Does multiple myeloma specifically affect the immune system in a different way than other cancers do?
Yes, it does. Vaccinations often don’t work as strongly for immunocompromised people, and multiple myeloma patients, especially, are at risk for breakthrough infection. This is because multiple myeloma is a cancer of plasma cells, which are the body’s antibody-producing cells. One’s body produces antibodies in response to a vaccine, but in patients with multiple myeloma, that system is compromised because it’s been taken over by cancer. It’s still beneficial for those patients to get vaccinations, but they often require boosters and still may not reach the high level of immunity that a healthy person would.
Does that hold true for flu shots and other types of vaccinations also?
Absolutely. There’s evidence that giving a booster for the flu shots every year is beneficial for multiple myeloma patients, precisely for the same reason. They often don’t mount immunity to the single flu shot like a normal population of people. You can boost immunity by getting a one month-booster for the for the flu shot each year. We advise our patients to do that.
Do you advise your patients to get boosters for the COVID-19 vaccine as well?
We do. As soon as the third shot became available, we felt strongly it would benefit our patients. They’re at a higher risk for losing their immunity over time, so they’re the perfect population to get the booster. We recommend that for all of our patients with multiple myeloma.
What about the treatment for multiple myeloma? Does that affect the immune system as well?
It does, and it’s for the same reason, that it’s a cancer of plasma cells. The treatments we use are designed to kill plasma cells to control the cancer, but they can also have off-target effects on your normal plasma cells. Depending on what therapy a patient is on, they may not mount a robust antibody response to a vaccine. A patient who is in remission with good disease control still may be on medications that repress their immune response. Others might have a high level of disease that is the major deterrent to a good antibody response. It really depends on the specific patient situation.
Beyond vaccinations and boosters, what else are you telling patients now? Should they still be extra careful and stay protected with masks, maybe more so than the general public?
Yes, I think that being careful is still important for multiple myeloma patients in particular. We know that masking is effective, and it’s important to be as careful as you can without compromising your quality of life. We recommend to our patients that when you go out, try to minimize exposure to large crowds of people, and most importantly, wear a mask when you’re indoors and out in public. Sticking with these precautions while there remain ongoing new cases of COVID is beneficial.
Have you witnessed any breakthrough cases in any of your patients? Or have you heard of multiple myeloma patients that have had breakthroughs?
Luckily, we haven’t had too much of a problem with breakthrough cases in our patients with multiple myeloma. Patients have had cold-like symptoms, but not severe cases. I’ve had a couple of patients who have been vaccinated and had mild symptoms and recovered fine. They do well when they’re vaccinated and follow the booster recommendation.
We know multiple myeloma patients are at higher risk for breakthroughs, but what about patients with other types of cancers? Are they at higher risk as well?
Multiple myeloma patients are especially at risk, but it’s also true that chemotherapies and other treatments for cancer can affect a patient’s antibody response and other immune responses that are important in vaccine response. In general, cancer patients as a whole are at risk, so it’s good for them to get boosters as well
Is there anything else you want multiple myeloma patients, or cancer patients in general, to be aware of?
It’s important to understand that everyone’s situation is a little different, and understanding the details of the specific situation, including the specific medical problems in a person, is really important. Speaking with your doctor about your particular situation is the most important thing. The specifics of Colin Powell’s case are very illustrative of that. If we didn’t know he had multiple myeloma, we wouldn’t know that probably had a role in him having a breakthrough case and dying of his disease. I don’t know for a fact that they’re related, but it certainly seems that he’s a good example of what can happen in our population.
