COMy 2022 | The importance of improving the efficacy of COVID-19 vaccination in patients with myeloma
Heinz Ludwig, MD, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria, discusses the impact of the COVID-19 pandemic on patients with multiple myeloma and the efficacy of vaccines in this patient population. Prof. Ludwig first highlights the increased risk of COVID-19 infection in myeloma patients, and then goes on to discuss new recommendations for administering vaccines to patients. Prof. Ludwig then explains the benefit of booster doses and the challenge of administering vaccines to patients being treated with immunotherapy, due to a reduction in humoral antibody response and T-cell response, as well as the need to improve this approach in the future. This interview took place at the 8th World Congress on Controversies in Multiple Myeloma (COMy) 2022, held in Paris, France.
Transcript (edited for clarity)
First of all, I think it’s important to say that myeloma patients have a twofold to threefold increased risk for acquiring COVID infection. And if they are newly diagnosed in the first six months, the risk is much higher. And they have a higher risk for developing severe disease, higher risk for mortality. And even if they are vaccinated, the vaccine effectiveness is lower than in the normal population...
First of all, I think it’s important to say that myeloma patients have a twofold to threefold increased risk for acquiring COVID infection. And if they are newly diagnosed in the first six months, the risk is much higher. And they have a higher risk for developing severe disease, higher risk for mortality. And even if they are vaccinated, the vaccine effectiveness is lower than in the normal population. So the question is, what can we do? And so now there are new recommendations from the NCCN, which have just recently been published to consider baseline vaccination as a vaccination which includes three doses. And then you follow up and in my opinion, depending on the immune response of the individual patient also, that is not recommended by all authorities, but I think you need to know about the immune response of your individual patient, and then you schedule additional doses.
And for the future, we know that patients with certain treatments like CD38 antibody treatment, BCMA-targeted therapies have very low response rates. So we need different vaccines for patients with B-cell deficiencies subjected to specific treatments. And there are some attempts which are interesting, which have been published recently at the American Association of Cancer Research with the vaccine, which is intended to stimulate a strong T-cell response. So they used different epitopes from the spike protein, membrane protein, nucleocapsid protein, open reading frame 8 in order to elicit a T-cell response in patients which have a very low likelihood to produce antibodies. And that may help. But of course, that is something which needs to be shown. The effectiveness needs to be shown in clinical practice.
So these data show that a fourth vaccine, so there is actually a decline in humoral antibody response, and probably also a decline, less pronounced decline in T-cell response. But the decline in antibody response is very substantial. So when you look at these kinetics, that shows you that you need to come in with booster vaccinations. And probably the recommendation is after three doses to come with a booster after three months, and then to follow with another booster between three to six months, depending on the response. So it’s an ongoing process, unless we are able to establish, let’s say a more permanent humoral and cellular immunity.
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