COVID-19 in a Multiple Myeloma Patient: Cellular and Humoral Immunity Against SARS-CoV-2 in a Short- and Long-term View

Abstract Multiple myeloma patients are often treated with immunomodulatory drugs, proteasome inhibitors or monoclonal antibodies until disease progression. Chronic therapy in combination with the underlying disease frequently results in severe humoral and cellular immunodeficiency, which often manifests in recurrent infections. Here we report on the clinical management and immunological data of one multiple myeloma patient diagnosed with COVID-19. Despite severe hypogammaglobulinemia, deteriorated T cell counts and neutropenia, the patient unexpectedly combated COVID-19 by balanced response of innate immunity, strong CD8+ and CD4+ T cell activation and differentiation, development of specific T-cell memory subsets, as well as development of anti-SARS-CoV-2 type IgA and IgG antibodies. Even 6 months after re-introduction of lenalidomide maintenance therapy, specific T cell response and antibody levels remained detectable, indicating persisting immunity against SARS-CoV-2. We conclude that in MM patients who tested positive for SARS-CoV-2 and were receiving active MM treatment, immune response assessment could be a useful tool to help guide decision-making regarding the continuation of anti-tumor therapy and supportive therapy.