Cellular mechanisms associated with sub-optimal immune responses to SARS-CoV-2 bivalent booster vaccination in patients with Multiple Myeloma

BACKGROUND

The real-world impact of bivalent vaccines for wild type (WA.1) and Omicron variant (BA.5) is largely unknown in immunocompromised patients with Multiple Myeloma (MM). We characterize the humoral and cellular immune responses in patients with MM before and after receiving the bivalent booster, including neutralizing assays to identify patterns associated with continuing vulnerability to current variants (XBB1.16, EG5) in the current post-pandemic era.

METHODS

We studied the humoral and cellular immune responses before and after bivalent booster immunization in 48 MM patients. Spike binding IgG antibody levels were measured by SARS-CoV-2 spike binding ELISA and neutralization capacity was assessed by a SARS-CoV-2 multi-cycle microneutralization assays to assess inhibition of live virus. We measured spike specific T-cell function using the QuantiFERON SARS-CoV-2 (Qiagen) assay as well as flow-cytometry based T-cell. In a subset of 38 patients, high-dimensional flow cytometry was performed to identify immune cell subsets associated with lack of humoral antibodies.

FINDINGS

We find that bivalent vaccination provides significant boost in protection to the omicron variant in our MM patients, in a treatment specific manner. MM patients remain vulnerable to newer variants with mutations in the spike portion. Anti-CD38 and anti-BCMA therapies affect the immune machinery needed to produce antibodies.

INTERPRETATION

Our study highlights varying immune responses observed in MM patients after receiving bivalent COVID-19 vaccination. Specifically, a subgroup of MM patients undergoing anti-CD38 and anti-BCMA therapy experience impairment in immune cells such DCs, B cells, NK cells and TFH cells, leading to an inability to generate adequate humoral and cellular responses to vaccination.

FUNDING

National Cancer Institute (National Institutes of Health), National Institute of Allergy and Infectious Diseases (National Institutes of Health), NCI Serological Sciences Network for COVID-19 (SeroNet) and The Icahn School of Medicine at Mount Sinai.

Triple MAPK inhibition salvaged a relapsed post-BCMA CAR-T cell therapy multiple myeloma patient with a BRAF V600E subclonal mutation

Background

Multiple Myeloma (MM) is a progressive plasma cell neoplasm characterized by heterogeneous clonal expansion. Despite promising response rates achieved with anti-BCMA CAR-T cell therapy, patients may still relapse and there are currently no clear therapeutic options in post-CAR-T settings. In this report, we present a case of a post-BCMA CAR-T relapsed/refractory (RR) MM patient with skin extramedullary disease (EMD) in which a novel MAPK inhibition combinatorial strategy was implemented based on next-generation sequencing and in vitro experiments.

Case presentation

A 61-year-old male with penta-refractory MM penta- (IgA lambda), ISS stage 3 with hyperdiploidy, gain of 1q21 and del13 was treated with anti-BCMA CAR-T cell therapy, achieving a best response of VGPR. He progressed after 6 months and was salvaged for a short period with autologous stem cell transplantation. Eventually, he progressed with extramedullary disease manifested as subcutaneous nodules. Based on whole-exome sequencing, we identified a BRAF (V600E) dominant subclone in both bone marrow and cutaneous plasmacytoma. Following in vitro experiments, and according to our previous studies, we implemented a triple MAPK inhibition strategy under which the patient achieved a very good partial response for 110 days, which allowed to bridge him to subsequent clinical trials and eventually achieve a stringent complete response (sCR).

Conclusion

Here, we show the applicability, effectiveness, and tolerability the triple MAPK inhibition strategy in the context of post-BCMA CAR-T failure in specific subset of patients. The triple therapy could bridge our hospice bound RRMM patient with BRAF (V600E) to further therapeutic options where sCR was achieved. We will further evaluate triple MAPK inhibition in patients with BRAF V600E in a precision medicine clinical trial launching soon.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13045-022-01330-3.

[Why medicine? Analyzing students' motives for studying medicine]

BACKGROUND

Despite increasing numbers of physicians, shortage of doctors is a predominant problem in the German health care system.

AIM

AIM of the present study is a detailed and gendered analysis of current motives to study medicine in order to deduce implications for securing medical care in the future.

METHODS

Study motives of medical students from Duisburg-Essen and Muenster were assessed using an online questionnaire. 13 given motives had to be rated on a 5 point Likert-scale according to their relevance for the decision to study medicine. Descriptive analysis regarding age, gender, location and study period was performed and a dichotomization of data (agreement vs. disagreement) was undertaken for logistic regression analysis.

RESULTS

1545 medical students took part in the survey (64.5% female). "Many-faceted workspaces", "varied tasks", "helping patients", "scientific interest" and "good career prospects" - backward-sorted - were the most frequent study motives indicated by medical students. The aspect "helping patients" was more important to female than to male students, the latter rated career-associated motives e. g. income, reputation etc. as more relevant. Only for about 8% of the respondents - independently of gender - compatibility of job and family was a motive to study medicine.

CONCLUSION

Perspectively, results of this study could help to shape medicine in a way that will appeal to the growing up generation of doctors: a sophisticated, demanding and fulfilling occupation compatible with family with options to carve out a career for those who want to - regardless of gender. Furthermore, coaching programs paralleling either medical studies or work as clinician should be considered to improve the matching of gender-specific study motives and careers.

[Gender-specific Aspects of Knowledge and Gender Sensitivity in Medical Education - An Inventory]

BACKGROUND

Gender competence is an essential prerequisite for individualized patient care.

OBJECTIVES

The aim of this study is to survey the level of knowledge and attitudes towards gender-related aspects at 2 German medical schools.

MATERIALS AND METHODS

An online questionnaire was used to collect data on gender competence in medicine including biological basics of sex differences, clinical aspects, socio-cultural factors as well as questions regarding gender role concepts. In total 1 671 students, 330 basic scientists, 413 physicians and 53 professors from the German Medical Schools Münster and Duisburg-Essen took part in the survey.

RESULTS

The level of knowledge on gender-specific aspects in medicine is unsatisfactory at both medical schools. The average of correct answers on gender-related questions of all groups is less than 55%. Looking at gender sensitivity the existence and importance of gender disparities in medicine is agreed upon by the majority of participants. However, most of them regard only the patients' but not the physician's sex as relevant.

CONCLUSIONS

The study reveals a lack of knowledge and the necessity for improvement: the integration of gender-specific aspects into medical routine is an important step towards a truly individualized medical care.