What to know about multiple myeloma and COVID-19 vaccinations

Should a person still get it?

As MM affects the immune system, it can cause people to become more susceptible to infections, such as SARS-CoV-2, because the abnormal plasma cells cannot effectively fight viral or bacterial infections. Research also suggests that people living with blood cancers are more likely to have severe cases of COVID-19. The results showed a mortality rate of about 39% among those hospitalized, with a 33% risk specifically for those with MM.

As people with MM have an increased risk of severe COVID-19, the American Society of Clinical Oncology (ASCO) advises them to get a COVID-19 vaccination. Although people with MM may experience a decreased response to the vaccine, it will still likely provide benefit and reduce the risk or severity of COVID-19.

It is important that family members and friends also receive the vaccine and continue practices such as hand washing to provide the most protection for those with MM.

Due to the increased susceptibility of people with MM, many sources note that these individuals may be a higher priority for vaccination to prevent complications. This status means that they should attempt to get a vaccination as soon as it is feasible.

However, a person should discuss this with their doctor, as if they are currently receiving immunosuppressive therapy, it may be beneficial to wait to increase the likelihood of developing immunity from the vaccine.

As scientists complete more clinical trials and research on the efficacy and safety of COVID-19 vaccines, the medical community’s understanding of the optimal timing and dosing schedule will increase.

Which people with MM should get the vaccine? 

Before scheduling a vaccination, a person should talk with their primary care doctor about the shot, as well as their current treatment status. A person’s doctor is the best resource for determining when and who should get the vaccine.

The International Myeloma Foundation offers a similar sentiment, saying that a person should work with their doctor to determine whether the vaccine is the best choice for them and when they should get it. They also strongly encourage people living with MM to get the vaccine.

Will it still be as effective? 

Although there are concerns that the vaccine may not elicit a sufficient immune response, research suggests that a single dose of a COVID-19 vaccine can trigger an immune response in about 70% of people with MM. Notably, no participants in the study had any serious COVID-19 symptoms.

The study adds that people with MM are likely to have some protection after one vaccine, which may improve after the second. Therefore, the timely administration of a second vaccine dose may help boost the immune response. This is similar to how booster doses help assure adequate protection against other viruses, such as seasonal influenza.

It is also worth noting that as MM is most prevalent among older adults, this may affect the immune response, as otherwise healthy older adults also have a lower immune response following vaccination. Although vaccines may have varying rates of efficacy, this highlights the importance of following recommendations to reduce infection risk and achieve herd immunity.

Is it safe, and will it cause side effects? 

Current research from the Centers for Disease Control and Prevention (CDC) and the International Myeloma Foundation indicates that it is best for a person living with multiple myeloma to get the vaccine to help protect them against COVID-19.

The vaccine can cause side effects in anyone, including those living with multiple myeloma. It is still not known whether a person living with multiple myeloma is more likely than those without the condition to experience side effects from the shot. Some possible side effects include:

• swelling
• redness or other discoloration
• muscle pain
• pain
• tiredness
• fever
• headaches
• nausea
• chills

Which vaccines are available to those with multiple myeloma? 

At present, a person living with MM can get one of three COVID-19 vaccines that have approval through the Food and Drug Administration’s (FDA’s) emergency use authorization. The options are:

• Moderna, which requires two shots
• Pfizer, which requires two shots
• Johnson & Johnson, which requires one shot

Does a person need to get the same vaccine for both shots?

The CDC states that the Pfizer and Moderna vaccinations are not interchangeable. As a result, a person should get the first and second shot from the same company. A person should make sure that the agency performing the vaccination is aware of which vaccine they received initially.

Until there is more research, it is not advisable for a person to receive different brands, more inoculations, or higher doses of COVID-19 vaccines. If the second dose is not currently available, a slight delay to wait for the same brand is acceptable. If availability is an issue, a person may consider an alternative brand of vaccine but should discuss this with their doctor.

When will a person with MM receive each dose?

Currently, people with MM should follow the same recommendations as other people for receiving their vaccines. For vaccines that require two shots, people should wait 3–4 weeks for their second dose, depending on which vaccine they get. However, a gap of up to 6 weeks between doses is fine.

A person should talk with their doctor about the ideal time for them to receive their doses. Certain therapies will require special timing of the vaccination. In some cases, a person may need to stop therapy before their first dose and then resume it after their second dose.

Will it interfere with treatment?

People living with MM may be at different points in their therapy. In some cases, a person will not be able to receive their vaccination immediately based on the treatments they are receiving.

Many treatments for MM may affect a person’s immune system. For the body to generate protective immunity following a vaccine, the immune system and immune cells, such as plasma cells, must be functioning properly. Therefore, a person may need to stop treatment temporarily to ensure that they can generate an immune response.

A person should discuss the timing of their vaccines with their doctor.

Should a person with multiple myeloma get a flu shot?

Evidence suggests that a person with MM should get the seasonal flu shot each year. Similar to the COVID-19 vaccination, a flu shot can help protect a person from severe illness and complications.

Anyone considering a flu shot should discuss this with their doctor. The doctor may want the person to space out the shots or get them around the same time. They may also advise whether to receive a flu shot on its own or alongside a COVID vaccine.

When to contact a doctor after the vaccine

According to the CDC, a person should talk with their doctor following the vaccination if side effects last longer than a few days or the area around the site gets worse after 24 hours.

They also advise a person not to get a second dose if they experience a severe allergic reaction to the first. A person should let their doctor know if they experience a severe allergic reaction so that they are aware of the situation.

Summary

People living with MM should get their COVID-19 vaccination as soon as it is available for them to do so. However, they should talk with their doctor before getting the vaccination to make sure that it will not interfere with their current therapy or treatment.

Although the vaccine may not elicit as strong a response as it may in other people, research still suggests that it is effective and can help a person reduce their risk of severe illness, hospitalization, and death. A person should talk with their doctor if they have any concerns about receiving their vaccination.