysaccharide vaccine Prevenar 23 using an ELISA platform. Repeat serology was taken approximately six weeks following vaccine administration. Patients were stratified in to three groups based on whether they were newly diagnosed (vaccinated prior to any therapy), or currently on (or within three months of ceasing) either PI or IMiD based therapy. An appropriate response was defined as a four-fold increase in antibody concentrations or an absolute value increase of >1.3 ug/mL. An optimal response was defined as an appropriate response in >75% of tested serotypes (>5 of the 7 tested serotypes).
Results
A total of 63 patients were vaccinated and had baseline serology, 51 follow-up serology samples were available for analysis. Median age was 67 (range 43-89), and 42 (67%) patients were male. Median ages did not differ between treatment groups. There was a significant difference between weekly dexamethasone dose (49mg vs 17.5mg vs 30.7mg, p<0.001), prior lines of therapy (0 vs 1.9 vs 0.89, p=0.002), paraprotein size (32 vs 5.5 vs 14.6g/L p<0.001) and level of residual gamma globulins (3 vs 5.4 vs 4.1g/L, p=0.003). Baseline pre-vaccination anti-Pneumococcal IgG antibody geometric mean concentrations (GMCs) were 0.12, 0.21, 0.16, 0.47, 0.20, 0.34 and 0.20 respectively for serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. Post vaccination GMCs were 0.34, 0.61, 0.56, 2.25, 1.26, 1.05 and 0.55. One-way ANOVA demonstrated significant increases in antibody concentration (P<0.001) however with differences only seen with serotypes 14 and 18. 41 (80%) patients responded to at least one serotype. Median number of seroconverted serotypes was 3 (IQR = 4). 18 (35%) had an optimal response to vaccination. There was one case of documented Pneumococcal infection following vaccination. Two-way ANOVA demonstrated a difference in response between serotypes (p<0.001) but not treatment group (p=0.36).
Conclusion
Baseline levels of pneumococcal immunity in this population are low. Although most patients are capable of seroconverting to at least one serotype, the rates of protective post-vaccination antibody concentrations remain low. Choice of therapy does not appear to influence seroconversion rates however this may be confounded by other clinical and disease related factors.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Infection, Myeloma, Vaccination
Abstract: PB2154
Type: Publication Only
Background
Patients with myeloma are at increased risk of infective complications and current international guidelines recommend the use of immunization against S. pneumoniae, H. influenzae and influenza A and B. Prior studies assessing response to influenza vaccine have demonstrated poor rates of seroconversion. Modern myeloma therapy is based around combinations of immunosuppressive proteasome inhibitors (PI) and immunomodulatory (IMiD) agents.
Aims
We sought to assess the rate of seroconversion in patients with myeloma receiving different treatment regimens.
Methods
This study was conducted as a pilot study. Patients had serological assessment for the pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F prior to vaccination with the 23-valent purified polysaccharide vaccine Prevenar 23 using an ELISA platform. Repeat serology was taken approximately six weeks following vaccine administration. Patients were stratified in to three groups based on whether they were newly diagnosed (vaccinated prior to any therapy), or currently on (or within three months of ceasing) either PI or IMiD based therapy. An appropriate response was defined as a four-fold increase in antibody concentrations or an absolute value increase of >1.3 ug/mL. An optimal response was defined as an appropriate response in >75% of tested serotypes (>5 of the 7 tested serotypes).
Results
A total of 63 patients were vaccinated and had baseline serology, 51 follow-up serology samples were available for analysis. Median age was 67 (range 43-89), and 42 (67%) patients were male. Median ages did not differ between treatment groups. There was a significant difference between weekly dexamethasone dose (49mg vs 17.5mg vs 30.7mg, p<0.001), prior lines of therapy (0 vs 1.9 vs 0.89, p=0.002), paraprotein size (32 vs 5.5 vs 14.6g/L p<0.001) and level of residual gamma globulins (3 vs 5.4 vs 4.1g/L, p=0.003). Baseline pre-vaccination anti-Pneumococcal IgG antibody geometric mean concentrations (GMCs) were 0.12, 0.21, 0.16, 0.47, 0.20, 0.34 and 0.20 respectively for serotypes 4, 6B, 9V, 14, 18C, 19F and 23F. Post vaccination GMCs were 0.34, 0.61, 0.56, 2.25, 1.26, 1.05 and 0.55. One-way ANOVA demonstrated significant increases in antibody concentration (P<0.001) however with differences only seen with serotypes 14 and 18. 41 (80%) patients responded to at least one serotype. Median number of seroconverted serotypes was 3 (IQR = 4). 18 (35%) had an optimal response to vaccination. There was one case of documented Pneumococcal infection following vaccination. Two-way ANOVA demonstrated a difference in response between serotypes (p<0.001) but not treatment group (p=0.36).
Conclusion
Baseline levels of pneumococcal immunity in this population are low. Although most patients are capable of seroconverting to at least one serotype, the rates of protective post-vaccination antibody concentrations remain low. Choice of therapy does not appear to influence seroconversion rates however this may be confounded by other clinical and disease related factors.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Infection, Myeloma, Vaccination