From the Guidelines
Yes, pneumonia vaccines are strongly recommended for multiple myeloma patients, and they should receive either a single dose of PCV20 or 1 dose of PCV15 followed by a dose of PPSV23 ≥1 year later, as recommended by the Advisory Committee on Immunization Practices, United States, 2023 1. Multiple myeloma patients have an increased risk of infections due to the disease-inherent immune suppression, and because of the immune suppressive effects of therapy. Pneumococcal vaccines help stimulate the immune system to produce antibodies against Streptococcus pneumoniae, a common cause of pneumonia. Some key points to consider:
- Multiple myeloma causes immunosuppression by impairing normal antibody production, and treatments like chemotherapy, steroids, and stem cell transplantation further compromise the immune system, increasing the risk of infections, particularly pneumonia 1.
- Pneumococcal vaccines, including PCV20 and PCV15, have been shown to be effective in preventing pneumococcal disease in the general population, and their use is recommended for multiple myeloma patients 1.
- The response to vaccination in myeloma patients may be less vigorous than in the general population, and measurement of post-vaccination antibody titers and/or repeating the vaccination may be necessary 1.
- Annual influenza vaccinations are also recommended for multiple myeloma patients to prevent another common cause of infection and morbidity in this population. It is essential to note that while vaccine effectiveness may be reduced in immunocompromised patients, some protection is still provided and can prevent severe disease. Ideally, vaccination should occur before starting immunosuppressive therapy when possible, but can still be beneficial at any point during treatment.
From the Research
Pneumonia Vaccination in Multiple Myeloma Patients
- Multiple myeloma patients are at an increased risk of infections with Streptococcus pneumoniae, making vaccination a recommended practice 2, 3.
- Studies have shown that pneumococcal vaccination can be effective in reducing the incidence of pneumonias in multiple myeloma patients, with an absolute risk reduction of 33.3% 4.
- The response to pneumococcal vaccination can vary, with some studies reporting a response rate of around 30-40% 3, while others have found a higher response rate of 85% 5.
- Factors such as disease stage and treatment approach can impact the response to vaccination, with patients responding well to induction therapy showing a better response to the vaccine 2.
- Vaccination status has been shown to impact overall survival, with vaccinated patients having a lower risk of death due to infections 6.
Vaccination Strategies
- Different vaccination strategies have been studied, including the use of 23-valent polysaccharide-based pneumococcal vaccine 2 and 13-valent pneumococcal conjugate (PCV13) vaccine 4.
- The timing of vaccination is also important, with some studies suggesting that vaccination should be administered prior to autologous stem cell transplantation (ASCT) 2.
- The use of multiple vaccine doses, such as a 3-dose regimen of PCV13, has been shown to be effective in reducing the incidence of pneumonias 4.
Clinical Implications
- Pneumococcal vaccination is an important aspect of infection prevention in multiple myeloma patients, and vaccination status should be recorded in prospective clinical trials as it may affect survival 6.
- Further studies are needed to understand the benefit of vaccination strategies in multiple myeloma patients and to determine the optimal vaccination approach 5.