title: Poor Correlation between Pneumococcal IgG and IgM Titers and Opsonophagocytic Activity in Vaccinated Patients with Multiple Myeloma and Waldenstrom's Macroglobulinemia.
abstract: Patients with multiple myeloma and other B cell disorders respond poorly to pneumococcal vaccination. Vaccine responsiveness is commonly determined by measuring pneumococcal serotype-specific antibodies by enzyme-linked immunosorbent assay (ELISA), by a functional opsonophagocytosis assay (OPA), or by both assays. We compared the two methods in vaccinated elderly patients with multiple myeloma, Waldenstrom's macroglobulinemia, and monoclonal gammopathy of undetermined significance (MGUS). Postvaccination sera from 45 patients (n= 15 from each patient group) and 15 control subjects were analyzed by multiplexed OPA for pneumococcal serotypes 4, 6B, 14, and 23F, and the results were compared to IgG and IgM antibody titers measured by ELISA. While there were significant correlations between pneumococcal OPA and IgG titers for all serotypes among the control subjects (correlation coefficients [r] between 0.51 and 0.85), no significant correlations were seen for any of the investigated serotypes in the myeloma group (r= -0.18 to 0.21) or in the group with Waldenstrom's macroglobulinemia (borderline significant correlations for 2 of 4 serotypes). The MGUS group resembled the control group by having good agreement between the two test methods for 3 of 4 serotypes (r= 0.53 to 0.80). Pneumococcal postvaccination IgM titers were very low in the myeloma patients compared to the other groups and did not correlate with the OPA results. To summarize, our data indicate that ELISA measurements may overestimate antipneumococcal immunity in elderly subjects with B cell malignancies and that a functional antibody test should be used specifically for myeloma and Waldenstrom's macroglobulinemia patients.
authors.affiliation: Department of Infectious Diseases, NU Hospital Group, Trollhättan/Uddevalla, Sweden Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden Department of Hematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden johanna.karlsson@vgregion.se.
authors.forename: Johanna
authors.initials: J
authors.lastname: Karlsson
authors.affiliation: Immunobiology Section, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Roalfe
authors.affiliation: Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Harriet
authors.initials: H
authors.lastname: Hogevik
authors.affiliation: Immunobiology Section, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Marta
authors.initials: M
authors.lastname: Zancolli
authors.affiliation: Department of Hematology/Internal Medicine, NU Hospital Group, Trollhättan/Uddevalla, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Andréasson
authors.affiliation: Immunobiology Section, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Goldblatt
authors.affiliation: Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Christine
authors.initials: C
authors.lastname: Wennerås
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology*; D009895:Opsonin Proteins / Q000097:blood*; D010587:Phagocytosis; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D008258:Waldenstrom Macroglobulinemia / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D009895:Opsonin Proteins; D022242:Pneumococcal Vaccines