Journal Article

COVID-19 Vaccine Experience: Loss of Humoral Response Following Autologous Stem Cell Transplantation in Multiple Myeloma Patients and Positive Effect of Booster Dose

Nardo, Antonella, Milone, Giuseppe, Scirè, Paola, Amato, Gabriella, Di Raimondo, Francesco, Moschetti, Gaetano, Carcò, Daniela, Marino, Sara, Duminuco, Andrea, Martorana, Emanuele, Markovic, Uros, Parrinello, Nunziatina Laura, Romano, Alessandra, Milone, Giulio Antonio, Galbo, Federica, Giunta, Giuliana, Conticello, Concetta, Iachelli, Valeria, Scalisi, Elvira

2025

Overview

Background/Objectives: This prospective study investigated the impact of high-dose chemotherapy and autologous stem cell transplantation (ASCT) on anti-COVID-19 antibody levels in previously vaccinated multiple myeloma (MM) patients with confirmed antibody response (AR). Methods: All patients underwent at least a two-dose regimen mRNA vaccination and later received a high-dose melphalan conditioning regimen and ASCT. Results: Fourteen MM patients with confirmed AR underwent a total of nineteen ASCT reinfusions; their median age was 55 (34–67). The study found a significant and progressive decrease in antibody levels after ASCT, from 311 BAU/mL at baseline to 276 BAU/mL and 188 BAU/mL after one and three months, respectively, with a median anti-COVID-19 antibody level reduction of 39% (range 16–66%) that was statistically significant (p = 0.014) using the Friedman test. However, the third “booster” vaccination post-ASCT improved the humoral response at six months in nine patients (50% response rate) and corrected, at least in part, the negative impact of high-dose chemotherapy (p = 0.597). Despite the antibody decline, three patients who contracted COVID-19 after ASCT experienced mild, outpatient-managed infections, suggesting sufficient immune response. Furthermore, booster doses increased the proportion of high-responders (AR > 500 BAU/mL) post-ASCT from 22% to 55% (5/9 patients) at three and six months, respectively. Conclusions: The study concludes that ASCT negatively affects the humoral response, but booster vaccination can improve it, and residual antibodies may prevent severe COVID-19 in these vulnerable patients.

• Publisher: MDPI AG,MDPI
• Subject: Antibodies / Care and treatment / Chemotherapy / COVID-19 vaccines / Hematology / Immune response / Immunity (Disease) / Infections / Lymphocytes / Mortality / mRNA vaccines / Multiple myeloma / Pandemics / Patients / Proteins / Severe acute respiratory syndrome coronavirus 2 / Stem cell transplantation / Stem cells / Transplantation / Variables