Antibody response to pneumococcal vaccine in patients with multiple myeloma.

Patients with multiple myeloma and Waldenström's macroglobulinemia respond poorly to antigenic stimuli and may not be protected by pneumococcal vaccine. Thirty-seven patients and 10 controls received 14-valent pneumococcal capsular polysaccharide vaccine. The patients had lower (P less than 0.01) titers of antibody to 11 of the 12 antigens assayed before vaccination and to 10 of 12 antigens (P less than 0.01) after vaccination than did controls, but the ratios of antibody titers before vaccination to those after vaccination were remarkably similar. A poorer antibody response was observed in patients receiving multiagent chemotherapy than in those receiving chemotherapy with alkylating agents (P less than 0.01 for six of the antigens). That these patients did respond to the vaccine (although titers of antibody after vaccination were significantly lower than those in controls) suggests that patients with multiple myeloma or macroglobulinemia may benefit from pneumococcal vaccine.