20
views
0
recommends
+1 Recommend
4 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found

      Development of antibody response to SARS‐CoV‐2 following asymptomatic infection in patients with plasma cell disorders on immunomodulatory therapy

      letter

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Patients with multiple myeloma and related plasma cell disorders (PCD) are considered extremely vulnerable to SARS‐CoV‐2 infection due to disease‐related impaired humoral and cellular immunity as well as receipt of immunosuppressive therapy. 1 Overall mortality from COVID‐19 disease in 650 PCD patients across 10 countries was 33%. 2 Poor outcomes from COVID‐19 disease have resulted in recommendations for modifications to systemic anti‐cancer therapy (SACT) to reduce the risk of infection whilst balancing the potential complications of untreated PCD. 3 With the rollout of the COVID‐19 vaccines, there is urgent need to understand seroconversion in immunocompromised patients for ongoing patient management and recommendation. Previous influenza vaccine experience in PCD has demonstrated a poor response, up to 40% after the first dose with doubling after a booster dose. 4 A Cochrane review revealed a significant but limited reduction in mortality of patients with solid and haematological malignancies, including PCD, 5 therefore recommendations remain for influenza vaccinations in PCD patients. 4 Limited information is available about humoral responses to SARS‐CoV‐2 infection, or the influence of SACT. We introduced SARS‐CoV‐2 antibody screening with the Elecsys Anti‐SARS‐CoV‐2 assay (Roche Diagnostics, Basel, Switzerland), a semi‐quantitative assay of IgG and IgM against the nucleocapsid (N) antigen 6 as routine care in July 2020 for patients having blood tests at our institution. We report findings after six months of antibody screening which includes two high‐incidence periods of SARS‐CoV‐2 in London, UK, one from March–May 2020, and an ongoing second wave from October 2020, 7 exacerbated by the variant identified in Kent, UK. 8 Here we describe positive antibody findings, and relationship with symptomatic infection, PCD characteristics and associated SACT. Table I gives diagnostic and clinical information in 243 patients who had at least one antibody test, of whom 106 had longitudinal samples. Table I Patient characteristics. Characteristic All patients with antibody results n = 243 Patients with PCR‐positive COVID‐19 disease n = 41 Positive antibody test post PCR‐positive COVID‐19 disease n = 12 Screening‐positive antibody test only n = 14 Male sex (%) 140 (57·6) 22 (53·7) 7 (58·3) 5 (35·7) Median age [Range] 65 [31–84] 62 [31–88] 58·5 [32–79] 63·5 [35–79] BMI [Range] 29·4 [15·4–53·5] 25·1 [20·9–36·1] 25 [21–33] 27·9 [25·3–35·6] Caucasian (%) 129 (53·1) 19 (46·3) 8 (66·7) 5 (35·7) African/Caribbean (%) 38 (15·6) 9 (22·0) 1 (8·3) 3 (21·4) Asian (%) 23 (9·5) 6 (14·6) 1 (8·3) 4 (28·6) Other (%) 22 (9·1) 6 (14·6) 2 (16·7) 1 (7·1) Undisclosed (%) 31 (12·8) 1 (2·4) 0 (0·0) 1 (7·1) ISS Staging Stage 1 (%) 79 (32·5) 12 (29·3) 5 (41·7) 6 (42·9) Stage 2 (%) 42 (17·3) 10 (24·3) 4 (33·3) 2 (14·3) Stage 3 (%) 41 (16·9) 6 (14·6) 1 (8·3) 1 (7·1) Not performed (%) 81 (33·3) 13 (31·7) 2 (16·7) 5 (35·7) cytogenetic risk at diagnosis and most recent relapse (%) 86 (35·3) 19 (46·3) 6 (50·0) 6 (42·9) Adverse risk (%) 82 (33·7) 13 (31·7) 5 (41·7) 5 (35·7) Not performed (%) 75 (30·9) 9 (22·0) 1 (8·3) 3 (21·4) IgG (%) 144 (59·3) 30 (73·2) 8 (66·7) 6 (42·9) IgA (%) 52 (21·4) 4 (9·8) 2 (16·7) 2 (14·3) LC (%) 35 (14·4) 4 (9·8) 2 (16·7) 3 (21·4) Other (%) 12 (4·9) 3 (7·3) 0 (0·0) 3 (21·4) MGUS (%) 4 (1·6) 0 (0·0) 0 (0·0) 0 (0·0) SMM (%) 15 (6·2) 1 (2·4) 0 (0·0) 0 (0·0) MM (%) 212 (87·2) 37 (90·2) 12 (100·0) 11 (78·6) Other (i.e. plasmacytoma, AL amyloid, POEMS with or without associated MM) (%) 12 (4·9) 3 (7·3) 0 (0·0) 3 (21·4) Median time since MM diagnosis in months [Range] 45 [1–331] 41 [1–175] 15 [6–175] 32 [6–233] Median prior lines of therapy [Range] 2 [0–8] 1 [0–5] 3·5 [1–6] 1 [0–3] On active treatment (%) 139 (57·2) 28 (68·3) 7 (58·3) 7 (50·0) Prior treatment with PI (%) 207 (85·2) 36 (87·8) 11 (91·7) 10 (71·4) Prior treatment with anti‐CD38 mAb (%) 70 (28·8) 11 (26·8) 4 (33·3) 3 (21·4) Prior treatment with IMiDs (%) 171 (70·4) 28 (68·3) 11 (91·7) 9 (64·3) Has received an ASCT (%) 151 (62·1) 27 (65·9) 9 (75·0) 6 (42·9) Disease status at time of antibody test PD (%) 35 (14·4) 6 (14·6) 0 (0·0) 2 (14·3) SD/PR (%) 81 (33·3) 19 (46·3) 6 (50·0) 3 (21·4) VGPR/CR (%) 96 (39·5) 14 (34·1) 6 (50·0) 8 (57·1) Not yet performed (%) 31 (12·8) 2 (4·9) 0 (0·0) 1 (7·1) Other comorbidities COPD (%) 4 (1·6) 3 (7·3) 0 (0·0) 1 (7·1) Diabetes (%) 23 (9·5) 4 (9·8) 0 (0·0) 4 (28·6) HTN (%) 65 (26·7) 4 (9·8) 0 (0·0) 6 (42·9) IHD (%) 9 (3·7) 2 (4·9) 0 (0·0) 1 (7·1) CKD (%) 23 (9·5) 6 (14·6) 0 (0·0) 0 (0·0) Immuneparesis (%) 70 (28·8) 13 (31·7) 3 (25·0) 6 (42·9) Receiving IVIG (%) 4 (1·7) 0 (0·0) 0 (0·0) 2 (14·3) BMI Body Mass Index; ISS International Staging System; ISS Stage 1, B2‐microglobulin <3·5 mg/l and albumin >35 g/l; ISS stage 3, B2‐microglobulin >5·5 mg/l; ISS Stage 2, patients not fulfilling criteria for stage 1 or 3; adverse risk, cytogenetics defined as per International Myeloma Working Group (IMWG) criteria t(4;14), t(14;16), t(14;20), del17p and 1q gain. MM, multiple myeloma; SMM, smouldering myeloma; MGUS, monoclonal gammopathy of undetermined significance; ASCT, autologous stem cell transplant; PI, proteosome inhibitor; mAb, monoclonal antibody; IMiD, immunomodulatory drug; PD, progressive disease; SD, stable disease; PR, partial response; VGPR, very good partial response; CR, complete response. Disease response assessed as per IMWG criteria. COPD, chronic obstructive pulmonary disease; HTN, hypertension; IHD, ischaemic heart disease; CKD, chronic kidney disease; IVIG, intravenous immunoglobulins. Immuneparesis is defined as IgG levels <6·5 g/l. John Wiley & Sons, Ltd Twenty‐six (10·7%) patients had positive antibody results, 12 of whom had documented nose and throat polymerase chain reaction (PCR)‐swab‐positive COVID‐19 disease. In a separate but overlapping cohort, 41 patients have had PCR‐confirmed COVID‐19 disease (Table I). Their clinical outcomes are summarised in Fig 1B. In a subset of 20 patients who have recovered and undergone testing, 12 (60%) seroconverted at median time to antibody testing from PCR positivity of 60 (range 5–256) days for all tested patients. Eight seronegative patients were tested at median 30·5 (range 5–176) days. Seven patients who died did not have antibody testing prior to death, and 14 have not been tested (Figure S1). Fig 1 Clinical outcomes and characteristics of all patients who had a positive SARS‐CoV‐2 antibody test in our cohort. In screening the asymptomatic cohort, 14 (6·3%) had an unexpected positive antibody result. Their clinical course, with relevant exposure details, are summarised (Fig 1A). Two patients described symptoms suggestive of COVID‐19 disease two weeks or more prior to a positive antibody test, while the rest described no COVID‐19‐attributable symptoms. All possible contacts or exposures are indicated (Fig 1A). Seven (50%) were on SACT (including ixazomib, pomalidomide, lenalidomide and dexamethasone) throughout the period from their possible exposure to positive antibody test, none had their long‐term oral immunomodulatory treatment interrupted. Failure to mount an antibody response was not correlated with more lines of therapy, or with age, body mass index, ethnicity, time since PCD diagnosis, International Staging System (ISS) stage, genetic risk, autologous stem cell transplantation (ASCT), anti‐CD38 therapy, disease status [partial response (PR) or active disease vs complete response (CR)/very good PR (VGPR)], immuneparesis (IgG < 6·5g/l), timing of antibody test, or time to viral clearance. To explore antibody strengths between patients, positive results were semi‐quantified as follows: borderline (<1·5), weak (<10), strong ( ≥ 10) and very strong positive ( ≥ 100) based on signal and a cut‐off optical density of 1 (Figure S2). Antibody strength did not correlate with symptomatic [(χ2 df 3, n = 25) 1·886, P = 0·60] or PCR‐confirmed diagnosis vs incidental [(χ 2 df 3, n = 25) 3·973, P = 0·26]. At least two longitudinal positive antibody tests (median 45 days, range 21–119, apart) were documented in 10 patients. Strength of response fell between first and second test (mean difference −11·99, t(9) = 1·661, P = 0·13) (Figure S3). Total seroprevalence rates over six months of 10·7% (26/243), and in asymptomatic patients, 6·3% (14/223), are lower but not dissimilar to that reported in London over a similar time period 9 , 10 reflecting the shielding behaviours of our patients, but also challenges in protecting them during high SARS‐CoV‐2 incidence in the community. In those with PCR‐confirmed disease, seroconversion rates of 60% were lower than reported in the general population (95%), 11 , 12 another PCD cohort (96%), 13 a chronic lymphocytic leukaemia (CLL) cohort (67%) 14 and an acute leukaemia cohort (88%), 15 although differences in assays may account for some of this variation. Positive antibody test post PCR‐confirmed infection occurred at a median of 86·5 days compared to 30·5 days for those who tested negative, suggesting a delayed response compared to the general population of 14–28 days. 12 Our study and analyses are limited by small number of seropositive patients and those undergoing antibody testing post PCR‐diagnosed COVID‐19 disease. Although our analyses failed to reach statistical significance, we suspect failure or delay to mount an antibody response to be more likely with uncontrolled PCD, a heavily pre‐treated PCD population and concurrent SACT. Antibody testing post PCR positivity was not uniform due to limited availability of testing early in the pandemic. Timings of antibody samples are based on patient attendances for blood tests and therefore heterogenous. In summary we report that some PCD patients are able to mount and maintain a humoral response to SARS‐CoV‐2 infection through routine screening of a predominant outpatient population, although seroconversion rates are lower than reported for other populations. Notably, seroconversion can occur following asymptomatic infection, and despite receipt of immunomodulatory therapy. No seropositive patients have had SARS‐CoV‐2 re‐infection in our cohort, although longer follow‐up in a larger population of seropositive PCD patients will be required to understand the protection conferred. This evidence supports advice for COVID‐19 vaccination to be offered to all PCD patients although the delayed humoral response calls for close antibody monitoring of all vaccinated patients, and consideration of timely booster doses. Attention should also be paid to PCD patients undergoing a range of therapies including ASCT, to inform an optimised vaccination protocol for these patients. Conflict of interest KLY has received honoraria from Janssen, Takeda, Sanofi, GSK and Amgen. KLY receives research funding from Sanofi, Celgene, Takeda, Janssen and Autolus. NR has received Janssen consultancy, travel support for meetings and Speakers Bureau outside the submitted work. Author contributions WYC, ES, SJC, CSYL and LA collected the data. WYC, ES and KLY analysed the data. WYC and KLY wrote the manuscript. WYC, ES, SJC, CSYL, LA, KX, BW, SM, XP, CK, JS, AW, RP, NR, LL, EN and KLY critically revised the final manuscript. Supporting information Fig S1. Consort diagram of Screening and COVID‐19 PCR positive patients. Fig S2. Patients with positive SARS‐CoV‐2 antibody test categorised by PCR‐positive patients and unexpected antibody test positive patients. Fig S3. Strength of response in positive antibody patients with longitudinal antibody test samples. Click here for additional data file.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: not found

          Longitudinal observation and decline of neutralizing antibody responses in the three months following SARS-CoV-2 infection in humans

          Antibody responses to SARS-CoV-2 can be detected in most infected individuals 10-15 d after the onset of COVID-19 symptoms. However, due to the recent emergence of SARS-CoV-2 in the human population, it is not known how long antibody responses will be maintained or whether they will provide protection from reinfection. Using sequential serum samples collected up to 94 d post onset of symptoms (POS) from 65 individuals with real-time quantitative PCR-confirmed SARS-CoV-2 infection, we show seroconversion (immunoglobulin (Ig)M, IgA, IgG) in >95% of cases and neutralizing antibody responses when sampled beyond 8 d POS. We show that the kinetics of the neutralizing antibody response is typical of an acute viral infection, with declining neutralizing antibody titres observed after an initial peak, and that the magnitude of this peak is dependent on disease severity. Although some individuals with high peak infective dose (ID50 > 10,000) maintained neutralizing antibody titres >1,000 at >60 d POS, some with lower peak ID50 had neutralizing antibody titres approaching baseline within the follow-up period. A similar decline in neutralizing antibody titres was observed in a cohort of 31 seropositive healthcare workers. The present study has important implications when considering widespread serological testing and antibody protection against reinfection with SARS-CoV-2, and may suggest that vaccine boosters are required to provide long-lasting protection.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            New variant of SARS-CoV-2 in UK causes surge of COVID-19

            Tony Kirby (2021)
            For most of November, 2020, England was in lockdown to force down the incidence of COVID-19 cases that had steadily increased in the late summer and autumn. Other countries in the UK (Wales, Scotland, and Northern Ireland) had also been reimposing and subsequently lifting restrictions, since each of the four nations is in charge of its own COVID-19 control plans. For a while, the strategy in England appeared to have worked, with many areas that previously had high case incidence seeing rates drop sharply in November, including northwest England and Yorkshire, areas which had previously seen some of the highest incidence rates in the UK. However, it soon became apparent that the English lockdown had not had the same effect in every region. In Kent, a large county in the southeast, cases actually continued to increase during the lockdown, despite having the same restrictions as other regions. When, on Dec 2, 2020, England lifted its lockdown and moved back into a three-level tiered restrictions system, cases continued to increase sharply in Kent and then rapidly in Greater London and other parts of the southeast. And despite the approval of two vaccines in recent weeks, the UK now faces a race against time to vaccinate as many vulnerable and elderly people as possible. The reason: a new variant of SARS-CoV-2, which various modelling exercises have estimated to be up to 70% more transmissible than the previously circulating form of the virus. In September, 2020, this variant represented just one in four new diagnoses of COVID-19, whereas by mid-December, this had increased to almost two thirds of new cases in London. UK Prime Minister, Boris Johnson, decided with his scientific advisors that he had no credible alternative other than to impose even stricter restrictions on these parts of England, creating a new tier 4, which meant all non-essential shops and gyms closed, and people were asked to stay at home wherever possible (hospitality venues already had to close in tier 3). However, until late December, 2020, the proportion of cases caused by the new variant were much lower in other parts of the country, with the northwest region that includes Liverpool and Manchester recording only 1 in 20 new cases of COVID-19 that were due to the new variant. As a result, many parts of England continued in the lower tier of restrictions, until on Dec 30, 2020, Johnson, in response to surging numbers of new diagnoses including an all-time high of 53 000 on Dec 29, 2020, decided to move all parts of England into tier 3 or 4. This effectively meant that no restaurants, bars, or other hospitality venues would be open on New Year's Eve. However, the latest data (early January, 2021) shows that cases due to the new variant are increasing in all areas of the country, although the south and southeast continue to be the worst affected. Commentators have questioned the logic of this move, and called instead for an England-wide lockdown equivalent to tier 4 restrictions. Scotland, Wales, and Northern Ireland are already in such nationwide lockdowns. “It is good that the majority of the country is in tier 4 as there is evidence we need at least this level of restriction to prevent rapid spread of the new variant”, explains Andrew Hayward, Professor of Infectious Disease Epidemiology and Inclusion Health Research at University College London, London, UK. Hayward, who is a member of the UK Government's Scientific Advisory Group for Emergencies (SAGE), adds: “The areas that are not currently in tier 4 can expect rapid increases in new variant cases which will likely lead to them needing to move into tier 4. Doing that now, instead of later, would prevent unnecessary hospitalisations and deaths and may decrease the length of time they need to be in tier 4.” At the time that this article went to press, the UK Government had been determined that school children would all be returning to school, albeit in a staggered fashion, immediately after the Christmas and New Year holidays. However, this plan is now in doubt, with the government suggesting only primary school children and secondary school children who are in important exam years (essentially 16 and 18 year olds) will return to the classroom immediately. Then, on New Year's Day, 2021, the Government announced a sudden change in strategy—all primary schools in London were told not to reopen as planned on Jan 4. There were calls (including from teachers' unions) to delay reopening of primary schools in all of England for 2 weeks, but in a hastily arranged television interview on the morning of Sunday Jan 3, Johnson said that only primary schools in the areas worst affected by the new variant would not reopen. He told the BBC that there is “no doubt in my mind that schools are safe” but did not rule out further closures. The leader of the opposition Labour Party, Kier Starmer, said in response that the virus was out of control and further school closures were “inevitable”. Starmer is among those calling for an immediate nationwide lockdown. Hayward explains that the decision to close schools or not could be the key factor in whether or not cases continue to increase. He said: “There is a high likelihood tier 4 will be insufficient to reduce the R number to below 1. Cases will continue to increase, albeit more slowly. This is based on the observation that the new strain increased in Kent and the southeast during lockdown, which is a more severe restriction than the current tier 4. Schools and universities being open may make the difference between being able to reduce R below 1 or not.” Following the latest announcements from the Prime Minster, Hayward adds that: “Even though schools have been provided with detailed guidance, and financial and practical support, it will be extremely challenging to implement mass testing of all pupils within the expected timeframes along with serial testing of classroom and other contacts of positive cases. The uptake and impact of school mass testing programmes is highly uncertain, as is the extent to which the new strain will increase transmission in schools and from school children to the wider community.” © 2021 Caia Image/Science Photo Library 2021 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. According to research published on Dec 29, 2020, by the UK Health Agency Public Health England, the new variant appears to be no worse than the previous dominant strain of SARS-CoV-2 in terms of the risk of hospital admission, severity of illness, or mortality. The UK is confronting this new variant during the same month that two vaccines against the virus have been approved; the Pfizer-BioNTech and the Oxford-Astra Zeneca vaccines. The Oxford vaccine in particular has raised hopes that the UK could regain control and turn the tide on the COVID-19 pandemic by as early as April 2021, since its storage requirements are a lot less complex than the deep cold required for the transport and storage of the Pfizer vaccine. This means that it will be far easier for vital vaccine supplies to reach, and be stored at, venues such as care homes for the elderly. Vaccinations with the new Oxford vaccine were due to begin across the UK on Jan 4, while vaccinations with the Pfizer-BioNTech vaccine continue. In another key policy shift, the UK's medical experts said it was crucial to inoculate as many vulnerable people as possible with the first dose, since this would offer the most protection, rather than giving people the regular two-dose schedule of either vaccine. The second dose, they explained, can be given in the subsequent weeks or months after mortality and admissions have hopefully stablised. At a media briefing on Dec 30, 2020, PM Johnson said: “The public must redouble its efforts to control the virus at this critical moment” before adding he was confident the country's situation will be “very much better” by April 5, 2021 (Easter weekend). “All of these measures in the end are designed to save lives and protect the NHS. For that very reason, I must ask you [the public] to follow the rules where you live tomorrow night and see in the new year safely at home.” However, the new variant has piled additional pressure on to the speed at which vaccination must be achieved. Hayward is worried that, just as had been possible in the first wave, very vulnerable people, such as the homeless, could be ruthlessly exposed due to plunging winter temperatures and the failure of the UK government to so far provide local authorities with the resources to house homeless people in single room accommodation, mainly hotels, which are mostly standing empty due to the temporary death of the tourism industry. Back in March, 2020, the government helped the appropriate agencies and organisations get everybody off the streets and into such accommodation. “Many homeless people have this time had to stay on the street because of the dangers of opening communal night shelters and alternative provision not being available. This new coronavirus variant especially could cause havoc and a huge surge of cases in people least equipped to face them”, says Hayward. The charity Crisis at Christmas has housed large numbers temporarily in single room accommodation over the Christmas period, but they will need to return to the streets in early January. Hayward warns that: “If there are severe cold weather spells after this it is likely communal shelters will need to open to prevent people freezing. Due to the government's failure so far to repeat their efforts of earlier this year, homeless people are currently facing a stark choice between the dangers of cold or the dangers of COVID-19.” The UK remains one of the most badly affected countries. As of Dec 30, 2020, it had recorded more than 2 million cases of infection and more than 70 000 deaths. Driven by the new variant's increased infectiousness, the UK has reported more than 50 000 cases a day (a new record) in the last few days of December and the first few days of the new year. Almost 1000 deaths were reported on Dec 30, 2020, alone, and there are fears that the pandemic may get very much worse in the country before it gets better. However, the hope is that deaths and hospitalisations will plummet as the number of elderly and vulnerable people receiving the vaccine sharply increases in the coming weeks. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948152/Technical_Briefing_VOC202012-2_Briefing_2_FINAL.pdf
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set.

              The primary cause of morbidity and mortality in patients with multiple myeloma (MM) is an infection. Therefore, there is great concern about susceptibility to the outcome of COVID-19-infected patients with MM. This retrospective study describes the baseline characteristics and outcome data of COVID-19 infection in 650 patients with plasma cell disorders, collected by the International Myeloma Society to understand the initial challenges faced by myeloma patients during the COVID-19 pandemic. Analyses were performed for hospitalized MM patients. Among hospitalized patients, the median age was 69 years, and nearly all patients (96%) had MM. Approximately 36% were recently diagnosed (2019-2020), and 54% of patients were receiving first-line therapy. Thirty-three percent of patients have died, with significant geographic variability, ranging from 27% to 57% of hospitalized patients. Univariate analysis identified age, International Staging System stage 3 (ISS3), high-risk disease, renal disease, suboptimal myeloma control (active or progressive disease), and 1 or more comorbidities as risk factors for higher rates of death. Neither history of transplant, including within a year of COVID-19 diagnosis, nor other anti-MM treatments were associated with outcomes. Multivariate analysis found that only age, high-risk MM, renal disease, and suboptimal MM control remained independent predictors of adverse outcome with COVID-19 infection. The management of MM in the era of COVID-19 requires careful consideration of patient- and disease-related factors to decrease the risk of acquiring COVID-19 infection, while not compromising disease control through appropriate MM treatment. This study provides initial data to develop recommendations for the management of MM patients with COVID-19 infection.
                Bookmark

                Author and article information

                Contributors
                weiyee.chan@nhs.net
                Journal
                Br J Haematol
                Br J Haematol
                10.1111/(ISSN)1365-2141
                BJH
                British Journal of Haematology
                John Wiley and Sons Inc. (Hoboken )
                0007-1048
                1365-2141
                29 July 2021
                September 2021
                29 July 2021
                : 194
                : 5 ( doiID: 10.1111/bjh.v194.5 )
                : 857-861
                Affiliations
                [ 1 ] Department of Haematology University College London Hospitals NHS Foundation Trust London UK
                [ 2 ] Research Department of Haematology UCL Cancer Institute London UK
                [ 3 ] Department of Clinical Virology University College London Hospitals NHS Foundation Trust London UK
                Author information
                https://orcid.org/0000-0003-0471-2059
                https://orcid.org/0000-0002-1359-9847
                https://orcid.org/0000-0001-9233-6967
                https://orcid.org/0000-0003-0630-7065
                https://orcid.org/0000-0002-2453-4475
                https://orcid.org/0000-0002-1393-2793
                https://orcid.org/0000-0002-6487-276X
                Article
                BJH17441
                10.1111/bjh.17441
                8444933
                34323287
                340f415a-90ec-4529-9127-5422a92651e9
                © 2021 British Society for Haematology and John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 05 March 2021
                : 17 February 2021
                : 08 March 2021
                Page count
                Figures: 1, Tables: 1, Pages: 5, Words: 2710
                Funding
                Funded by: National Institute for Health Research University College London Hospitals Biomedical Research Centre
                Categories
                Correspondence
                COVID‐19 Letters
                Custom metadata
                2.0
                September 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.7 mode:remove_FC converted:16.09.2021

                Hematology
                antibody response,covid‐19 disease,multiple myeloma,plasma cell disorders,sars‐cov‐2

                Comments

                Comment on this article