Serological responses against seasonal influenza viruses in patients with multiple myeloma treated or untreated with daratumumab after two doses of tetravalent vaccine.

Objectives: Daratumumab-treated myeloma patients may face increased seasonal influenza risk due to weakened postvaccination immune responses, especially with daratumumab treatment. We aimed to assess humoral responses to boosted influenza vaccination in daratumumab-treated or -untreated patients.
Methods: In a single-center study, we evaluated humoral responses (hemagglutination-inhibition assay) one month following a two-injection (4-weeks apart) influenza vaccination (standard dose) in 84 patients with multiple myeloma (40 with daratumumab in the past year).
Results: Seroprotection rates (titer ≥1/40) after the second vaccine injection were low across vaccinal subtypes (except for A-H3N2): 71.3% (A-H3N2), 19.7% (A-H1N1pdm09), 9.9% (B-Victoria), 11.3% (B-Yamagata). Only A-H3N2 seroprotection rates significantly increased with the booster in daratumumab-treated patients (30% (12/40) after one injection vs 55% (22/40) after the boost; P = 0.01).After propensity score weighting, daratumumab was not significantly associated with a reduced likelihood of seroprotection against at least one vaccine strain (OR 0.65 [95% CI: 0.22-1.88]).
Conclusion: While daratumumab treatment did not lead to a significant reduction in seroprotection rates following influenza vaccination, a booster vaccine injection demonstrated potential benefit for specific strains (A-H3N2) in patients undergoing daratumumab treatment. Nevertheless, the overall low response rates in patients with multiple myeloma necessitates the development of alternative vaccination and prophylaxis strategies.
Competing Interests: Declarations of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: F. Lemonnier received research funding from Institut Roche and travel grant from Gilead, G. Melica received honoraria from lectures from Astellas, Pfizer, Gilead, MSD, Janssen. S. Fourati received research grants from Moderna, and consulting fees from Moderna, Astrazeneca, Pfizer, GSK and Cepheid, as well as support for traval from Astellas, Gilead and Pfizer. C. Haioun received research funding and consulting honoraria for lectures from Amgen, Celgen, Gilead, Janssen, Novartis, F.Hoffmann-La Roche, Servier, Takeda, Miltenyi. F. Lemonnier received research funding from La Roche Institute and support for attending meetings from Gilead. F. Le Bras received research funding from Takeda and Celgene BMS, and honoraria from Takeda, Kite Gilead and Novartis. K. Belhadj received nonfinancial research support from AbbVie.
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