COVID-19 Vaccine and Myeloma Update

ATAGI 4th dose (booster) recommendation and what to do if you have symptoms

The Australian Technical Advisory Group on Immunisation (ATAGI) have now provided updated information that recommends individuals who are immunocompromised (low immune system) and have received 3 primary doses of COVID-19 vaccine now, have a 4th dose of COVID-19 vaccine which is also referred to as a booster. For those aged over 18 who are not immunocompromised, it is recommended to have a 3rd dose or booster of COVID-19 vaccine.

You can read the full statement from ATAGI here

Please note: The video above relates to information available when the third dose of COVID-19 vaccine was recommended. The broad messages remain relevant today.

AM I ELIGIBLE FOR A 4th DOSE OF VACCINE IF I HAVE MYELOMA?

As previously recommended with the third dose of vaccine, those with an active haematological malignancy are eligible for the booster. This applies to anyone who has a diagnosis of smouldering myeloma or myeloma whether you are currently having treatment or not. Myeloma and its treatments suppress the immune system, meaning that people living with myeloma will be more susceptible to all infections, including COVID-19 and will not achieve the same level of protection from three doses of the COVID-19 vaccine when compared to someone with a healthy immune system. Receiving a 4th dose of vaccine will reduce the chance of becoming very unwell and requiring hospitalisation should you be exposed to COVID-19.

WHICH VACCINE SHOULD I RECEIVE FOR MY 4th DOSE OF COVID-19 VACCINE?

The guidelines recommend receiving an mRNA vaccine (Pfizer or Moderna) for the fourth dose unless there was a significant adverse reaction to the first doses of mRNA vaccine. In that case the AstraZeneca vaccine should be used for the fourth dose.

WHEN SHOULD I GET THE 4th DOSE OF COVID-19 VACCINE?

It is recommended to have the fourth dose of COVID-19 vaccine 3 months after your third dose.  If you are currently on treatment, speak to your treating team about the best time to have your fourth vaccine dose.

I HAVE HAD A STEM CELL TRANSPLANT OR CAR T-CELL THERAPY, WHAT SHOULD I DO?

It is recommended to wait 3-6 months after your transplant or CAR T-cell therapy to allow your immune system enough time to recover and have the best chance of achieving a response to the vaccines. You will need to have the full four doses regardless of whether you had already received three doses before transplant or CAR T-cell therapy, as any protection from previous vaccines will have been lost.

DO I NEED TO PROVIDE PROOF OF ELIGIBILITY WHEN ATTENDING MY APPOINTMENT?

You should not need to provide evidence of your myeloma diagnosis if you are receiving your 4th dose of vaccine at your GP clinic or a service who is familiar with your medical history. However, if you are attending a large vaccination hub, you may need to take with you a document that states you have myeloma.

HOW WILL I KNOW IF THE VACCINES HAVE BEEN EFFECTIVE?

Unfortunately, there is no reliable way to check the level of immunity achieved from the vaccines. The best way to protect yourself from COVID-19 is to have four doses of vaccine, encourage your close contacts to get vaccinated, wear a mask when necessary, follow good hand hygiene and get tested at the first sign of symptoms.

WHAT DO I DO IF I THINK I HAVE COVID-19?

There are some treatments available to treat COVID-19 but they are most effective when used early. If you have symptoms or think you have come into contact with someone who has COVID-19 you should be tested straight away and seek guidance from your treating team.

I’M UNSURE IF I SHOULD GET A FOURTH DOSE OF VACCINE, WHAT SHOULD I DO?

If you are unsure if it is appropriate for you to have a fourth dose of vaccine, please contact your GP or treating team for guidance. If you haven’t received the COVID-19 vaccine at all to date, you can still receive your first dose via your GP, pharmacist or local vaccination hub.

For more information about coronavirus, the COVID-19 vaccines and myeloma, please see below

Updated 29 January 2022

COVID-19 Vaccine and Myeloma

Many people in the myeloma community have questions about the COVID-19 vaccine and some people might have hesitations about being vaccinated.

Through our support groups and Telephone Support Line, our Myeloma Support Nurses have received questions about how well the vaccines work in people with myeloma, if the vaccines can be safe after being developed so quickly, and the possible risk of developing blood clots after the AstraZeneca vaccine.

We understand that these are important questions and that you need reliable, evidence-based information. We also understand that there is some misinformation about the vaccines – and it can be difficult to tell this apart from the facts. That’s why we have reviewed current literature and guidelines to answer your questions.

The information in this article can help you to make a more informed decision about COVID-19 vaccination, but please remember that your doctor is always your best source of information about all medicines and vaccines that are best suited to your needs.

DOES THE COVID-19 VACCINE WORK IN PEOPLE WITH MYELOMA?

As at May 2021, one research paper has been published that looks at whether people with myeloma are able to mount an immune response to COVID-19 vaccines.

Early data published after people had received one of the two planned vaccine doses shows that 7 out of 10 people in the myeloma group had an increase in their total immune response, while nearly all the people in the control group had an increase in their total immune response.

While this shows that the response to the vaccine is lower in people with myeloma than in the general population, there is still good evidence of benefit.

Because people with myeloma are at higher risk for COVID-19 infection and also at higher risk of serious outcomes that may need them to be admitted to hospital or intensive care, protecting against COVID-19 infection is especially important.

As well as protecting through vaccination, this means that it is still vital for people with myeloma to keep taking extra precautions to protect themselves against COVID-19 infection – including handwashing, physical distancing and wearing a mask where necessary. It also means that it is very important for your family and close contacts to be vaccinated to help create a protective circle around you.

Research into the effectiveness of COVID-19 vaccines in people with myeloma is continuing, and this will guide ongoing medical advice. 

WERE COVID-19 VACCINES DEVELOPED TOO QUICKLY TO BE SAFE?

Research into how to respond to a pandemic started long before COVID-19. Information from other coronavirus outbreaks, such as Severe Acute Respiratory Syndrome (SARS CoV) in 2002 and Middle East Respiratory Syndrome (MERS) in 2012, gave researchers a head start on how to develop vaccines against COVID-19.

The COVID-19 vaccines were able to be developed faster than previous vaccines because of the unique collaboration between scientists, manufacturers and distributors, along with a level of global funding that has never been seen before. This allowed the development and implementation planning phases for the vaccines to be run side-by side, instead of one after the other.

In Australia, the Therapeutic Goods Administration (TGA) has been rigorously assessing all potential COVID-19 vaccines for safety, quality and effectiveness. The TGA will continue to do this with future vaccines before they are approved and made available in Australia.

Once approved, each vaccine batch is checked to make sure it meets the same quality standards.

WHAT IS THE RISK OF DEVELOPING BLOOD CLOTS AFTER HAVING THE ASTRAZENECA (AZ) VACCINE?

A very small number of people who have received the AstraZeneca (AZ) vaccine worldwide have developed an extremely rare immune response that causes blood clots and low levels of blood platelets. This is called thrombosis with thrombocytopenia syndrome (TTS) and is similar to a very rare reaction to heparin treatment called heparin-induced thrombocytopenia (or HIT).

The overall rate of TTS is estimated to be about six cases per million people vaccinated in all age groups – or 20-40 cases per million in people under 50 years.

It is important and helpful for you to know that the way that this rare blood clotting side effect develops after the AZ vaccine is different from the way that clots develop when they cause deep vein thrombosis (DVT) or pulmonary embolism (PE) associated with active myeloma or its treatments.

In Australia, the Australian Technical Advisory Group on Immunisation (ATAGI) now recommends that the Pfizer COVID-19 vaccine is the preferred vaccine for adults aged under 60 years.

The AZ vaccine is recommended for most people with myeloma who are aged 60 years or over. However, your GP may want to confirm this with your haematologist. If you have myeloma and a history of blood clotting problems, please talk with your haematologist about the best approach to COVID-19 vaccination for you.

What are the possible symptoms of a blood clotting problem after having the AZ vaccine? 

In Australia, people who have developed symptoms of TTS experienced these 4-26 days after receiving their first dose of the AZ vaccine.

If you have had your first dose of the AZ vaccine, please seek urgent medical attention if you experience any of the following symptoms:

  • shortness of breath
  • chest pain
  • swelling in your leg
  • persistent abdominal (tummy) pain
  • neurological symptoms, including severe and persistent headaches or blurred vision
  • tiny blood spots under your skin beyond the injection site

WHAT ARE THE COMMONLY REPORTED SIDE EFFECTS OF COVID-19 VACCINES?

Like many other vaccines, common side effects with any of the COVID-19 vaccines may include:

  • tenderness, pain and swelling at the injection site
  • tiredness
  • headache
  • muscle and joint pain
  • chills

Most side effects are mild and will go away within 1-2 days.

If you have had a COVID-19 vaccination and think you may be experiencing side effects, you can check how severe they might be with this online tool: https://www.healthdirect.gov.au/COVID-19-19-vaccine-side-effect-checker

WHY DO VACCINES CAUSE SIDE EFFECTS?

Common side effects from vaccines, such as fever and tiredness, are often a good sign that your immune system has been activated and is learning how to fight the disease.

 

MAKING YOUR DECISION TO GET VACCINATED

Deciding if you will have the COVID-19 vaccine is very similar to deciding whether you want to have any medicine to treat myeloma and its effects, or to treat any other health problem. It really comes down to answering the question “Is the benefit of taking this medicine worth the risk of experiencing a potential side effect?”.

Most people with myeloma do experience some side effects from their treatment, but they are usually manageable and are outweighed by the benefit of having their condition under good control.

COVID-19 can cause serious illness, ongoing health problems, and sometimes death. People with myeloma are at higher risk of COVID-19 infection and also at higher risk of serious outcomes that may need them to be admitted to hospital or intensive care.

The vaccines are designed to ensure that, even if you do catch COVID-19, you do not get seriously ill and reduce your risk of being admitted to hospital or intensive care.

Getting vaccinated is the best way you can protect yourself, your loved ones, and our community.

For the vast majority of people with myeloma, the benefits of being vaccinated against COVID-19 outweigh any risks. Ask your doctor when will be the best time for you to be vaccinated depending on your current myeloma treatment plan.

For a list of references used to develop this article, please email nurses@myeloma.org.au

With rising community concern about the novel coronavirus or COVID-19, Myeloma Australia would like to provide the following information detailing risks and preventative measures specific to the myeloma population.

The coronavirus family are known to cause a range of respiratory illnesses ranging from the common cold to more severe illnesses like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). COVID-19 is the name that has been given to this particular outbreak of coronavirus that is thought to have originated in Wuhan, China in December 2019.

The name COVID-19 is derived from COronaVIrus Disease 2019.

How is coronavirus (COVID-19) spread?

The virus is spread through droplets that are sneezed or exhaled by an infected person. These may land directly on the mouth, nose or eyes of another person or onto surrounding surfaces such as door handles and benches. It is then transmitted when someone touches these items and touches their nose, eyes or mouth. It is known that the virus can remain ‘live’ on surfaces. How long it survives varies depending on the material the surface is made from.

Symptoms of coronavirus (COVID-19)

Common Symptoms
  • Fever
  • Dry cough
  • Fatigue
Less Common Symptoms
  • Shortness of breath
  • Sore throat
  • Nasal congestion
  • Runny nose
  • Headache
  • Nausea and vomiting
  • Aches and pains
  • Diarrhoea
  • Red or irritated eyes
  • Loss of taste and/or smell
  • Skin rash or discolouration
Rare Symptoms
  • Difficulty breathing
  • Chest pain or pressure
  • Loss of speech
  • Loss of movement
  • *If any of these symptoms occur, call 000 immediately

It is possible to contract coronavirus and not experience any symptoms. 80% of people with coronavirus will recover without needing any intervention. However, those that are most at risk of becoming very ill with the virus are the elderly. Some patients with an underlying medical condition such as lung and heart disease may also be at risk. People whose immune system is already compromised are also at risk, including patients with myeloma. The risk will vary according to their underlying disease severity and current medications.

How to prevent infections like coronavirus (COVID-19)

It is important to mention that while we are on high alert at the moment with this current outbreak, those living with myeloma should always be actively taking measures to prevent infections.

It may not be necessary to wear a face mask. Those that have symptoms of respiratory illness or are in the presence of someone with a respiratory illness and health care workers caring for those infected need to take this measure.

*Please note: There are varying degrees of restrictions around the country with some areas required to wear a mask at all times in public. Please follow the advice of the Chief Health Officer in your state.

Strategies to reduce the risk of contracting COVID-19:

  • Stay home as much as possible
  • If it is necessary to go out, practice social distancing. This means remaining at least 1.5 metres away from anyone who is not from your immediate household.
  • Washing hands regularly and thoroughly with soap and water or alcohol-based hand gels
  • Maintain excellent food hygiene
  • Regularly and thoroughly clean commonly used items such as mobile phones, TV remotes and door/drawer handles
  • If being in the company of someone with a visible respiratory illness is unavoidable, try to remain at least 1.5 metres away from them to avoid droplet exposure
  • Have an annual flu vaccination and any other vaccines recommended by the doctor (note: the flu vaccine will NOT directly protect from coronavirus). Encourage family and friends to do the same

What to do if coronavirus (COVID-19) is suspected

If symptoms develop and there is concern that there may have been contact with COVID-19, self-isolate and contact the GP for guidance. It is important to call ahead to alert the clinic of the possible COVID-19 infection so they can properly prepare to ensure others aren’t put at risk.

If symptoms are those of a common cold and there has been no known exposure to COVID-19, self-isolate until symptoms resolve.

If experiencing a fever or shortness of breath (with or without a fever), contact the myeloma medical team for advice.

Any general questions about COVID-19 can be directed to the Australian Department of Health National Coronavirus Health Information Line: 1800 020 080

Travel

All international travel is currently on hold. If interstate travel is essential please do so under the guidance of the medical team.

Changes to treatment for myeloma

During this time of required social distancing many people will have noticed changes in the way hospitals are operating. Measures have been put in place to limit the necessity to go to a hospital to decrease the risk of exposure to COVID-19.

Most consultations with the doctor will be done by phone or video call and blood tests will be referred to local pathology centres where possible.

In some cases, those who were planned to have an autologous stem cell transplant will find this has been postponed. Autologous stem cell transplants, while very effective at treating myeloma, involve giving a very large dose of chemotherapy. This effectively wipes out the immune system until the transplanted stem cells have a chance to regenerate healthy infection fighting cells (approximately 2 weeks). Therefore, depleting a person’s immune system during a pandemic carries much higher risk than usual. It is also necessary to preserve hospital resources during this time to cope with increased demand and a depleted workforce. It is completely safe to postpone transplants for some people leaving space and adequate resources for those who are not in a position to wait.

It may also be appropriate to decrease the frequency or cease altogether some other treatments for myeloma if the disease is under good control and it is thought that the treatment might suppress the immune system too much.

Myeloma Australia’s Medical and Scientific Advisory Group lobbied the Pharmaceutical Benefits Advisory Committee (PBAC) to make special consideration for people with myeloma who have commenced or are about to commence induction therapy with bortezomib (Velcade®) in anticipation of an autologous stem cell transplant.

As of 1 April 2020, the PBAC have extended access to bortezomib for up to 6 months during the COVID-19 pandemic. The enables those people to remain on treatment until such time that they can have their transplant.

In some cases, it may also be necessary to limit the use of supportive care medications to keep people out of hospital as much as possible. This may mean that the usual infusion of bone strengthening medication or intravenous immunoglobulin is put on hold where safe to do so.

It is also possible that some hospitals may be changing the way they deliver medicines to allow for more treatments to be given in the home.

It is wise to be extra prepared for limited contact with the hospital. Requesting pathology slips ahead of time and ensuring there is enough medication in the house and repeat scripts are available is advised. Some hospitals and community pharmacies are posting medications to further reduce the need to leave the home.

Changes to clinical trials

In some cases, it has been necessary to delay the commencement of new clinical trials or pause the recruitment to existing clinical trials. Those currently on a clinical trial may also see some changes to the way they are run. The local medical team are best placed to answer any questions relating to specific clinical trials.

Looking after our mind, body and spirit

We are going to be in social isolation for quite some time, so it is important to pay extra attention to our physical and mental well-being. Some people find it helpful to set a daily agenda being conscious of dedicating time to:

  • Exercising outside (maintaining 1.5m from anyone from outside your household)
  • Drinking adequate fluid
  • Maintaining a healthy diet
  • Contacting loved ones via phone or video conferencing
  • Participating in mindfulness activities such as meditation or yoga. There are excellent videos on You Tube and apps to help with mindfulness activities.

There are many businesses continuing their services via virtual platforms. It may be possible to still seek support from physiotherapists or exercise classes online.

We appreciate that these are extremely trying times and invite anyone who would like to speak to an experienced Myeloma Support Nurse, you can do so in confidence Monday to Friday 9am – 5pm AEST by calling our Telephone Support Line: 1800 693 566

Archived Videos

Professor H Miles Prince

Myeloma Australia Coronavirus Update – Associate Professor Dipti Talaulikar

Myeloma Australia Coronavirus Update – Emeritus Professor Douglas E Joshua

Myeloma Australia Coronavirus Update – Associate Professor Peter Mollee

Myeloma Australia Coronavirus Update

Further resources

World Health Organisation
Australian Government Department of Health
Beyond blue – Coronavirus Mental Wellbeing Support Service