COVID-19 has thus far claimed 5 million lives and infected more than 250 million people worldwide. Patients with comorbid conditions have been disproportionately affected by the disease. For example, people with multiple myeloma—a type of blood cancer that develops in the bone marrow—often present with considerable immune impairment and are more susceptible to viral infection and death. Subsequently, patients with multiple myeloma—as well as numerous other comorbid conditions—have been prioritized to receive COVID-19 vaccines, and more recently, booster shots. 

However, vaccines may not achieve full effectiveness for some patients. A growing body of evidence indicates that some individuals with underlying comorbidities may exhibit suboptimal antibody response to COVID-19 vaccination. According to research from the Icahn School of Medicine at Mount Sinai, patients with multiple myeloma lacking an antibody response to the COVID-19 vaccine may consequently fail to trigger a T-cell response, which can otherwise kill cells infected by the virus. 

Combatting Increased Risk 

The vulnerability of patients with multiple myeloma has received special attention lately due to the recent passing of former Secretary of State General Colin Powell, 84, related to complications from COVID-19. Although he was fully vaccinated, Powell had a compromised immune systems associated with multiple myeloma, for which he was undergoing treatment. “Patients with multiple myeloma are [often] older [and] on continuous therapy, even while in remission,” explains Parameswaran Hari, MD, MRCP, MS, professor of hematology and chief of the Division of Hematology and Oncology at the Medical College of Wisconsin. “Myeloma itself, as well as many of the therapies, are immune-suppressive and inhibit the ability of the body to produce antibodies against the virus,” he adds. 

Based on recent clinical trials, hospitalized patients with multiple myeloma who have COVID-19 have higher mortality rates (34%-39%) compared to age- and sex-matched hospitalized patients without multiple myeloma who have COVID-19 (16%-23%). Data suggest that at least some people with multiple myeloma who are vaccinated may remain unprotected due to reported suboptimal COVID-19 immune responses related to comorbid factors such as immunosuppression, uncontrolled disease, or concomitant therapy.  

“Myeloma patients [undergoing] treatment who are not in complete remission are less likely to be successfully vaccinated,” says David H. Vesole, MD, PhD, director of the Myeloma Program at MedStar Georgetown University Hospital in Washington, DC. Dr. Vesole encourages patients with multiple myeloma to get the vaccine: “To improve the success rate of vaccination, myeloma patients should absolutely be vaccinated and receive the third booster immunization as well.”
  

Monitoring the immune response to COVID-19 vaccination in patients with multiple myeloma, says Dr. Hari, and administering supplementary doses of the same or another vaccine, may provide some guidance for the clinical management of these patients. 

Looking Forward 

ACCC developed the project Returning to Practice in the Post-COVID-19 Era: Hematology Disease Education to highlight cancer programs that have successfully adapted their services to the ongoing—though now more manageable—COVID-19 pandemic. This project enables multidisciplinary cancer care teams about what can be anticipated as vaccinations slowly make it possible for programs to resume their pre-pandemic services—specifically for patients with hematologic malignancies such as multiple myeloma. “Education is essential for understanding the biology, complications, prevention, and treatment and outcomes in COVID-infected individuals,” says Dr. Vesole. Information on how to remain safe in high COVID-19 transmission areas must be made available to all—particularly healthcare staff and those with the highest risk of infection. 

Immunocompromised patients, like those diagnosed with multiple myeloma, may not be able to mount the immune response of a healthy person fully vaccinated against the SARS-CoV-2 infection, as evidenced by the unfortunate death of General Colin Powell. However, being fully vaccinated can reduce the risk of patients getting infected and becoming severely ill, while also dramatically reducing their risk of hospitalization or death.