In this episode, Dr. Brian G.M. Durie discusses if myeloma patients should alter their treatment regimen to attempt to achieve a better response to Covid-19 vaccination.
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 a
t 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 t
o 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 daratumuma
b 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 w
ell, 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.
Comments
Thank you Dr. Durie🙏
I've had two Astrazenica vaccinations plus a Pfizer booster. My treatment for a year has been Revlimid. With the mention that Daratumumab may require a timing adjustment, I can imply from the video that my vaccination antibody response is probably quite reasonable. Thank you Dr Durie