The BOTTOM Line: The priority is to achieve or maintain remission by continuing treatment. Patients in remission can talk to their doctor about minor treatment adjustments. The use of mRNA vaccines plus the booster may achieve a significant antibody response without needing to alter treatment.
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This week’s “Ask Dr. Durie” is a common question right now during this COVID-19 pandemic. The question comes from several patients who want to know: Should I change my treatment to try and improve my response to the COVID-19 vaccination?
We know that some patients may have poor antibody responses to the vaccine because of the underlying myeloma that makes them immune-compromised. But also because of the effect or the impact of the ongoing treatment.
The question is extremely important. Doctors at different myeloma treatment centers have discussed this back and forth. The consensus is that the top priority is to maintain treatment so that the myeloma comes under control. We know that if the myeloma is active and it's not coming under control with the treatment, that can also increase the risk.
And so, the top priority is to maintain the treatment to achieve that response that you need and then think about or talk about what could be feasible after that.
The first step, if possible, is to have a response at a level of very good partial response or complete response. This would be excellent. If this is achieved, you can talk to your doctor about maybe spacing out the maintenance and the therapy and see if that could be an opportunity to enhance the impact of the vaccination.
Now, there are a couple of types of treatment that we know can have a negative impact in terms of antibody production. One of them is the use of the anti-CD38 monoclonal antibodies, which would be daratumumab or isatuximab. But anti-b-cell maturation antigens, BCMA monoclonal antibodies, also seem to suppress Covid-19 antibody production.
And so, the thing to discuss very carefully with your doctor is maybe spacing out. If you’re taking daratumumab once a month, for example, an idea would be to get vaccinated right before you’re due for your next dose. That would be a four-week gap. Unfortunately, we don’t have clear data yet to see what the impact of that is. But it certainly is worth considering. And, likewise, with anti-BCMA monoclonal antibody therapy
So, this is something to think about. We are realizing that with the ongoing treatment, the use of the mRNA vaccines, the Pfizer, or the Moderna plus the booster, may be able to overcome the negative impact of the ongoing therapy.
The BOTTOM LINE here is that this is an important topic. Do talk to your doctor about it. The priority is to achieve the best response that you need to do well. That is the ongoing priority. If you are doing well, you can talk to your doctor about some minor adjustments that could help improve the antibody response. But, careful discussion. Just don’t rush into it. Be sure along the way to maintain all of the precautions that you need to including wearing masks in any kind of risky situations, and the normal precautions that we’ve been using these past months.
Professor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is a co-founder of the IMF and a member of the IMF Board of Directors.
