HealthTree for Multiple Myeloma has presented a number of posts over the past few years dealing with the subject of Covid-19 vaccination and boosting for those of us with multiple myeloma. A number of papers have been published documenting that those of us with hematological malignancies [not just myeloma, but also the different lymphoma and leukemia variants] are not receiving the full protection of the Covid vaccines seen in the general population.

A paper just published in the journal Cancer builds on this prior knowledge with a retrospective study of 378 patients with blood/bone marrow cancers tracked over the period since the Covid vaccines have become available.

Before continuing you need to be familiar with the term "seroconversion" - the development of specific antibodies in the blood serum as a result of infection or immunization, including vaccination. During infection or immunization, antigens enter the blood, and the immune system begins to produce antibodies in response. Seroconversion means that you developed Covid antibodies.

Some of the conclusions from this study re-confirm outcomes from other published studies, and some present novel observations and recommendations. The list below presents some key conclusions, but not all discussed in the referenced paper.

• Among patients with hematologic malignancies, seroconversion after initial vaccination was significantly associated with younger age, type of hematologic malignancy, disease status, receipt of anti– B-cell monoclonal antibody therapy, type of vaccine used, higher total white blood cell or lymphocyte count, longer time from last treatment to antibody testing, and later calendar time (possibly because most patients on active therapy were tested earlier in the year).” In the case of plasma cell disorders [e.g., myeloma, MGUS], 60% of the patients showed Covid antibody presence after initial vaccination, though patients treated with Darzalex showed 42% seroconversion.
• "There was not a significant association between seroconversion after initial vaccination and a history of stem cell transplantation.”
• … we observed that booster vaccinations can promote seroconversion in a significant proportion of patients who are seronegative after the initial vaccination course.” In other words, boosting will most likely give you added protection.
• … the rates of seroconversion among patients with plasma cell neoplasms (reported as 65% – 95%) [after boosting !] may be near rates in the general population. … Importantly, we found better-than-expected rates of seroconversion in previously seronegative patients at 56%, illustrating that boosters offer significant additional protection, even for patients who remain on active anti-cancer therapy. Our findings suggest that boosters should be given to patients with hematologic malignancies whenever they are eligible rather than delaying boosters until the completion of therapy.”
• Patients with active disease consistently have shown lower rates of seroconversion than those under watchful waiting or in remission.
• Rates of seroconversion after booster vaccination were similar among the individual vaccines used. using either of the mRNA vaccines [i.e., the Pfizer/BioNTech or the Moderna vaccine] to boost this population is reasonable given early data suggesting that these products may retain more efficacy against the omicron variant compared with the Johnson & Johnson vaccine.
• Although postvaccination seroconversion may not be associated with a decrease in any (including asymptomatic) COVID-19 infection, the authors experience suggested that effective vaccination (including a booster), supplemented by passive immunization using tixagevimab/cilgavimab [Evusheld] in case of lack of seroconversion, effectively eliminated the risk of COVID-19 death in the otherwise high-risk population.

You may wonder what this Evusheld is. Evusheld was given an Emergence Use Authorization by the Food and Drug Administration; at the end of December 2021. This product, developed, manufactured and sold by Astra-Zeneca is a prevention therapy for certain high-risk individuals that can help protect them from COVID-19 before they are exposed to the virus.

Evusheld is the first pre-exposure prophylaxis product for COVID-19 apart from vaccines. Evusheld is a combination of two medications given together: tixagevimab and cilgavimab. Both are monoclonal antibodies, which are lab-made proteins that act like antibodies made by your immune system to fight an infection. Evusheld is administered by two injections immediately given one after another. Based on clinical trial data, Evusheld is administered every six months to offer the most protection.”

Limited supplies of Evusheld were available early in 2022 and the product was parceled out to those patients in highest need. That short supply has been alleviated since April and Evusheld is now readily available in infusion centers. The guidance I have received is that Evo shield can be administered at the same time as our myeloma treatment, but that there should be about a month of time either before or after the administration of Covid vaccination/boosters. If your myeloma specialist/doctor has not yet raised this topic with you than it is suggested you raise it with her/him.