COMy 2021 | Impacts of COVID-19 on patients with multiple myeloma

Last year was a very difficult year for the planet. Amongst that, patients with myeloma struggled particularly with the pandemic. Many of us in different countries tried to collect data to try and delineate exactly the impact of COVID-19 on the lives and survivorship of myeloma patients.

In the UK, on behalf of the UK Myeloma Forum, I ran a registry similar to colleagues across Europe and in the US. The problem with these types of registries is that they are inherent to selection bias. That is that, the notification to the registry is based on a clinician identifying a patient and forwarding the appropriate information to the registry, in this case, the registry that I held. Therefore, what we were getting was a snapshot, but not necessarily a true denominator, of the impact. But anyway, we have what we have. Looking at that data, it does highlight that patients with myeloma, particularly during the first wave, were struggling to get through the pandemic and there was a significant impact on survivorship.

Of the blood cancers, patients with myeloma seemed to have the poorest outlook. It’s not just about age. It’s not just about comorbidity. It did seem to be something inherent to myeloma that perhaps was driving this. As I said at the outset of this answer, what we really need is to get a proper handle, using digital health and resources to work out what the denominator is. There will be patients who were tested in the community that we don’t know anything about. There are patients who will have been infected and managed in the community that we don’t know anything about. The true survivorship picture still needs to be defined.

Then, of course, we move into the realms of the vaccination. We’ve known for years that myeloma patients, because of their inherent cellular and humoral deficiencies, struggle with vaccinations, whether they be seasonal flu, or pneumococcal and haemophilus influenza vaccines. Therefore, the expectation is that the COVID vaccines will probably have a less impactful use for myeloma patients because of that. But we don’t know. Also, the COVID vaccines are using different vaccine technologies that perhaps might have a better impact in myeloma patients than the standard seasonal flu vaccines or the anti-bacterial vaccines. We will need to wait and see.

As the audience is aware, the UK, for once, was actually ahead of the curve with regards to vaccines. We’ve been looking at myeloma patients responses to vaccines. Not only serological but, what I believe more importantly, is looking at T-cell responses and the deep immunophenotypic strategy. In the UK, this has been run through the OCTAVE study, which is funded by Medical Research Council, through the National Core Studies programme. This is recruiting myeloma patients to the blood cancer cohort. It is a trial that’s looking at COVID vaccine efficiencies in immunocompromised patients across solid organ transplantation, renal liver disease, and stem cell transplantation as well as patients with autoimmune disorders. For the blood cancer cohort, it’s going to be myeloma. We are currently collecting and analyzing that data, which hopefully will inform the the clinical community about the efficiency of the vaccines, which were AstraZeneca and the initial one was Pfizer so there were a combination of vaccines in there. This may form the foundation for evidence-based practice to actually give further booster vaccinations to myeloma patients and/or there may be something to be gained from switching brands, because of the different biological effects of those vaccines.