July 1, 2021

Current guidelines 

The simple recommendations for myeloma patients remain the same:

• Get vaccinated. The key is to be fully vaccinated (2 doses of the Pfizer or MODERNA vaccine if possible). 
• Wear a mask, especially indoors, whenever you are in contact with individuals of unknown vaccination status.
• Be especially cautious when community levels of COVID-19 infection rise (above 8% is the current cutoff) because of concerns about the new highly infectious Delta variant.

Confusion about CDC and WHO guidelines 

The Centers for Disease Control (CDC) surprised many by indicating that fully vaccinated individuals do not need to wear a mask indoors. The World Health Organization (WHO), and recently, L.A. County, revised their recommendations to say that masks are “strongly recommended” indoors as an ongoing precaution. The difference in the recommendations is due primarily to concerns about the highly infectious Delta variant. This variant has caused a surge of new infections in Europe and Israel, where it emerged that partially vaccinated people (first shot only), as well as unvaccinated younger individuals, were at particular risk for the Delta variant infection. 

Specific concerns for myeloma patients 

As I indicated in a recent “Myeloma Today” article, myeloma patients need to be especially cautious because even fully vaccinated patients may still have low levels of neutralizing antibodies (the important antibodies). A recent article by Dr. Alfredo Addeo and colleagues in the journal Cancer Cell highlight this issue for patients with blood cancers. They note that the second vaccination dose is absolutely crucial for cancer patients, but also that even then some patients have very poor antibody responses. As part of a recent presentation at the 2021 IMWG Summit, Dr. Evangelos Terpos indicated that patients currently on antibody treatments against CD38, as well as on immune therapies targeting BCMA, were a particular concern. These patients have lower neutralizing antibody levels. 

BOTTOM LINE

Myeloma patients need to continue to wear masks indoors and in all situations of exposure risk in order to stay as safe as possible. Some patients may be well-protected by vaccination, but others are not. Better to be on the safe side!

FOCUS ON FINDING A CURE 

As we relax over the Fourth of July weekend it is important to always remember the IMF’s relentless commitment to find a cure for myeloma. As part of the Black Swan Research Initiative, researchers around the world are working on projects every day to improve our understanding of how a cure can be achieved and conducting treatment trials to achieve sustained MRD negative disease status as a steppingstone to a permanent cure.