Infectious Disease

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

December 12, 2021

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

Disclosure:
Fillmore does not report any financial information. Please refer to the executive summary for all relevant financial information from the other researchers.

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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 due to immunosuppression from the disease process and associated therapy.

The researchers presented the results of the large retrospective Veterans Affairs cohort study at the ASH annual meeting and exhibition.

Pfizer vaccine vials.  Source: Adobe Stock

Source: Adobe Stock.

“We decided to continue this research in the VA because, as a large, nationwide healthcare system that offers its patients excellent access to vaccinations and tests, the VA data enables us to evaluate how well patients are being vaccinated multiple myeloma in the real world, ” Nathanael R. Fillmore, PhD, Associate director of machine learning and advanced analytics at VA Boston Healthcare System and lecturer in medicine at Harvard Medical School, said Healio.

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

The researchers compared 818 vaccinated patients 1: 1 with unvaccinated or not yet vaccinated controls.

Nathanael R. Fillmore, PhD

Nathanael R. Fillmore

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

Researchers classified patients with unvaccinated controls based on age, race and ethnicity, VA facility, rural location, 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 as the primary endpoint. Fillmore and colleagues defined the effectiveness of the vaccination as 1 minus the relative risk of COVID-19 infection for vaccinated subjects compared to unvaccinated controls.

The results showed a vaccine efficacy of 5.6% (95% CI, 64.5 to 47.5) in the appropriate cohort of patients with multiple myeloma starting 14 days after the second dose. Meanwhile, efficacy 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 mismatched cohort of multiple myeloma patients, 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 Patients whose last multiple myeloma treatment was more than 6 months prior to vaccination.

Researchers called for further studies to assess the relationship between multiple myeloma disease stages, when to treat, and the types of therapies that may affect vaccine effectiveness, and to determine whether patients benefit from post-vaccination serologies or booster vaccines would.

“The main message from this study is that while vaccination is an effective strategy for preventing SARS-CoV-2, its effectiveness in patients with multiple myeloma may be reduced and therefore other strategies are needed to prevent infection and poor outcomes . “In this population,” Fillmore said to Healio.

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ASH annual conference and exhibition

ASH annual conference and exhibition

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