Increased Infection Risk in MGUS Patients

A short article was just published in the journal Clinical Interventions in Aging that discusses the effectiveness of vaccination of MGUS patients with Prevnar (Pfizer’s 13-valent pneumococcal conjugate vaccine). The article provides some cautions for MGUS patients, such as:

‘Numerous studies have confirmed the association of MGUS with infections, particularly pneumonia, infections caused by viruses (cytomegalovirus, Epstein-Barr virus, chronic viral hepatitis), and tuberculosis. Additionally, the mean survival for patients with MGUS is shorter compared with the healthy population. The major reason for early mortality in this group is infection. Despite a frequently asymptomatic clinical course, MGUS leads to the development of secondary immunodeficiency. The incidence of infections in patients with MGUS is twice as high as that of the healthy population. Patients with MGUS have a 2.4-fold higher risk of pneumonia compared with healthy subjects, and an association between infections and rapid progression from MGUS to Multiple Myeloma was proposed.’ [emphasis added]

The authors’ study objective was ‘… to assess the immune response to the 13-valent pneumococcal conjugate vaccine (PCV13) in treatment-naive MGUS patients versus healthy subjects.’ 

A group of newly diagnosed MGUS patients was vaccinated immediately after diagnosis and their incidence of infections was monitored over a period of five years and compared against vaccinated healthy patients. All infections in both groups were recorded during the follow-up period.

The authors concluded :

• [Prevnar] vaccination in MGUS patients is safe and effective in protecting against pneumoniae infection.
• Vaccination should be carried out as soon as possible after the diagnosis. It can protect patients against serious infectious complications, which may contribute to extending the time to progression and transformation into more aggressive diseases like MM.
• … the response to immunization worsens with the increase of M protein in the serum. This dependence agrees with the observations of Kristinsson et al. who found that the risk of infection is higher in patients with MGUS in whom the M protein concentration exceeds 2.5 g/dL.
• Serum M protein concentration in patients diagnosed with MGUS may be a useful predictor of the effectiveness of vaccination.’

The authors make several other very worthwhile observations :

• ‘The lack of available literature on the effectiveness of vaccinations among patients with MGUS suggests the need to deepen the study on this subject and plan further research on a larger group of patients. This is particularly important because, as Augustson et al showed in their research, 45% of early deaths (deaths that occurred up to 60 days from the diagnosis of multiple myeloma) are caused by infections, mainly by pneumonia and sepsis. [emphasis added]
• It is likely that the introduction of preventive vaccinations against pneumoniae, inter alia, for patients with MGUS would contribute to mortality reduction in those patients in whom MGUS progresses to multiple myeloma.
• Although anti-pneumococcal vaccine is recommended in MGUS and multiple myeloma patients, vaccination coverage is low. Preliminary data from the Insight-MM study, including 650 patients with MM, revealed that only 17% of newly diagnosed and 24% of relapsed/refractory multiple myeloma patients received the recommended anti-pneumococcal vaccination in the past 5 years. [emphasis added]

This is something you can do for yourself if you are a MGUS patient and have not yet been vaccinated with a pneumococcal conjugate vaccine. This is a good time to do so, together with your flu vaccine. By the way, Prevnar is a 13-valent vaccine (in other words, it provides protection against 13 pneumococcus strains). There is also a 23-valent vaccine that has more recently entered the market. I suggest that you discuss this (vaccination) topic with your physician and receive guidance as to which of the different vaccines would be the better option for you.