Patients With Multiple Myeloma Advised to Receive COVID-19 Vaccination

The European Myeloma Network (EMN) has recommended that all patients with monoclonal gammopathy of unknown significance, smoldering multiple myeloma, multiple myeloma, and monoclonal gammopathies of clinical significance should be vaccinated with a COVID-19 vaccine, following a thorough literature review. The panel also recommends considering risk factors for poor response, including uncontrolled disease, immunoparesis, the number of previous lines of therapy, and patient age.

The investigators gave recommendations for the optimal window for vaccination, which included:

• Before the onset of active multiple myeloma.
• During well-controlled disease and at times of minimal residual disease negativity, complete response, or very good partial response.
• Before the start of therapy, before stem-cell collection, and more than 3 months after autologous hematopoietic stem-cell transplantation.
• During periods without therapy (exception: lenalidomide maintenance therapy).

The EMN also recommended that vaccination should be considered based on provider judgment for patients with poorly controlled disease or ongoing therapy, but that induction of protective immune response is less likely. The investigators further suggest that patients with previously confirmed COVID-19 infection should be vaccinated as well, though they note that 1 dose of the vaccine might be sufficient.

For patients with immune impairment, the panel recommends the administration of a third vaccine dose. Further, patients who are insufficiently protected should comply with principles for the reduction of infection risk, and will depend on herd immunity, benefitting from a “vaccination ring” of partners and close social contacts.

They recommend that, in general, household members of patients with multiple myeloma and health care personnel providing them care should be vaccinated. For immunosuppressed patients who contract COVID-19 or have been exposed to SARS-CoV-2, the investigators recommend considering the administration of monoclonal antibodies.

To compile these recommendations, a panel of 36 experts in multiple myeloma and malignant hematological diseases convened 3 times during virtual meetings of the EMN between April and June 2021. These experts evaluated and discussed the rapidly emerging data relating to COVID-19 vaccination and multiple myeloma, which were obtained by a comprehensive literature review. They also reviewed the recommendations on COVID-19 vaccination from the International Myeloma Society.

REFERENCE

COVID-19 vaccination in patients with multiple myeloma: a consensus of the European Myeloma Network. The Lancet Haematology; October 28, 2021. Accessed November 1, 2021. https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00278-7/fulltext