• People with multiple myeloma currently may be eligible for a third dose of the Pfizer and Moderna COVID-19 vaccine at least 28 days after their initial two doses.
• The Centers for Disease Control and Prevention (CDC) also has recommended Pfizer COVID-19 vaccine booster shots for adults over 65 and other high-risk individuals at least six months after their second dose.
• There is currently no official guidance for additional shots or boosters for those who have received the Johnson & Johnson vaccine.

People with multiple myeloma may be eligible to receive a third dose of the Pfizer or Moderna COVID-19 vaccine shot. Additionally, those who received two doses of the Pfizer vaccine may be eligible for a Pfizer booster shot.

On Aug. 12, the U.S. Food and Drug Administration (FDA) amended the Pfizer and Moderna vaccines’ emergency-use authorizations to allow a third vaccine dose at least 28 days after the second dose for certain immunocompromised individuals. Some immunocompromised people may not develop an adequate immune response after the two-dose COVID-19 vaccination series.

Individuals defined as immunocompromised include:

• People currently receiving cancer treatment for tumors or blood cancers
• People who received a stem cell transplant in the last two years
• People who are organ donor recipients and taking immunosuppressive drugs
• People taking high-dose steroids or other immunosuppressive drugs, as well as those with certain other health conditions

People with myeloma may qualify as immunocompromised under the above criteria. The CDC recommends individuals consult their doctors to determine if a third dose is appropriate.

There is not yet guidance from the FDA or CDC on additional doses for immunocompromised people who received the Johnson & Johnson vaccine.

Vaccine Booster Shots

If a person with myeloma or a related condition doesn’t qualify for a third vaccine dose at least 28 days after their second Pfizer or Moderna shot, they may be eligible to receive a Pfizer booster shot under new guidelines from the CDC. These boosters are intended for those who received the two-dose series of the Pfizer vaccine but then experienced a drop in immunity over time.

On Sept. 24, the CDC recommended booster shots of the Pfizer COVID-19 vaccine at least six months after a second dose in the following groups:

• People 65 and older
• Residents of long-term care facilities
• People ages 50 to 64 with underlying medical conditions that place them at high risk for severe COVID-19

The CDC recommendations state that people ages 18 to 49 with underlying medical conditions and people ages 18 to 64 who are at risk of COVID-19 exposure due to their work or living arrangements “may receive a booster shot” of the Pfizer vaccine “based on their individual benefits and risks.”

The CDC and FDA have not released booster recommendations about the Moderna vaccine or the single-dose Johnson & Johnson vaccine. Both companies have submitted data on booster shots to the FDA for review.

Do People With Myeloma Need Additional Doses or Boosters?

People with multiple myeloma often have weakened immune systems, due to either low or poorly functioning white blood cell levels caused by the disease itself or a side effect of cancer treatment. This has important implications for how people with myeloma respond to the COVID-19 vaccines, according to Dr. Brian Durie, chairman of the International Myeloma Foundation. “At least half of the patients with myeloma when they get the two-shot Pfizer or Moderna vaccinations, they do not achieve good antibody levels,” he commented in a video released by the foundation.

Antibody levels are an indication of how well a person’s immune system can recognize the coronavirus after getting the vaccine. Lower antibody levels show that people with myeloma are still at a higher risk for severe disease following a standard vaccination schedule.

Dr. Matt Kalaycio, a board-certified hematologist and a professor at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, echoed Dr. Durie’s comments in a conversation with MyMyelomaTeam in September.

The CDC and FDA recommendations for third doses of the Pfizer and Moderna vaccines “are for those patients whose immune systems are compromised — and that would include every single person who has a blood cancer,” Dr. Kalaycio said.

“Everyone with blood cancer is not really fully vaccinated unless they get that third dose,” Dr. Kalaycio added, due to the impact of myeloma on the immune system.

Dr. Kalaycio assured people with myeloma and other blood cancers that both the Pfizer and Moderna COVID-19 vaccines work. “They do create an immune response, but not to the degree that it does in the normal population. So the third dose does seem to bring the immunity up to the level of everybody else,” he said.

Learn More About COVID-19 Vaccines

“We recommend vaccinations for all of our patients with blood cancers, and the only exception to that rule are those who have had stem cell transplants in the last three months,” Dr. Kalaycio stated in his September conversation with MyMyelomaTeam.

Dr. Kalaycio previously answered questions about the COVID-19 vaccines in March. In that conversation, he spoke in greater detail about COVID-19 vaccination and treatments for myeloma, and safety questions about the vaccines.

Talk To Your Doctor

If you have multiple myeloma or a related condition, talk to your doctor about whether you qualify now to receive a third COVID-19 vaccine dose or a booster.