1
|
Hughes D, Yong K, Ramasamy K, Stern S, Boyle E, Ashcroft J, Basheer F, Rabin N, Pratt G. Diagnosis and management of smouldering myeloma: A British Society for Haematology Good Practice Paper. Br J Haematol 2024; 204:1193-1206. [PMID: 38393718 DOI: 10.1111/bjh.19333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Multiple myeloma is a bone marrow-based plasma cell tumour that develops from asymptomatic pre-cursor conditions smouldering myeloma and monoclonal gammopathy of uncertain significance and all are characterised by the presence of a monoclonal protein in the blood. Diagnosis and distinction between these conditions is based on blood tests, the bone marrow biopsy and cross sectional imaging. There are various risk stratification models that group patients with smouldering myeloma into risk groups based on risk of progression to symptomatic disease. Management is mainly observational for patients with smouldering myeloma although clinical trials for high-risk disease may be available. Restaging is required if evidence for progression.
Collapse
Affiliation(s)
- Daniel Hughes
- UCL Cancer Institute, University College London, London, UK
| | - Kwee Yong
- UCL Cancer Institute, University College London, London, UK
| | - Karthik Ramasamy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Translational Myeloma Centre, NDORMS, University of Oxford, Oxford, UK
| | - Simon Stern
- Epsom and St Helier University Hospitals NHS Trust, Sutton, UK
| | - Eileen Boyle
- UCL Cancer Institute, University College London, London, UK
| | - John Ashcroft
- The Mid Yorkshire Teaching Hospitals NHS Trust, Wakefield, UK
| | - Faisal Basheer
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil Rabin
- University College London Hospitals, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
2
|
Ludwig H, Kumar S. Prevention of infections including vaccination strategies in multiple myeloma. Am J Hematol 2023; 98 Suppl 2:S46-S62. [PMID: 36251367 DOI: 10.1002/ajh.26766] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
Infections are a major cause of morbidity and mortality in multiple myeloma. The increased risk for bacterial and viral infections results mainly from the disease-inherent and treatment-induced immunosuppression. Additional risk factors are older age with immune senescence, T cell depletion, polymorbidity, and male gender. Hence, every effort should be taken to reduce the risk for infections by identifying patients at higher risk for these complications and by implementing prophylactic measures, including chemoprophylaxis and immunization against various relevant pathogens. Here, we review the available evidence and provide recommendations for medical prophylaxis and vaccination in clinical practice.
Collapse
Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Center for Medical Oncology and Hematology with Outpatient Department and Palliative Care, Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Almeida Neto JBD, Arce IL, Figueiredo VLDP, Vicari P. Immunogenicity profile after COVID-19 vaccination in patients with onco-hematological diseases. EINSTEIN-SAO PAULO 2023; 21:eAO0089. [PMID: 36946824 PMCID: PMC10010256 DOI: 10.31744/einstein_journal/2023ao0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/27/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To evaluate the influence of onco-hematological pathologies on seroconversion to COVID-19 vaccines, in addition to the effects of chemotherapy treatment on this response. METHODS The present study evaluated the immunogenic response of 76 patients with onco-hematological diseases to multiple vaccine platforms compared to 25 control individuals. RESULTS Our results showed positive response rates of 74.02% in patients with onco-hematological diseases and 100% in controls. When analyzed according to etiological group, patients with lymphoproliferative disorders achieved a positive vaccine response rate of 58.7%, whereas those with myeloproliferative diseases achieved a 100% response rate. We also observed that patients previously exposed to COVID-19 presented a 75% increase in their antibody values after vaccination, and these values were 37% higher than those of patients who did not have such exposure. We found that patients who underwent B-lymphocyte-depleting therapy in the last 2 years before vaccination had a worse response rate of 18.75%. CONCLUSION Despite the immunosuppression of patients with onco-hematological diseases, caused by the biology of their diseases and treatment, benefit and safety in vaccinating these patients are observed, in view of the important recall immune response and incidence of adverse effects similar to those of the healthy population.
Collapse
Affiliation(s)
| | - Inara Lúcia Arce
- Hospital do Servidor Público Estadual de São Paulo , São Paulo , SP , Brazil
| | | | - Perla Vicari
- Hospital do Servidor Público Estadual de São Paulo , São Paulo , SP , Brazil
| |
Collapse
|
4
|
Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol 2022; 9:e143-e161. [DOI: 10.1016/s2352-3026(21)00283-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
|
5
|
Romaru J, Bahuaud M, Lejeune G, Hentzien M, Berger JL, Robbins A, Lebrun D, N’Guyen Y, Bani-Sadr F, Batteux F, Servettaz A. Single-Dose 13-Valent Conjugate Pneumococcal Vaccine in People Living With HIV – Immunological Response and Protection. Front Immunol 2021; 12:791147. [PMID: 34987514 PMCID: PMC8721113 DOI: 10.3389/fimmu.2021.791147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background Patients living with HIV (PLHIV) are prone to invasive pneumococcal disease. The 13-valent conjugated pneumococcal vaccine (PCV13) is currently recommended for all PLHIV, followed in most guidelines by a 23-valent polysaccharide pneumococcal vaccine. Data are scarce concerning the immunological efficacy of PCV13 among PLHIV. Objective To assess the immunological response at one month, and the immunological protection at 1-, 6-, and 12 months in PLHIV with a CD4 cell count above 200 cells/µl after a single dose of PCV13, as measured by both ELISA and opsonophagocytic assay (OPA). Methods PLHIV with CD4 cell count >200 cells/µl were included. Specific IgG serum concentrations for eight serotypes by ELISA and seven serotypes by OPA were measured at baseline, 1-, 6-, and 12 months after the PCV13 vaccination. Global response was defined as a two-fold increase from baseline of specific IgG antibody levels (μg/ml) assayed by ELISA or as a four-fold increase in OPA titer from baseline, for at least five serotypes targeted by PCV13. Global protection was defined as an IgG-concentration ≥1 µg/ml by ELISA or as an opsonization titer ≥LLOQ by OPA for at least five tested serotypes targeted by PCV13. Factors associated with global response and global protection were assessed using logistic regression. Results Of the 38 PLHIV included, 57.9% and 63.2% were global responders, 92.1% and 78.9% were globally protected at one month, and 64.7% and 55.9% were still protected at 12 months, by ELISA and OPA respectively. A CD4/CD8 ratio of >0.8 was significantly associated with a better global response by OPA (OR=6.11, p=0.02), and a CD4 nadir <200 was significantly associated with a poorer global response by ELISA (OR=0.22, p=0.04). A CD4 cell count nadir <200 and age over 50 years were associated with poorer global protection by OPA at M1 (OR=0.18, p=0.04) and M12 (OR= 0.15, p=0.02), respectively. Plasma HIV RNA viral load <40 copies/ml was significantly associated with a better global protection at M1 by ELISA and OPA (OR=21.33, p=0.025 and OR=8.40, p=0.04) Conclusion Vaccination with PCV13 in these patients induced immunological response and protection at one month. At one year, more than half of patients were still immunologically protected.
Collapse
Affiliation(s)
- Juliette Romaru
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Mathilde Bahuaud
- Plateforme d’Immunomonitoring Vaccinal, Laboratory of Immunology, Cochin Hospital and University Paris-Descartes, APHP, Paris, France
| | - Gauthier Lejeune
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
- Department of Internal Medicine and Infectious Diseases, CH de Charleville-Mézières, Charleville-Mézières, France
| | - Maxime Hentzien
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
- *Correspondence: Maxime Hentzien,
| | - Jean-Luc Berger
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Ailsa Robbins
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
- Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France
| | - Delphine Lebrun
- Department of Internal Medicine and Infectious Diseases, CH de Charleville-Mézières, Charleville-Mézières, France
| | - Yohan N’Guyen
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Frédéric Batteux
- Plateforme d’Immunomonitoring Vaccinal, Laboratory of Immunology, Cochin Hospital and University Paris-Descartes, APHP, Paris, France
| | - Amélie Servettaz
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
- Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France
| |
Collapse
|
6
|
Robbins A, Bahuaud M, Hentzien M, Maestraggi Q, Barbe C, Giusti D, Le Naour R, Batteux F, Servettaz A. The 13-Valent Pneumococcal Conjugate Vaccine Elicits Serological Response and Lasting Protection in Selected Patients With Primary Humoral Immunodeficiency. Front Immunol 2021; 12:697128. [PMID: 34290713 PMCID: PMC8287634 DOI: 10.3389/fimmu.2021.697128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
Background Patients with primary humoral immunodeficiency are more prone to invasive as well as recurrent pneumococcal infections. Therefore, anti-pneumococcal vaccination including the 13-valent conjugate vaccine is recommended. Nevertheless, to date, no data is available on immunogenicity of this vaccine in this population. Objective To assess the immunogenicity and the persistence of protection up to one year after a 13-valent pneumococcal conjugate vaccine in patients with primary humoral immunodeficiency. Methods Twenty-nine patients with common variable immunodeficiency or IgG subclass deficiency were vaccinated. Immune response and immune protection at baseline as well as at one, six and twelve months after vaccination were evaluated by measuring specific IgG serum concentrations (ELISA), and opsonophagocytic activities directed against selected pneumococcal (MOPA). Results By ELISA, half of the patients had protective IgG concentrations before vaccination, 35.7% showed an immune response one month after vaccination, 71.4%, 66.7% and 56.0% of the patients were protected at one, six and twelve months respectively. Conversely, by MOPA, 3.4% of the patients were protected at baseline, 10.7% showed an immune response and 28.6%, 48.2% and 33.3% were protected at one, six and twelve months respectively. IgG subclass deficiency, Ig replacement therapy and higher IgG2 concentrations at diagnosis were associated with long-term protection. Conclusion Pneumococcal conjugate vaccine improves immune protection and antibodies’ functionality in a subset of patients with primary immunodeficiency. Prime-boost vaccine strategy needs to be better and individually adapted.
Collapse
Affiliation(s)
- Ailsa Robbins
- Internal Medicine, Clinical Immunology and Infectious Diseases Department, University Hospital Centre, Reims, France.,Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France
| | - Mathilde Bahuaud
- Plateforme d'Immunomonitoring Vaccinal, Laboratory of Immunology, Cochin Hospital and University Paris-Descartes, APHP, Paris, France
| | - Maxime Hentzien
- Internal Medicine, Clinical Immunology and Infectious Diseases Department, University Hospital Centre, Reims, France
| | - Quentin Maestraggi
- Internal Medicine, Clinical Immunology and Infectious Diseases Department, University Hospital Centre, Reims, France
| | - Coralie Barbe
- Clinical Research Department, EA3797, University of Reims-Champagne-Ardenne, Reims, France
| | - Delphine Giusti
- Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Richard Le Naour
- Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France
| | - Frederic Batteux
- Plateforme d'Immunomonitoring Vaccinal, Laboratory of Immunology, Cochin Hospital and University Paris-Descartes, APHP, Paris, France
| | - Amélie Servettaz
- Internal Medicine, Clinical Immunology and Infectious Diseases Department, University Hospital Centre, Reims, France.,Laboratory of Immunology, EA7509 IRMAIC, University of Reims Champagne-Ardenne (URCA), Reims, France
| |
Collapse
|
7
|
Immunogénicité du vaccin antipneumococcique conjugué 13-valences chez les patients adultes avec déficit immunitaire humoral primitif. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Tournaire G, Conte C, Perrot A, Lapeyre-Mester M, Despas F. Vaccination during the First Diagnosis of Multiple Myeloma: A Cohort Study of the French National Health Insurance Database. Vaccines (Basel) 2020; 8:vaccines8040722. [PMID: 33276450 PMCID: PMC7712872 DOI: 10.3390/vaccines8040722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: Infections are frequent and often result in serious complications in patients with multiple myeloma (MM). Prophylactic vaccination is recommended for influenza virus, Streptococcus pneumoniae (SP), and Hemophilus influenzaeb (Hib). The aims of this study were to measure the vaccination rates within 24 months after the diagnosis of multiple myeloma and to identify factors associated with vaccine use. Methods: MM patients were selected through the French national health insurance database from 1 January 2010 to 31 December 2015. Patients with a previous history of MM were excluded. Results: Vaccination rates against influenza, SP, and Hib among 22,831 newly diagnosed MM patients were, respectively, 28.5%, 10.3%, and 1.4%. Only 0.7% received all three vaccines. Factors associated with vaccination were young age, male gender, an absence of comorbidity, a history of higher medication and vaccine consumption, Herpes simplex virus (HSV), Varicella zoster virus (VZV), and the use of pneumocystis prophylaxis. Conclusion: The low rates of vaccination indicate the need to improve physician and MM patient adherence and education regarding vaccination.
Collapse
Affiliation(s)
- Guilhem Tournaire
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
| | - Cécile Conte
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
| | - Aurore Perrot
- Département d’Hématologie et de médecine Interne, Institut Universitaire du Cancer-Oncopole, CHU de Toulouse, 31000 Toulouse, France;
| | - Maryse Lapeyre-Mester
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- INSERM Centre d’Investigation Clinique 1436 Toulouse, Centre d’Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
| | - Fabien Despas
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- INSERM Centre d’Investigation Clinique 1436 Toulouse, Centre d’Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-561-145-961; Fax: +33-561-145-642
| |
Collapse
|
9
|
McMasters M, Blair BM, Lazarus HM, Alonso CD. Casting a wider protective net: Anti-infective vaccine strategies for patients with hematologic malignancy and blood and marrow transplantation. Blood Rev 2020; 47:100779. [PMID: 33223246 DOI: 10.1016/j.blre.2020.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Patients who have hematologic malignancies are at high risk for infections but vaccinations may be effective prophylaxis. The increased infection risk derives from immune defects secondary to malignancy, the classic example being CLL, and chemotherapies and immunotherapy used to treat the malignancies. Therapy of hematologic malignancies is being revolutionized by introduction of novel targeted agents and immunomodulatory medications, improving the survival of patients. At the same time those agents uniquely change the infection risk and response to immunizations. This review will summarize current vaccine recommendations for patients with hematologic malignancies including patients who undergo hematopoietic cell transplant.
Collapse
Affiliation(s)
- Malgorzata McMasters
- Division of Hematologic Malignancy and Bone Marrow Transplant, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Barbra M Blair
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn D Alonso
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
| |
Collapse
|
10
|
Chilson E, Scott DA, Schmoele-Thoma B, Watson W, Moran MM, Isturiz R. Immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine in patients with immunocompromising conditions: a review of available evidence. Hum Vaccin Immunother 2020; 16:2758-2772. [PMID: 32530360 PMCID: PMC7746253 DOI: 10.1080/21645515.2020.1735224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
Immunocompromising conditions increase the risk of invasive pneumococcal disease (IPD). Vaccine uptake in patients with these conditions may be low in part because of concerns about decreased immunogenicity and safety in these high-risk groups. We conducted a literature search to identify publications describing antibody responses to 13-valent pneumococcal conjugate vaccine (PCV13) in immunocompromised individuals recommended for PCV13 vaccination by the US Advisory Committee on Immunization Practices (ACIP). This review summarizes immunogenicity data from 30 publications regarding the use of PCV13 comprising 2406 individuals considered at high risk for IPD by the ACIP. Although antibody responses to PCV13 in individuals with immunocompromising and high-risk conditions were variable and generally lower compared with healthy controls, the vaccine was immunogenic and was largely well tolerated. Based on these findings, concerns regarding immunogenicity and safety of PCV13 are not supported and should not be barriers to vaccination in high-risk populations.
Collapse
Affiliation(s)
- Erica Chilson
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Daniel A. Scott
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | | | - Wendy Watson
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Mary M. Moran
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Raul Isturiz
- Vaccine Medical Development & Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| |
Collapse
|
11
|
Ludwig H, Boccadoro M, Moreau P, San-Miguel J, Cavo M, Pawlyn C, Zweegman S, Facon T, Driessen C, Hajek R, Dimopoulos MA, Gay F, Avet-Loiseau H, Terpos E, Zojer N, Mohty M, Mateos MV, Einsele H, Delforge M, Caers J, Weisel K, Jackson G, Garderet L, Engelhardt M, van de Donk N, Leleu X, Goldschmidt H, Beksac M, Nijhof I, Abildgaard N, Bringhen S, Sonneveld P. Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network. Leukemia 2020; 35:31-44. [PMID: 32814840 PMCID: PMC7787974 DOI: 10.1038/s41375-020-01016-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
Abstract
Vaccination is one of the most successful medical interventions that has saved the life of millions of people. Vaccination is particularly important in patients with multiple myeloma, who have an increased risk of infections due to the disease-inherent immune suppression, and because of the immune suppressive effects of therapy. Hence, all appropriate measures should be exploited, to elicit an effective immune response to common pathogens like influenza, pneumococci, varicella zoster virus, and to those bacteria and viruses (haemophilus influenzae, meningococci, and hepatitis) that frequently may pose a significant risk to patients with multiple myeloma. Patients after autologous, and specifically after allogeneic transplantation have severely reduced antibody titers, and therefore require a broader spectrum of vaccinations. Response to vaccination in myeloma often is less vigorous than in the general population, mandating either measurement of the postvaccination antibody titers and/or repeating the vaccination. Here, we compile the existing data on vaccination in multiple myeloma and provide recommendations for clinical practice.
Collapse
Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, c/o 1st Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Vienna, Austria.
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Philippe Moreau
- Service hematologie et thérapie cellulaire, PRC. cic 1402 Inserm, CHU poitiers, Poitiers, France
| | - Jesus San-Miguel
- CIMA, IDISNA, CIBERONC, Clínica Universidad de Navarra, Pamplona, Spain
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Thierry Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - Christoph Driessen
- Department of Medical Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Melitios A Dimopoulos
- Hematology & Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Evangelos Terpos
- Hematology & Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Niklas Zojer
- 1st Department of Medicine, Center for Hematology, Oncology, and Palliatic Care, Clinic Ottakring, Vienna, Austria
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Hospital Saint-Antoine, Sorbonne University, Paris, France
| | | | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Jo Caers
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
| | - Katja Weisel
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Graham Jackson
- NCCC, Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, UK
| | - Laurent Garderet
- INSERM, UMR_S 938, Centre de Recherche Saint-Antoine-Team Proliferation and Differentiation of Stem Cells, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service d'Hématologie, Sorbonne Université, Paris, France
| | - Monika Engelhardt
- Interdisciplinary Tumor Center, Faculty of Freiburg, University of Freiburg, Freiburg, Germany
| | - Niels van de Donk
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Inger Nijhof
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pieter Sonneveld
- Erasmus MC Cancer Institute, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
12
|
Mustafa SS, Shah D, Bress J, Jamshed S. Response to PCV13 vaccination in patients with multiple myeloma versus healthy controls. Hum Vaccin Immunother 2018; 15:452-454. [PMID: 30303441 PMCID: PMC6422465 DOI: 10.1080/21645515.2018.1534516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in individuals with multiple myeloma (MM). These individuals exhibit humoral dysfunction and show a suboptimal response to pneumococcal polysaccharide vaccine (PPV23). Since pneumococcal conjugate vaccine (PCV13) elicits a T cell dependent response, it is recommended in patients with multiple myeloma. This study compares the initial response to PCV13 and durability of the response at 6 months in patients with multiple myeloma versus normal controls. Seven patients with multiple myeloma and 18 control patients were enrolled in the study. Streptococcal pneumonia serotype IgG titers were drawn at baseline, day 30, and day 180 after MM patients and controls received PCV13. Although vaccination with PCV13 produced a similar initial response in patients with multiple myeloma compared to control subjects, the duration of response may have waned in patients with multiple myeloma as compared to control subjects.
Collapse
Affiliation(s)
- S Shahzad Mustafa
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA.,b Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Deep Shah
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA
| | - Jonathan Bress
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA.,c Rochester Institute of Technology , Rochester , NY , USA
| | - Saad Jamshed
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA
| |
Collapse
|