Defense Against Breakthrough COVID-19 With Myeloma: Double Vaccines, Antivirals, and More | MyMyelomaTeam

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Defense Against Breakthrough COVID-19 With Myeloma: Double Vaccines, Antivirals, and More

Medically reviewed by Leonora Valdez, M.D.
Written by Ted Samson
Posted on October 19, 2023

People living with multiple myeloma again face the choice of whether to get an updated messenger RNA (mRNA) COVID-19 vaccine. The International Myeloma Foundation (IMF) “strongly recommends that patients with multiple myeloma (MM), smoldering multiple myeloma (SMM), or monoclonal gammopathy of undetermined significance (MGUS) get vaccinated either with the Pfizer COVID-19 vaccine or Moderna vaccine, whichever is available.” According to the agency’s website, “These vaccines offer excellent benefits, and in general, have very limited and brief side effects.”

For people who are immunocompromised — that is, who have a weakened immune system due to conditions such as multiple myeloma — getting the updated mRNA COVID-19 vaccine may be just one part of a multipronged defense against COVID-19. If you have multiple myeloma, read on to learn about the new mRNA COVID-19 vaccines, other steps you can take to prevent severe illness, and what the latest research says about COVID-19 vaccines for people with multiple myeloma. Equipped with this knowledge, you and your health care team can have an informed conversation about when and if a COVID-19 vaccination is right for you.

The New Monovalent COVID-19 Vaccines

The U.S. Food and Drug Administration (FDA) has approved a new round of updated mRNA COVID-19 vaccines for adults and children ages 6 months and up. These new versions of the Moderna and Pfizer vaccines are recommended by the Centers for Disease Control and Prevention (CDC).

In the previous round, mRNA vaccines were bivalent, meaning they contained blueprints of spike proteins found in two different versions of SARS-CoV-2, the virus that causes COVID-19. These new vaccines are monovalent — they contain the blueprints of a single variant, called Omicron variant XBB.1.5 and nicknamed “Kraken.”

Health experts have identified XBB.1.5 as being highly transmissible and contagious. People who have received previous vaccinations or previously had COVID-19 have still been infected with this newer variant.

Who Should Get the New Vaccine?

All people ages 5 and up are eligible for one dose of the new vaccine as long as it’s been at least two months since their last vaccination. Children 6 months to 4 years old may receive more than one dose of the new vaccine, depending on their vaccination status.

People who are moderately or severely immunocompromised (have weakened immune systems) also should receive the new vaccine. The CDC cautions that these people are “at increased risk of severe COVID-19 illness and death.”

Are the New Vaccines Safe?

The FDA based its approval of the new mRNA vaccines on the safety and effectiveness of previous versions, which were manufactured in the same way as the new round. Per the CDC, millions of Americans have received COVID-19 vaccines “under the most intense safety-monitoring program in U.S. history.”

The FDA noted that the benefits of receiving the vaccine outweigh any risks. Potential side effects — both common and rare but serious — are similar to those of previous versions of the vaccine. Common side effects are generally similar to flu symptoms, including temporary fever, chills, aches, and fatigue, along with irritation or soreness at the injection site.

COVID-19 Vaccines: An Effective First Step for People With Multiple Myeloma

As noted, people who are immunocompromised, including those with multiple myeloma, face a higher risk of severe illness and death from COVID-19. While staying up to date on vaccinations can help, they can only do so much. This is because people who are immunocompromised aren’t able to generate and maintain the same levels of defense against COVID-19 as the general population.

A small 2023 study from Cancer Reports looked at the effects of getting a second dose of the COVID-19 mRNA vaccination among people with multiple myeloma. They found that, within 16 weeks of getting the shot, the majority of study participants didn’t have sufficient antibody levels to contribute to preventing COVID-19.

In reviewing available research about COVID-19 and people with multiple myeloma, the European Myeloma Network (EMN) concluded that people with multiple myeloma are at a relatively high risk for breakthrough cases of COVID-19. Breakthrough cases are when someone who was previously fully vaccinated gets COVID-19. The EMN researchers also noted that the reduced antibody response in people with multiple myeloma is caused both by the condition itself as well as some treatments that further suppress the immune system, including steroids, monoclonal antibodies, autologous stem cell transplantation, and novel cellular therapies, such as CAR T-cell therapy.

Other risk factors for breakthrough infections include being older and having additional health conditions — such as chronic obstructive pulmonary disease (COPD) or heart disease.

Vaccine Side Effects

COVID-19 side effects appear to be no worse among people with multiple myeloma than they are among the general population, and vaccines don’t appear to cause disease progression, according to Dr. Brian G.M. Durie, chairman of the board of the International Myeloma Foundation.

Per the IMF, the most common side effects include:

  • Pain, discoloration, and swelling at the injection site
  • Tiredness
  • Headache
  • Muscle pain
  • Chills
  • Fever
  • Nausea

Some people experience adverse events after getting a vaccination, but it’s very rare. If you experience any of the following after a vaccination, you should seek immediate medical attention:

  • Breathing difficulties
  • A drop in blood pressure
  • Tongue or throat swelling
  • Rash or hives

Though vaccine effectiveness is lower among people who are immunocompromised compared to the general population, the shots still offer a measure of protection against severe illness from COVID-19.

4 More Ways To Protect Yourself Against Breakthrough COVID-19

Staying up to date on vaccines provides some protection against COVID-19 for people with multiple myeloma who are immunocompromised. To better protect yourself, however, the following are some additional steps you should take.

1. Devise a COVID-19 Protection Plan With Your Doctor

Health agencies such as the IMF and EMN have specific guidance for how people with multiple myeloma can protect themselves against COVID-19. However, there’s no one-size-fits-all strategy. As noted, several factors can increase your odds of developing severe COVID-19, including which medications you’re taking, whether you have additional health conditions, and your age.

Therefore, before even getting your vaccination, speak with your health care provider. They can offer the best possible guidance as to whether the updated vaccine is right for you — and if so, when to get it. They may recommend scheduling it around your treatment regimen or during a period of remission (when you aren’t showing symptoms and the bone marrow has recovered) so the vaccine will be most effective.

2. Take Preventive Measures, Including Masking and Avoiding Crowds

COVID-19 spreads via droplets and particles released into the air through speaking, sneezing, and coughing. Wearing a face mask provides protection by preventing you from inhaling those droplets and particles through your mouth and nose.

Various types of masks and respirators are available, and the CDC has some guidance on how they differ. Some research from UC Davis Health suggests that N95 or KN95 masks offer the highest level of protection. Whichever you choose, make sure that it fits well and that you wear it properly and consistently.

Avoiding crowded areas and keeping distance between yourself and others can also help reduce your risks of contracting COVID-19, according to the CDC.

The CDC also recommends other preventive measures:

  • Stay abreast of COVID-19 hospitalization levels in your area.
  • When indoors, seek spaces with good ventilation (e.g., open windows) and filtration.
  • Engage in outdoor activities instead of indoors, when possible.
  • Avoid people who have or may have COVID-19.
  • Get tested for COVID-19 immediately if you develop symptoms.
  • Get tested after at least five full days if you’re exposed to COVID-19.
  • Stay home if you have COVID-19 (or think you may).

3. Double Up on Flu Vaccines

Seasonal flu also poses a threat to people with multiple myeloma who are immunocompromised, potentially causing severe respiratory disease. As part of its comprehensive guidance for managing COVID-19 in people with multiple myeloma, the EMN recommends receiving two doses of flu vaccine, one month apart. The agency notes getting the COVID-19 and flu vaccines at the same time is safe. Speak with your doctor, first, before getting your vaccinations.

4. Act Fast if You Do Get COVID-19

Despite your best efforts, you may unfortunately still contract COVID-19. If you test positive, you should contact your health care provider as soon as possible — the quicker you can start treatment, the better your prognosis (outlook).

Importantly, you should seek emergency medical treatment if you or a loved one develops any of the following emergency warning signs of COVID-19:

  • Breathing difficulties
  • Ongoing pain or pressure in the chest
  • Sudden cognitive problems such as confusion
  • Difficulty waking up or staying awake
  • Discolored skin, lips, or nail beds (which could be pale, gray, or blue, depending on skin tone)

If you do develop COVID-19, your doctor may recommend one of several treatments designed to reduce the potential severity of the infection, including Paxlovid (nirmatrelvir/ritonavir), an oral antiviral treatment for COVID-19.

Other potential options to prevent serious infection in people with COVID-19 include:

  • Antiviral drugs remdesivir (Veklury) and molnupiravir (Lagevrio)
  • Immune modulators baricitinib (Olumiant) and tocilizumab (Actemra)

According to guidance from the EMN, “nirmatrelvir/ritonavir, molnupiravir, and remdesivir are effective against various Omicron subvariants and, in people with multiple myeloma, should be administered at the time of a positive COVID-19 test or within five days following the appearance of COVID-19 symptoms.”

Find Your Team

On MyMyelomaTeam, the online social network for people with multiple myeloma and their loved ones, more than 21,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple myeloma.

Are you planning to get the updated COVID-19 vaccine? What questions or concerns do you have about it? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. FAQs, Vaccines, Boosters, & Antivirals — International Myeloma Foundation
  2. Covid Continues To Rise, but Experts Remain Optimistic — The New York Times
  3. FDA Takes Action on Updated mRNA COVID-19 Vaccines To Better Protect Against Currently Circulating Variants — U.S. Food and Drug Administration
  4. CDC Recommends Updated COVID-19 Vaccine for Fall/Winter Virus Season — Centers for Disease Control and Prevention
  5. Omicron XBB.1.5 ‘Kraken’ Subvariant Is On the Rise: What To Know — Yale Medicine
  6. COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised — Centers for Disease Control and Prevention
  7. Selected Adverse Events Reported After COVID-19 Vaccination — Centers for Disease Control and Prevention
  8. Loss of Anti‐Spike Antibodies Following mRNA Vaccination for COVID‐19 Among Patients With Multiple Myeloma — Cancer Reports
  9. Management of Patients With Multiple Myeloma and COVID-19 in the Post Pandemic Era: A Consensus Paper From the European Myeloma Network (EMN) — Leukemia
  10. What To Know About Breakthrough COVID-19 Cases — Cleveland Clinic
  11. COVID-19 FAQ #29: Can COVID-19 Vaccinations Trigger Active Myeloma? — International Myeloma Foundation
  12. Coronavirus Face Masks FAQs — Johns Hopkins Medicine
  13. Types of Masks and Respirators — Centers for Disease Control and Prevention
  14. COVID-19 Face Masks: Your Questions Answered — UC Davis Health
  15. How To Protect Yourself and Others — Centers for Disease Control and Prevention
  16. COVID-19 by County — Centers for Disease Control and Prevention
  17. FDA Approves First Oral Antiviral for Treatment of COVID-19 in Adults — U.S. Food and Drug Administration
  18. FDA Takes Actions To Expand Use of Treatment for Outpatients With Mild-to-Moderate COVID-19 — U.S. Food and Drug Administration
  19. Frequently Asked Questions on the Emergency Use Authorization for Lagevrio (Molnupiravir) for Treatment of COVID-19 — U.S. Food and Drug Administration
  20. Frequently Asked Questions on Olumiant (Baricitinib) for the Treatment of COVID-19 — U.S. Food and Drug Administration
  21. Coronavirus (COVID-19) Update: FDA Authorizes Drug for Treatment of COVID-19 — U.S. Food and Drug Administration
    Posted on October 19, 2023
    All updates must be accompanied by text or a picture.

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    Leonora Valdez, M.D. received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute. Learn more about her here.
    Ted Samson is a copy editor at MyHealthTeam. Learn more about him here.

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