Infection is a serious threat to patients with multiple myeloma. The risk of specific bacterial infections such as pneumonia and septicemia, as well as viral infections like COVID-19, herpes zoster, and influenza, is higher by 7-10x in myeloma patients compared to patients without myeloma (Table 1). The risk of dying from an infection is also significantly elevated for an myeloma patient compared to controls.^1,2 

*COVID-19 related findings from Dai et al. were included Table adapted from Blimark et al. 

To prevent infections, vaccines are one of the best tools available. While most patients probably received vaccinations as a child they may no longer protect if the patient has received a stem cell transplant (SCT). In the case of the COVID-19 vaccination, it has been found that boosters, specifically a third, are effective in producing antibodies and protecting against COVID-19.³ 

In February 2022, Dr. Noopur Raje and 35 other doctors and researchers published a scientific article detailing a course of action for preventing and managing infections in patients with multiple myeloma. For a beautiful summarization of the Raje et al. article, click here.

In light of all the research that has been done, are infectious diseases still an issue for patients with MM or is this a thing of the past?

In the Summer of 2019, HealthTree Foundation conducted a vaccination-related survey with Dr. Michael Thompson. The goal of the survey was to find out if patients being vaccinated post-treatment (specifically after SCT) is included as a standard practice.⁴

Results of the survey showed: 

• A majority of respondants are receiving vaccination for pneumonia and the seasonal flu (see figure 1 and 2)
• Most respondants did not receive a shingles vaccine (see figure 3)
• Anti-viral drug (acyclovir and valacyclovir) was common, but not universal (see figure 4)
• Anti-bacterial drugs (bactrim and levofloxacin) use were reported by a minority of participants (see figure 5 and 6)

These results indicate some good news, spotlights some areas that need improvement, and answers the question that infectious disease is still an issue for patients. 

Most importantly, patients can take action by talking to their doctor or calling the Immunization Clinic at their hospistal to varify whether they need vaccinations or if their vaccinations are current. Italian poet, writer and philosopher, Dante Alighieri, once said, “the secret to getting things done is to act.”

Fig 1.

Fig 2. 

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Fig 4.

Fig 5. 

Fig 6.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281323/
2. https://pubmed.ncbi.nlm.nih.gov/32345594/
3. Thompson MA, Hallmeyer S, Fitzpatrick V, Liao Y, Mullane MP, Medlin S, Copeland K, Weese J. Real World Third COVID19 Vaccine Dosing and Antibody Response in Patients with Hematologic Malignancies. Journal of Patient Centered Research and Reviews. In Press
4. https://ascopubs.org/doi/10.1200/JCO.2020.38.15_suppl.e20567