Rates of neutralizing antibodies (nAbs) after COVID-19 vaccination are significantly higher with the Moderna vaccine than with the Pfizer-BioNTech vaccine in patients with multiple myeloma (MM), according to research published in the Journal of Clinical Oncology.

In a study of more than 200 patients, the rate of nAbs was 67% with the Moderna vaccine and 48% with the Pfizer-BioNTech vaccine (P <.006).

“Although both … vaccines have yielded broadly comparable immunogenicity in healthy adults, mRNA1273 [the Moderna vaccine] led to significantly higher rates of nAbs in this cohort,” the researchers wrote. “These data therefore support the choice of mRNA1273 as the preferred initial vaccine in this patient population.”

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The researchers also found that nAb responses were positively associated with Black race and negatively associated with anti-CD38 monoclonal antibody treatment.  

For this study, researchers analyzed blood samples from 238 vaccinated patients with MM. After the second vaccine dose, antibodies to the receptor-binding domain (RBD) of the spike protein were detected in 87% of patients.

However, nAbs were detected in 54% of patients. The researchers noted that this rate is much lower than estimates from previous seroconversion studies in MM that did not monitor viral neutralization.

Although there was a strong correlation between anti-RBD antibodies and nAbs (r =0.8), a subset of patients did not exhibit nAb responses despite having high titers of anti-RBD antibodies.

In a multivariate analysis, 3 factors were significantly associated with nAb response:

  • Being Black (odds ratio [OR], 2.08; 95% CI, 1.12-3.85; P =.02)
  • Receiving the Moderna vaccine (OR, 2.54; 95% CI, 1.38-4.67; P =.003)
  • Receiving 2 or more lines of therapy with anti-CD38 monoclonal antibodies (OR, 0.48; 95% CI, 0.23-1.00; P =.05).

“Vaccine-mediated induction of nAbs is affected by race, disease, vaccine, and treatment characteristics,” the researchers wrote. “These data have several implications for the emerging application of booster vaccines in immunocompromised hosts.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Nooka AK, Shanmugasundaram U, Cheedarla N, et al. Determinants of neutralizing antibody response after SARS CoV-2 vaccination in patients with myeloma. J Clin Oncol. Published online March 8, 2022. doi:10.1200/JCO.21.02257