Examining the immunological responses to COVID-19 vaccination in multiple myeloma patients: a systematic review and meta-analysis

Abstract

Background: Impaired immune response in multiple myeloma renders the patients vulnerable to infections, such as COVID-19, and may cause worse response to vaccines. Researchers should analyze this issue to enable the planning for special preventive measures, such as increased booster doses. Therefore, this meta-analysis aimed to evaluate the response and efficacy of COVID-19 vaccines in patients with multiple myeloma.

Methods: This meta-analysis followed PRISMA 2020 guidelines, conducting a comprehensive database search using specified keywords. Study selection involved a two-phase title/abstract and full-text screening process. Data extraction was performed by two researchers, and statistical analysis involved meta-analysis, subgroup analysis based on vaccine dosage and study time, random effects meta-regression, and heterogeneity testing using the Q test.

Results: The meta-analysis revealed that patients with multiple myeloma (MM) had a lower likelihood of developing detectable antibodies after COVID-19 vaccination compared to healthy controls (Log odds ratio with 95% CI: -3.34 [-4.08, -2.60]). The analysis of antibody response after different doses showed consistent lower seropositivity in MM patients (after first dose: -2.09, [-3.49, -0.69], second: -3.80, 95%CI [-4.71, -3.01], a booster dose: -3.03, [-5.91, -0.15]). However, there was no significant difference in the mean level of anti-S antibodies between MM patients and controls (Cohen's d -0.72, [-1.86, 0.43]). Evaluation of T-cell responses indicated diminished T-cell-mediated immunity in MM patients compared to controls. Seven studies reported clinical response, with breakthrough infections observed in vaccinated MM patients.

Conclusions: These findings highlight the impaired humoral and cellular immune responses in MM patients after COVID-19 vaccination, suggesting the need for further investigation and potential interventions.

Keywords: COVID-19; Multiple myeloma; Plasma cell dyscrasia; SARS-CoV-2; Vaccine.

Fig. 1

PRISMA 2020 flow diagram of the study selection process

Fig. 2

Forest plot of antibody responses in MM patients and controls

Fig. 3

Forest plot of antibody responses in MM patients and controls categorized based on the number of the doses received

Fig. 4

Forest plot of antibody responses in MM patients and controls categorized based on the time passed since their vaccination

Fig. 5

Summarized Forest plot of antibody responses in MM patients and controls based on their vaccination dose and time since vaccination. K represent the number of the studies for each variable

Fig. 6

Forest plot of antibody titration results in MM patients and controls