SARS-CoV-2 Vaccination's Impact on the Progression of MGUS to MM

Dr. Robert Palmason discusses the results of a study investigating if SARS-CoV-2 vaccination impacts the risk of progression from MGUS to multiple myeloma

Abstract Title:

105 Sars-Cov-2 Vaccinations Do Not Lead to Progression of Monoclonal Gammopathy of Undetermined Significance: Results from the Population-Based Istopmm Screening Study

Purpose of the trial:

In patients with monoclonal gammopathy of undetermined significance (MGUS), the pre-malignant cells are antibody producing plasma cells. Stimulating humoral immunity mediated by plasma cells is an important factor in vaccine efficacy. Therefore, concerns have been raised about whether vaccine administration in patients with MGUS could trigger progression of the underlying pre-malignant clone, leading to an increase in the monoclonal-(M)-protein or even progression to full-blown malignancy. Immune stimulation has been found to be a risk factor for monoclonal gammopathies. However, immune stimulation inherent to vaccines and the subsequent antibody formation by plasma cells has, to our knowledge, not been studied in a systematic manner in MGUS. The current SARS-CoV-2 pandemic provide a unique opportunity to evaluate if SARS-CoV-2 vaccination has an impact on the risk of progression from MGUS to MM, or not. To study this we performed a prospective nationwide study based on the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study.

Video summary:

By cross-linking the vaccine data to the iStopMM database, MGUS patients who had received at least one SARS-CoV-2 vaccination and had follow-up serum samples after vaccination were identified. As M protein levels change with age, linear mixed modelling was used to estimate changes in M protein concentration as a function of age before vaccination and after vaccination. The slope of the evolution of M protein level over age was modelled as a continuous linear effect and compared before and after each vaccination to determine the effects of SAR-CoV-2 vaccination on changes in M protein levels. Comparing M protein levels pre- and post-vaccination showed a 1.9% increase in M protein concentration in males and 0.3% in females. However, there was no difference in the rate of M protein increase following vaccination compared to that observed before vaccination.

Conclusion:

In this large, prospective, population-based, screening study including 1,814 individuals with MGUS who were observed before and after covid vaccinations, we found no evidence for MGUS progression after SARS-CoV-2 vaccination. The same was true when analyzed separately by sex, age, type of vaccine, and the number of doses given. Our findings indicate that SARS-CoV-2 vaccination is safe in individuals with MGUS and does not lead to progression irrespective of the number of vaccine doses administered and type of vaccine used.

Trial information: 

ASH 2022: Abstract  (https://ash.confex.com/ash/2022/webprogram/Paper157138.html)#105 (https://ash.confex.com/ash/2022/webprogram/Paper157138.html)

Authors:

Robert Palmason, MD, Elias Eythorsson, MD, PhD, Sæmundur Rögnvaldsson, MD, Sigrun Thorsteinsdottir, MD, PhD, Sara Ekberg, PhD, Michael Crowther, PhD, Elin Ruth Reed, Jon Þórir Oskarsson, MSc, Gudrun Asta Sigurdardottir, Thor Aspelund, PhD, Brynjar Vidarsson, MD, Pall Torfi Onundarson, MD, Bjarni Agnar Agnarsson, MD, Margret Sigurdardottir, MD, Ingunn Thorsteinsdottir, MD, PhD, Signy Vala Sveinsdottir, MD PhD, Isleifur Olafsson, MD, PhD, Asdis Rosa Thordardottir, Asbjorn Jonsson, MD, Olafur Skuli Indridason, MD, MHS, Gauti Gislason, Andri Olafsson, Jon Kristinn Sigurdsson, Hlif Steingrimsdottir, MD, Thorir Einarsson Long, MD, PhD, Malin Hultcrantz, MD, PhD, Brian G.M. Durie, MD, Stephen Harding, PhD, Ola Landgren, MD, Runolfur Palsson, MD, Thorvardur Jon Love, MD, PhD and Sigurdur Y Kristinsson, MD, PhD