Recommendations for vaccination given to patients with multiple myeloma in real-world clinical practice and patients compliance with them
Authors: H. Ludwig, A. Meckl, M. Engelhardt
Journal: HemaSphere (2021)

Background: Infections are the second leading cause of death in multiple myeloma (MM). All available measures to curb this complication should be exploited, including vaccination against several bacteria and viruses. Aims: In this study, we examined the recommendations for vaccination given to patients (pts) with MM in real-world clinical practice and pts' compliance with them. We also analyzed the incidence of infections before and after diagnosis, and pts' willingness to be vaccinated against COVID-19. Methods: 335 pts with MM from Germany, Switzerland, and Austria participated in this survey. A questionnaire was designed in cooperation with pts groups to assess the vaccination recommendations given to them from their treating physicians, to evaluate their compliance with the advice received, to capture the infection rate of pts in the year before and the first six months after start of therapy, and to assess pts' willingness to be vaccinated against COVID-19. The invitation to participate in this electronic survey was distributed by 31 participating myeloma support groups. In addition, 500 hardcopy questionnaires were mailed directly to pts, reaching out to approximately 2,000 pts. Results: Pts' median age was 65 years;23.0% had 1, 34.8% 2-3, and 42.3% ≥ 4 lines of prior treatment. Pts' responses were similar between respondents to the online and printed version of the questionnaire. The number of pts who received recommendations for the various vaccinations and the proportion of pts who actually received the vaccine is shown in Figure 1. Influenza was the most frequently recommended vaccine (77.0%), followed by pneumococci (65.4%). Pts' compliance with their physicians' advice varied between 67% and 90%. At least one infectious period in the year preceding the diagnosis of MM was reported by 51.9% of the 322 responding pts, and by 42.4% of the 314 responding pts during the first six months after initiation of firstline therapy. Eighty-three percent of pts declared their willingness to be vaccinated against COVID-19, while 17% stated that they objected to it. Reasons for refusing SARS-CoV-2 vaccination were lack of long-term experience (76.6%), concerns regarding late effects (60.9%), insufficient confidence in the pharmaceutical industry (26.7%), and concerns that the vaccine will not be protective (15.6%). Summary/Conclusion: The vaccination recommendations varied widely depending on the type of vaccine, but compliance with these recommendations was remarkably high (>80%) for influenza, pneumococci, hepatitis B, and DTP. The high rates of recommendations for influenza and pneumococci seem to reflect the high prevalence of upper and lower respiratory tract infections in MM. Of note, 51.9% of pts reported a least one infectious episode in the year before, and 42.4% during the first six months after initiation of treatment. As 75.4% of pts did receive prior ASCT, vaccinations with DTP and MMR were recommended to substantial pt numbers. In contrast, fewer than expected pts were advised to get vaccinated against VZV (28%) and against Haemophilus influenzae (12.8%). Tick borne encephalitis is endemic in the some areas of the participating countries, which possibly explains the high compliance rate (78.8%) in the 26.8% of pts who were advised to be vaccinated. The high readiness of MM pts to get vaccinated with a SARS-CoV-2 vaccine (83%) seems remarkable and much higher than that of the general population. A possible explanation for this proactive attitude is the preferential participation of well-informed pts in this study.