April 22, 2021
For myeloma patients, staying healthy is an extra challenge as they focus on achieving response to treatments and sustaining remissions. The added burden of COVID-19 uncertainties is at times overwhelming. In an effort to build resilience it is helpful to take a step back and, especially on Earth Day, think about the health of planet Earth, and everyone and everything living here.
Eating healthy food
On Earth Day we remember the power of biodiversity and the hard work needed to sustain the fragile balances in our environment.
- REAL FOOD: Health begins with the food we eat. A recent episode of the television news program “60 Minutes” emphasized how access to what I call “Real Food”—fresh fruits and vegetables, and non-processed products of all types – is a huge advantage in achieving every aspect of healthy living. Without this access, impoverished people living in food deserts end up on a path to dramatically poorer health outcomes. It was wonderful to see the impact of a new grocery store on the people living in South Atlanta, Georgia, an African-American neighborhood previously deprived of ready access. This changes the dynamics of so many social behaviors and opportunities.
- BLUE ZONES: In the past I have written about Blue Zones, regions in the world where people are more likely to live to be over 100 years old. Their diets consistently include a Mediterranean-type food, with a major focus on local fresh produce and an absence of processed foods and drinks. (No burgers or diet cokes.)
- EATING OUT AGAIN: In this time of COVID-19 it has been especially challenging to stick with healthy foods. Now, as many restaurants are reopening for outside dining, it is possible to eat out and order healthy meals in places where most guests are vaccinated, and masks and social distancing are respected (or you can get home delivery or pick-up if you still have concerns). But even better, if you have the time and inclination, is preparing food in your own kitchen. I have previously written about books like the “Ikaria” cookbook by Diane Kochilas, which includes many healthy recipes for vegetable, fish and chicken dishes. A fantastic new addition to this type of book is “The Food of Oaxaca” (Mexico’s culinary capital) by Alejandro Ruiz, which combines really healthy options with incredible flavors. If you want to really understand how healthy food can be delicious and flavorful, “Delicious,” a new book by Rob Dunn and Monica Sanchez, is a tour de force in explaining how connecting back to the real flavors and tastes of planet earth is so important.
The impact of vaccination
Getting vaccinated is vital to re-entering the community. It is now becoming feasible for most patients with MGUS, SMM or active myeloma to be vaccinated. The widely available Pfizer or Moderna vaccines are preferentially recommended, if possible.
- NEW REPORT DOCUMENTS ANTIBODY RESPONSES TO COVID-19 VACCINATION: Dr. Evangelos Terpos and his colleagues from the University of Athens, Greece summarized the antibody responses in elderly patients (median age 83 years) with smoldering or active myeloma. Antibody levels were checked 22 days after the first dose of the Pfizer vaccine. Obviously, two doses are recommended for full vaccination, so this study just assessed the early responses with the first dose. The active (inhibiting) antibody levels were 20.6% for myeloma patients versus 32.5% for normal controls overall. So, definitely, overall lower.
Looking more specifically at a 30% level of antibodies, a target for Day 22, this was achieved by 25% of myeloma patients versus 54.8% controls. Again, lower. Excellent antibody levels of over 50% occurred in just 4 out of the 48 patients in this study. These patients were in remission and off therapy at the time. Thus, ongoing active therapy clearly reduced antibody levels achieved. The small numbers did not allow discrimination between different types of anti-myeloma therapy, although all patients on daratumumab containing regimens appeared to have especially low antibody levels.
The lower antibody levels are not unexpected and appeared especially linked to low levels of normal immunoglobulins (IgG/IgA/IgM), “immunosuppression” in patients with both SMM and active MM. Of note, only 1 of 11 patients with SMM achieved antibody levels of over 30%. Thus, even in this patient group the immunosuppression contributes to suboptimal antibody responses.
Much larger studies are now ongoing and will assess further vaccination doses and actual prevention of COVID-19 infections or lack of serious outcomes in the vaccinated patients. It is certainly hoped that despite suboptimal antibody responses the vaccinations will be helpful in producing improved outcomes.
Try hard to stay healthy and get vaccinated! In addition to eating healthy food, it’s important to get regular exercise (walking with family and/or friends) and maintain social connections via Zoom, phone or in outdoor, socially distanced settings. Staying connected is the key to maintaining day-to-day sanity while we await a return to normal.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.