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First Covid jab provides protection for most myeloma blood cancer patients

A single dose of a Covid-19 vaccine triggers an immune response in around 70 per cent of patients with myeloma – suggesting that it does provide protection against the virus.

20 April 2021

Researchers tested for Covid-19 coronavirus antibodies in 93 people with the blood and bone marrow cancer, myeloma. A recent report with a smaller number of patients with myeloma suggested that blood cancer patients might receive limited protection after vaccination.

The study, led by The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, aimed to find out whether vaccine protocols needed to change for this group of cancer patients.

Myeloma is a cancer of the immune cells produced in the bone marrow. The disease puts patients at greater risk of severe Covid-19 infection and there were concerns that it could also cause them to have less protection in response to any vaccine.

The researchers tested the blood of patients who had received a first dose of vaccine, looking for SARS-CoV-2 immunoglobulin G (IgG) antibodies - an indicator of whether an individual has developed some immunity to Covid-19. They found that 56 per cent of the myeloma patients (52 of 93) tested positive for the coronavirus IgG antibodies. 

When the researchers further analysed the blood of 40 of the patients who tested negative to see if they had other types of antibody indicating some immune protection against Covid-19, they found an additional 13 patients had some anti-SARS-CoV-2 antibodies. Around 70 per cent of the patients with myeloma tested therefore had an immune response to the vaccine.

The research is published in the journal The Lancet Haematology today and was carried out by clinical academics at The Institute of Cancer Research (ICR) and The Royal Marsden.

The patients in the study had either received the AstraZeneca or Pfizer vaccine and been given a first dose at least three weeks prior to their antibody blood test.

There was no significant difference in the percentage of patients with a positive antibody result between those who received the Pfizer (26/48, 54 per cent) and AstraZeneca (26/45, 58 per cent) vaccines. This result supports the current guidance for people with myeloma to accept whichever vaccine is offered to them.

The researchers found that a patient’s age, sex, white blood cell level, or time since vaccination, had no impact on their immunity to the virus. They found the most striking difference between people with myeloma was based on how they were responding to cancer treatment – 66 per cent of those responding well to treatment showed immunity compared with only 30 per cent of patients responding poorly to treatment.

The study was a real-world retrospective assessment involving patients under the care of The Royal Marsden. The researchers stress that the results do not tell us for certain that the vaccines protect patients with myeloma against Covid-19 but they have been able to use the information to provide some reassurance to patients who were concerned that vaccines would not work at all.

The researchers found an association between poor immune response to the vaccine and patients being immunosuppressed or being on treatment at the time of vaccination. 

However, given that pausing of treatment carries its own risk of a patient’s myeloma progressing, the authors say that decisions around the possible pausing of treatment should be made on an individual basis. Patients should discuss their treatment with their own haematologist who will balance the risks and benefits.

The immune response might improve after a second dose of the vaccine and the ICR and Royal Marsden clinicians are continuing to test antibody status after patients have had a second jab. The researchers believe that it is important to identify and track people with myeloma who are not responding to the vaccine because they may be left vulnerable to severe Covid-19 infection – and might want to take additional precautions to reduce their risk.

The work was supported by the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and authors receive funding from Cancer Research UK and the Wellcome Trust.

Research into optimisation of the vaccine strategy for these patients is a high priority and at The Royal Marsden we have a number of studies evaluating the immunological response to Covid-19 infections and vaccines.

Professor David Cunningham, Director of Clinical Research at The Royal Marsden NHS Foundation Trust