Vaccination against seasonal influenza and pneumonia improves clinical outcome in multiple myeloma patients receiving continuous treatment with lenalidomide: A real-life survey
Authors: A. Bulla, A. Romano, M. L. Morella, C. Bellofiore, A. Curtopelle, V. D. Fabro, U. Markovic, F. Puglisi, F. D. Raimondo, C. Conticello
Journal: HemaSphere (2021)

Background: Respiratory infections are common complications of multiple myeloma(MM),leading to increased risk of death within first 90 days from diagnosis.Despite proven efficacy of vaccination and guidelines, this supportive care is underutilized in MM patients. Aims: We report the results of a single-center, retrospective evaluation of rate of hospitalization and infection in patients undergoing vaccination after start of anti-MM treatment, based on lenalidomide or proteasome inhibitors, alone or in combination with monoclonal antibodies. We report results of a single-center, retrospective evaluation of rate of hospitalization and infection in patients undergoing vaccination after start of anti-MM treatment based on lenalidomide or proteasome inhibitors, alone or in combination with monoclonal antibodies. Methods: We have retrospectively evaluated 290 consecutive MM patients from September 2019,distinguished in three cohorts: active disease requiring anti-MM treatment(group A, N=120),not active disease controlled by maintenance/continuous therapy(group B, N=107), and off-therapy due to stable disease remission(group C, N=63),who received vaccination against seasonal flu(FV)and/or pneumococcus(PV). We monitored the number of infections requiring hospitalization, including COVID-19,OS at 12 months,and MM and not-MM related factors associated to early death. Results: Of 290 patients, 71% received FV and 45% PV, 44% both. FV was performed in A, B and C groups, respectively in 71%, 72% and 71% patients. Among group A, B and C 45%, 48% and 40% patients respectively received PV.The rates of infections at 12 months in A, B and C groups were respectively 40%, 20% and 6%. The rates of hospitalization for infections at 12 months among group A, B and C were respectively 18%, 4% and 27%.In A group, factors associated to development of infection were age>65 years(OR, 3.95, p=0.005),male gender(OR, 4.46, p=0.0004),high-risk FISH(OR, 5.68, p=0.0039),ALC 65 years(OR, 9.50, p=0.03), male gender (OR, 8.71, p=0.005), ALC<1100 cells/mmc (OR, 10.91, p=0.03),and IgM<40 (OR 5.71, p=0.007).Continuous treatment with lenalidomide based regimens was associated to increased infection(OR, 3.70, p=0.004)and hospitalization rates(OR, 21.11, p=0.0036).FV was associated to reduced number of infections at one year in patients carrying high-risk cytogenetics or undergoing continuous treatment with daratumumab.PV reduced number of infections in patients carrying high-risk cytogenetics, ALC<1100/mmc, ANC<1500/mmc or who received ASCT before study entry. 29 patients(10%)died(6 for infection, 23 for disease progression).Predictors at study entry of shorter 12-mOS were age≥65 yo(p=0.009), frailty score≥1(p=0.03),ANC<1500/ mmc(p=0.0002),IgM<40mg/dL(p=0.01),active disease(p<0.0001),previous ASCT(p=0.002),occurrence of hospitalization(p<0.0001)or/and infections(p=0.001).Continuous therapy,including lenalidomide maintenance or daratumumab exposure did not affect 12-mOS in our cohort. In multivariable analysis active disease(HR 71.5, 95% CI 1.97 - 25.93, p=0.0028) and hospitalization for infection(HR 38.1,95% CI 1.27- 11.37,p=0.0167)significantly impact on OS. Summary/Conclusion: Vaccination coverage does not protect from infections patients with active MM, particularly when treated with lenalidomide.