COVID-19 vaccination may be less effective for patients with multiple myeloma


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Fillmore NR, et al. Abstract 400. Presented at: ASH Annual Meeting and Exposition. Dec. 11-14, 2021; Atlanta.

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Although vaccination is an effective strategy for COVID-19 prevention, its effectiveness may be reduced in patients with multiple myeloma, likely because of immunosuppression due to the disease process and related therapy.

Researchers presented the results of the large, retrospective Veterans Affairs cohort study at ASH Annual Meeting and Exposition.

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“We decided to pursue this research in the VA because as a large, nationwide health care system that provides excellent access to both vaccination and testing for its patients, the VA data allow us to evaluate how well vaccination works in patients with multiple myeloma in the real world,” Nathanael R. Fillmore, PhD, associate director for machine learning and advanced analytics at the VA Boston Healthcare System and instructor in medicine at Harvard Medical School, told Healio.

The analysis included 3,943 patients treated for multiple myeloma at VA hospitals between Dec. 15, 2019, and Dec. 15, 2020, and followed for COVID-19 vaccination for up to 287 days.

Researchers matched 818 vaccinated patients 1:1 with unvaccinated or not-yet-vaccinated controls.

Fillmore and colleagues also identified 11,946 patients with monoclonal gammopathy of undetermined significance (MGUS) for an added comparison with a less-immunocompromised population and matched them 1:1 with unvaccinated/not-yet-vaccinated controls.

Researchers matched patients with unvaccinated controls according to age, race and ethnicity, VA facility, rurality of home address, frailty and disease type (multiple myeloma vs. MGUS).

Receipt of a COVID-19 vaccine served as the primary exposure and laboratory-confirmed COVID-19 infection served as the primary outcome. Fillmore and colleagues defined vaccination effectiveness as 1 minus the relative risk for COVID-19 infection for vaccinated individuals compared with unvaccinated controls.

Results showed vaccine effectiveness in the matched cohort of patients with multiple myeloma of 5.6% (95% CI, 64.5 to 47.5) starting 14 days after the second dose. Meanwhile, effectiveness was 27.2% (95% CI, 5.6-49.9) starting 14 days after the second dose in the matched cohort of patients with MGUS.

In the unmatched cohort of patients with multiple myeloma, 5.2% of patients whose last treatment for their disease was no more than 90 days prior to vaccination experienced COVID-19 infection after vaccination, compared with 2.6% of those whose last multiple myeloma treatment was more than 6 months prior to vaccination.

Researchers called for further studies to evaluate the relationship between multiple myeloma disease states, treatment timing and types of therapies that may impact vaccine effectiveness, in addition to determining if patients would benefit from post-vaccination serologies or booster vaccines.

“The most important take-home message of this study is that even though vaccination is an effective strategy for preventing SARS-CoV-2, effectiveness may be reduced in patients with multiple myeloma, and thus other strategies are needed to prevent infection and poor outcomes in this population,” Fillmore told Healio.

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