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Covid Vaccination for Myeloma
Covid vaccination for myeloma patients and survivors is essential. Let me explain why. As MM patients know, myeloma is a cancer of the immune system causing a type of white blood cell to reproduce uncontrollably.
In fact, infection is the one of the most common causes of death according to research.
So it makes sense that myeloma patients and survivors are susceptible to virus’. And while MM patients don’t respond to vaccination as robustly as able-bodied people do, vaccinations do provide protection against deadly virus’.
What is the state of a myeloma patient’s immune system?
- Reduced Production of Normal Antibodies: The cancerous plasma cells produce large amounts of abnormal antibodies (monoclonal proteins or M proteins), but they crowd out normal plasma cells, leading to a decreased production of functional antibodies. This reduction in normal antibody levels weakens the immune system and makes the patient more susceptible to infections.
- Bone Marrow Suppression: The proliferation of myeloma cells in the bone marrow can interfere with the production of other types of blood cells, including red blood cells, white blood cells, and platelets. This can lead to anemia, increased risk of infection, and problems with blood clotting.
- Immune Suppression: Treatments for multiple myeloma, such as chemotherapy and corticosteroids, can further suppress the immune system. While these treatments aim to reduce the number of myeloma cells, they also affect normal immune cells, exacerbating the patient’s vulnerability to infections.
- Dysfunctional Immune Response: Myeloma cells can alter the immune environment within the bone marrow, disrupting the normal functioning of immune cells. This includes inhibiting the activity of T-cells and natural killer cells, which are essential for detecting and destroying cancer cells and infected cells.
What are the pros and cons for covid vaccination for myeloma patients?
Pros
- Protection Against Severe Disease:
- Reduced Risk of Severe Illness: Myeloma patients are at higher risk of severe COVID-19. Vaccination significantly reduces this risk.
- Decreased Hospitalization Rates: Vaccinated individuals, including those with underlying conditions, have lower hospitalization rates.
- Immune Response:
- Immunogenicity: Studies indicate that myeloma patients can still develop a protective immune response, albeit sometimes lower than the general population.
- Booster Efficacy: Additional booster doses can enhance the immune response in immunocompromised individuals.
- Community Protection:
- Herd Immunity Contribution: Vaccinated individuals contribute to herd immunity, indirectly protecting those who cannot be vaccinated or have weaker immune responses.
- Reduction in Transmission: Vaccination reduces the likelihood of transmitting the virus to others, which is particularly important for vulnerable groups.
- Peace of Mind:
- Psychological Benefit: Being vaccinated can provide peace of mind and reduce anxiety about contracting COVID-19.
Cons
- Reduced Vaccine Efficacy:
- Weaker Immune Response: Myeloma patients might have a weaker response to the vaccine, making it less effective compared to healthy individuals.
- Variable Response: Not all patients will respond equally to the vaccine; factors like the type of myeloma treatment can affect the response.
- Potential Side Effects:
- Common Side Effects: Mild side effects like pain at the injection site, fatigue, and fever are common and can be more pronounced in some patients.
- Rare Adverse Reactions: Though rare, there is a risk of more serious side effects, which needs to be considered, especially in immunocompromised patients.
- Timing with Treatments:
- Treatment Interference: The timing of vaccination can be crucial as certain myeloma treatments (like chemotherapy) can affect vaccine efficacy. Coordination with healthcare providers is necessary.
- Scheduling Challenges: Aligning the vaccine schedule with ongoing treatments can be logistically challenging.
- Uncertainty in Long-Term Efficacy:
- Duration of Protection: It’s still uncertain how long the protection lasts in myeloma patients and whether additional booster doses will be needed more frequently.
Recommendations
For myeloma patients considering COVID-19 vaccination, it is essential to:
- Consult Healthcare Providers: Discuss personal health conditions and treatment plans with oncologists or hematologists to determine the best timing and type of vaccine.
- Monitor for Side Effects: Report any side effects to healthcare providers, especially any severe or unusual symptoms.
- Continue Protective Measures: Even after vaccination, continue following public health guidelines, such as wearing masks and practicing social distancing, especially in high-risk settings.
When it comes to the Sars-Covid virus, becoming infected is all the more serious. Therefore, protection by vaccination becomes that much more important.
man hand holding his nutritional supplemets, healthy lifestyle background.
Are you a MM patient or survivor? If you would like to learn more about nutritional supplementation found to reduce the risk of the sars-covid virus, email me- David.PeopleBeatingCancer@gmail.com
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Immune dysfunction prior to and during vaccination in multiple myeloma: a case study based on COVID-19
“Infection is the leading cause of death in multiple myeloma (MM). However, the cellular composition associated with immune dysfunction is not defined…
- MM patients displayed altered distribution of most cell types (41/56, 73%), particularly within the B-cell (17/17) and T-cell (20/30) compartments.
- Using COVID-19 as a case study, we compared the immune response to vaccination based on 64,304 data points generated from the analysis of 1099 longitudinal samples.
- MM patients showed limited B-cell expansion linked to lower anti-RBD and anti-S antibody titers after the first two doses and booster.
n contrast with the humoral response, the percentage and antigen-dependent differentiation of SARS-CoV-2-specific CD8+ T cells was not altered in MM patients…
Discussion
The availability of newer immunotherapies has intensified research efforts to improve our understanding of the immune status of MM patients and to use that knowledge towards more individualized approaches with increased efficacy and decreased risk of adverse events such as severe infections.
Here, we provide an atlas of the immune composition in the blood of MM patients and how it affects the efficacy of vaccination strategies such as for COVID-19.
Most studies of immune profiling in MM have analyzed bone marrow samples to characterize mechanisms associated with disease progression and treatment resistance [14,15,16,17,18].
Here, we leveraged multidimensional and computational immune profiling to perform a comprehensive characterization of 56 subsets, most of which (73%) were found altered in MM compared to HCP older than 50 years.
Thus, this study provides a measurement of the magnitude of MM immune dysfunction with regard to what can be expected from aging and related comorbidities in healthy adults without cancer.
Because we analyzed a second control group of patients with a B-CLPD, our results also uncovered that MM was associated with more severe immune suppression.
Thus, we suppose that the magnitude of immune dysfunction in the blood of MM patients may indeed reflect the cumulative effect of
- host,
- tumor,
- and treatment-related factors.
The consensus guidelines for infection prevention from the International Myeloma Working Group recommend an individualized treatment plan adapted by risk after comprehensive staging at diagnosis and relapse [22]. This includes taking the clinical history, examining physical health, and evaluating the functional status of older patients. Interestingly, a complete blood cell count is not recommended. Thus, the possibility that immune profiling in the blood may uncover immune suppressive states resulting from host, tumor, and/or treatment-related factors supports its potential role during staging. This should be investigated in future studies, which can leverage the median values and ranges of the immune subsets analyzed here (Supplemental Table 4). In this regard, we and others have shown recently how immune profiling in blood was an independent prognostic factor of severe SARS-CoV-2 infection in individuals with and without blood cancer [23,24,25,26]. This becomes particularly relevant with the advent of BCMA-targeting bispecific antibodies, which deplete (tumor and normal) plasma cells and are associated with an increased incidence of infections [27].
It is well-known that MM patients often show suboptimal response to vaccination and one recent example was the COVID-19 vaccine [10, 12]. While there is a growing understanding of the treatment-related factors associated with inferior immunogenicity [10, 28,29,30], little is known about the cellular dynamics during the immune response to vaccination. Here, we provided one of the most comprehensive analyses of the cellular dynamics during the immune response to vaccination, measured at five different time points before and after the first two doses. Albeit somehow expected, it was nonetheless stunning to see that most immune cells remained unresponsive in MM.
The B-cell compartment showed the greatest number of alterations, at baseline and during vaccination, which correlated with decreased antibody production. Of note, no severe infections or deaths from COVID-19 have yet been recorded in our cohort of MM patients, which is in accordance with other studies showing the positive impact of COVID-19 vaccination on morbidity and mortality rates [9, 31, 32]. Thus, while ours and the other studies provide evidence of how patients’ clinical status and B-cell numbers correlate with antibody titers, a better understanding of the causation behind protection against SARS-CoV-2 in the absence of adequate seroconversion may require more comprehensive and functional immune profiling and how it associates with the risk of severe infection.
An interesting observation of our study was that the T-cell compartment was less altered, which correlated with an adequate percentage of SARS-CoV-2 specific CD8+ T cells. These results build upon previous findings in patients with hematological cancer [33,34,35,36] that in the absence of adequate seroconversion, T-cell responses may protect vaccinated MM patients from severe infection. In consequence, the development of guidelines for the periodicity of boosters should probably consider the generation and persistence of virus-specific T cells in addition to antibody titers.
The International Myeloma Working Group recommends that the timing of vaccination should be individualized on the basis of the risks and benefits of immunization, including individual susceptibility to a specific infection, and the patient’s immune status [22]. However, the latter is inferred from the disease stage (i.e., patients with asymptomatic precursor conditions vs. active disease requiring therapy), previous treatment exposure (i.e., newly diagnosed vs. relapsed/refractory patients), and the type of therapy (e.g., high-dose melphalan with autologous transplant vs. an immune modulatory agent alone or with a proteasome inhibitor). There is only one reference to the recovery of CD4 cell count being a reasonable guide to immune recovery [22, 37,38,39,40].
Our results suggest that, as opposed to cell counts, only the percentage of CD4 T cells before vaccination significantly predicted the odds of an adequate seroconversion. Conversely, dendritic cell numbers but not percentages were predictive, whereas both the count and percentage of B cells were significantly associated with the magnitude of seroconversion. These findings are consistent with the recent observation that MM patients having an immune profile deficient in dendritic cells, NK cells, follicular-helper T cells, and B cells show suboptimal response to vaccination [41]. These immune biomarkers can be readily measured using routine flow cytometry, and such a minimally invasive test could help individualize current guidelines of empirical boosters every 6–12 months after the last shot or documented COVID-19 infection [12]. Such a strategy could potentially be expanded to other vaccine types according to the recent observations of immune determinants of influenza vaccine immunogenicity in pediatric hematopoietic cell transplant recipients [42]. We believe that such efforts are worthy to reduce the leading cause of morbidity and mortality in MM patients and continue improving clinical outcomes.