• People over 50 and those who are immunocompromised are now eligible to get a second COVID-19 booster shot.
• The International Myeloma Foundation recently began recommending a second COVID-19 booster shot for most people with myeloma.
• People with myeloma should talk with their oncology teams about whether they should time any booster shots around cancer treatments.

The U.S. Centers for Disease Control and Prevention (CDC) is now recommending a second COVID-19 booster shot for individuals older than 50 and those with certain conditions that lead them to be immunocompromised. The American Cancer Society states, “Many expert medical groups recommend that most people with cancer or a history of cancer should get a COVID-19 vaccine.”

People who are living with multiple myeloma are typically considered immunocompromised, which can lead to an increased risk for severe disease and hospitalization with COVID-19. The new public health recommendations come after recent studies showed an immune response to the Moderna and Pfizer vaccines in many immunocompromised people, including individuals with blood cancer.

The New Recommendations

Health officials at the U.S. Food & Drug Administration and the CDC have authorized and recommended a second booster shot for people 50 and older and for those with immunocompromising conditions. This recommendation affects a similar age group to the one advised to receive the first booster dose. However, there are several details to know before you get this fourth dose:

• This additional booster is for people who received their first booster shot or last COVID-19 vaccine shot at least four months ago.
• The fourth shot will be either the Moderna or Pfizer vaccine, not the Johnson & Johnson vaccine.
• Even if you were previously vaccinated with the Johnson & Johnson vaccine, it is now recommended that this next dose be either the Moderna or Pfizer vaccine.
• For those who are immunocompromised and received a three-dose primary vaccination followed by an initial booster, this additional vaccine booster would count as your fifth shot.

How Booster Shots Have Affected People With Myeloma

If you’ve already had your first booster shot, you may be wondering what the research says about whether boosters are effective in people with myeloma. One study of 167 people with multiple myeloma found that although individuals with the condition did not produce a strong antibody response after their initial COVID-19 vaccination doses, a booster shot significantly improved their protection against the virus.

In addition, the International Myeloma Foundation recently began recommending a second booster shot against COVID-19 for most people living with myeloma. If you have any concerns about whether to get the booster or how to time it around your myeloma treatments, talk to your oncologist.

Response to the Moderna Vaccine

The CDC’s latest recommendations follow promising new results about the effectiveness of the vaccines in immunocompromised people. A recent study from Moffitt Cancer Center included people diagnosed with blood cancers, as well as individuals with solid tumors. Researchers tested levels of antibodies, the proteins the immune system makes to help destroy a target. In this case, the antibodies were to the SARS-CoV-2 virus that causes COVID-19, made in response to the Moderna COVID-19 vaccine.

On average, antibodies against the coronavirus were identified after the second vaccine dose in about 90 percent of people in the study. About 85 percent of people with blood cancers showed an antibody response.

People who had the following treatments generally had lower responses to the vaccine

• CD19 chimeric antigen receptor (CAR)-T cell therapy — Used to treat multiple myeloma, lymphoma, and leukemia
• Anti-CD20 monoclonal antibodies less than six months before vaccination
• Bruton tyrosine kinase inhibitors
• Phosphoinositide 3-kinase inhibitors — Used to treat a variety of cancers

People who had the following treatments showed a stronger response to the vaccine:

• Autologous stem cell transplants — A transplant of stem cells taken from within your own body
• B-cell maturation antigen CAR-T therapies — Used to treat multiple myeloma
• Allogeneic (donor) stem cell transplants

Response to the Pfizer Vaccine

While this recent study only included people given the Moderna vaccine for COVID-19, other research has looked at how immunocompromised individuals have responded to the Pfizer vaccine. These vaccines are based on the same technique: using a molecule called messenger RNA (mRNA) to teach cells how to make a protein that will trigger an immune system response and help prevent a SARS-CoV-2 infection.

In one study that included individuals with medical conditions that caused them to be immunocompromised (including myeloma), immune system response was, on average, about 67 percent. However, individuals with myeloma made antibodies after vaccination about 80 percent of the time, according to the study results.

Why These Results Matter

Additional doses of mRNA vaccines may be effective at increasing detectable antibodies in a similar way to the first and second doses. Other research indicates that antibody levels are likely to decrease over time, so getting booster doses at recommended intervals is necessary even in vaccinated people who made antibodies after their initial shots.

Simply making antibodies does not always necessarily translate to complete immunity from COVID-19 infection, but the findings from these studies are a good sign that the mRNA vaccines for COVID-19 can trigger strong responses even from compromised immune systems. It’s evidence that vaccines can protect people at higher risk from severe infections.

According to the CDC, getting vaccinated is still the best way to protect yourself and slow the spread of the virus.

Find Your Team

MyMyelomaTeam is the social network for people with multiple myeloma and their loved ones. On MyMyelomaTeam, more than 15,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Are you planning to get another booster vaccine? Do you have concerns about vaccine effectiveness, vaccine response, or time of vaccination? Share your insights in the comments below, or start a conversation by posting on MyMyelomaTeam.