“One of the hallmarks of the therapy of myeloma is more and more we give what we call continuous therapy … to continue to chip away at the last few abnormal cells in their system,” he said. “I certainly consider someone who has myeloma to be immunocompromised, really, for the rest of their lives.”
Fortunately, he said, the disease is increasingly treatable, but it remains incurable.
Preliminary research bears out the notion that multiple myeloma patients fare less well with COVID-19 than others.
An international survey of outcomes for 650 patients with plasma cell disorders, published in the journal Blood in December 2020, found that a high percentage of multiple myeloma patients hospitalized for COVID-19 died, ranging from 27% to 57%, depending on the country.
Other preliminary work also demonstrates that patients with multiple myeloma and other blood cancers are less likely to mount strong immune responses to vaccination.
Just 45% of 96 multiple myeloma patients with active disease developed an “adequate” antibody response to two doses of one of the mRNA vaccines, according to a paper published in the journal Leukemia in July, with 22% of such patients partially responding.
As that paper put it, “the same mechanisms that impede [multiple myeloma] patients’ ability to fend off infections also reduce their capability to generate immunity from vaccination.”
Other studies have found less drastic, but still concerning results. For example, a paper published in Cancer Cell in June found that 15.8% of the 260 patients with multiple myeloma failed to produce detectable coronavirus-specific antibodies following full vaccination — and that antibody levels in the rest of the patients could vary widely.
Another paper published in the same journal the following month found that 5% of the 184 patients with multiple myeloma did not produce coronavirus-specific antibodies following vaccination.
A limited study of 49 patients with various B cell malignancies also showed that while boosters can help some patients develop an antibody response, 35% did not make detectable antibodies even after the booster.
Stadtmauer said that in his clinic, about two-thirds of multiple myeloma patients produced coronavirus-specific antibodies after vaccination. That’s lower than the general population, he noted, but still a decent fraction of people — and all the more reason for them to be vaccinated.
“If there’s any group of patients who should get COVID vaccine and boosters and stay vigilant and seek medical attention early if they have symptoms consistent with COVID, it’s patients with myeloma,” he said.
In addition to myeloma, Powell’s advanced age and even his sex gave him higher odds of having a bad outcome.
Figures from the CDC show that when serious breakthrough infections occur, they primarily involve older people and are more likely in males. Of the breakthrough infections reported to the agency by Oct. 12 in those who died, for example, 85% were in people 65 years of age and older and 57% were in males.
In recognition of the increased risk for older people, the FDA, in the last two months, authorized a third booster shot of the Pfizer/BioNTech and Moderna vaccines for people 65 years or older, along with other higher-risk groups.
A second Johnson & Johnson dose is also authorized for all adults, given evidence that the single-dose shot, while effective, is less so than either of the two-dose mRNA vaccines.
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
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