Information about COVID-19 for myeloma patients

Multiple myeloma and its treatments can weaken the immune system, making people with this rare blood cancer more vulnerable to infections such as COVID-19.

COVID-19, short for coronavirus disease 2019, is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the COVID-19 pandemic began in 2020, doctors and researchers have learned more about the relationship between multiple myeloma and COVID-19. This has helped improve ways to reduce risk and treat infections.

After diagnosis, people with myeloma should ask their cancer specialist, or oncologist, about their infection risk and ways to lower it, including vaccination.

Does multiple myeloma increase the risk of severe COVID-19?

People with myeloma have a higher risk of severe COVID-19, including hospitalization or death, than people in the general population. Several factors may contribute to this higher risk, including:

• immune problems caused by myeloma: the disease weakens normal immune defenses against bacteria and viruses
• myeloma treatments: many treatments can weaken the immune system and make it harder to fight infections
• weaker vaccine responses: myeloma and some treatments can reduce the immune response to COVID-19 vaccines, and people with myeloma also have a higher risk of breakthrough infections

Individual risk can be influenced by several factors, including vaccination status, age, and overall health. Older people, those with more health problems, and those who are unvaccinated are at a higher risk of severe COVID-19.

Myeloma treatment can also increase the risk of severe COVID-19. Most myeloma treatments suppress immune function to some degree, and treatments that target B-cell maturation antigen (BCMA) or CD38 are associated with an increased risk of severe COVID-19. These treatments can weaken different parts of the immune response, including the cells and antibodies that help the body fight infection.

People with myeloma should talk with their healthcare team to understand their individual oncology treatment risks, including the risk of developing severe COVID-19.

How COVID-19 interacts with multiple myeloma

Several features of multiple myeloma may help explain why people with the disease have a higher risk of COVID-19 and its complications, including:

• myeloma cells are abnormal plasma cells that make fewer infection-fighting antibodies than healthy plasma cells
• as myeloma cells build up, they can interfere with the production of healthy blood cells, including cells that help fight infections

Together, these changes can make it harder for the immune system to fight COVID-19. Myeloma treatments that weaken the immune system can add to this risk.

Shared immune mechanisms in multiple myeloma and COVID-19 may also help explain why the infection can become severe in people with myeloma. For example, both conditions can involve inflammation, changes in blood vessels, and a higher risk of blood clots. These shared effects may contribute to serious complications.

Because myeloma and COVID-19 can cause some of the same symptoms, people with myeloma should contact their healthcare team about new or worsening symptoms rather than assume what is causing them, especially fever or trouble breathing.

COVID-19 vaccine safety and efficacy

Health authorities recommend COVID-19 vaccination for people who are immunocompromised. The International Myeloma Foundation advises people with multiple myeloma to get vaccinated against COVID-19.

Research into COVID-19 vaccine safety in myeloma supports vaccination as generally safe. COVID-19 vaccination can lower the risk of severe illness, hospitalization, and death.

The number of vaccine doses may depend on a person’s age and vaccination history, while myeloma treatment may affect the best timing. People with myeloma should talk with their oncology team about the best vaccination plan for them. They can also ask whether caregivers and household members should stay up to date on the COVID-19 vaccines recommended for them.

Vaccine response

COVID-19 vaccines train the immune system to recognize the virus that causes COVID-19 and build defenses against it. Because myeloma can weaken the immune system, people with the disease may not respond to vaccination as strongly as people without myeloma.

People with myeloma may have a higher risk of breakthrough COVID-19 infections after vaccination. Even with a weaker vaccine response, vaccination can still help lower the risk of COVID-19 and serious illness.

Vaccine response can vary from person to person. Factors that may increase the risk of a weaker response include:

• older age
• coexisting medical conditions
• low levels of certain immune cells or healthy antibodies that help fight infection
• certain myeloma treatments that can weaken antibody responses
• myeloma that is not well controlled, has returned, or has not responded fully to treatment

Vaccine timing

People with myeloma who are moderately or severely immunocompromised may need more than one COVID-19 vaccine dose. For people ages 12 and older who have already completed an initial vaccine series, CDC recommends two doses of the 2026–2027 COVID-19 vaccine, given six months apart. People who are unvaccinated or have not completed an initial series may need additional doses, depending on their vaccination history and the vaccine used. A healthcare provider can recommend the appropriate schedule.

Myeloma treatment may also affect the timing of vaccination. COVID-19 vaccination should not necessarily be delayed because someone is receiving immunosuppressive therapy. When possible, however, COVID-19 vaccination should be given at least two weeks before immunosuppressive treatment begins or resumes.

Protective guidelines and treatment options

In addition to vaccination, people with myeloma and those close to them should take steps to reduce the risk of infection. Local public health agencies may provide more specific guidance. General precautions may include:

• wearing a mask in crowded or higher-risk settings
• avoiding crowds and people who are sick
• keeping some distance from others when possible
• washing or sanitizing hands regularly

Depending on a person’s infection risk and immune status, doctors may also consider preventive treatments, such as:

• intravenous immunoglobulin (IVIG), a supportive treatment that provides antibodies from healthy donors and may be considered for people with recurrent or persistent infections and very low levels of IgG antibodies
• Pemgarda (pemivbart), an investigational antibody therapy authorized for emergency use in the U.S. to help prevent COVID-19 before exposure in certain immunocompromised people

If someone with myeloma develops COVID-19, they may be prescribed an antiviral medication to help reduce the risk of serious illness. Oral Paxlovid (nirmatrelvir/ritonavir) is usually the preferred option when appropriate.

Paxlovid can interact with other medications, including some myeloma treatments. If Paxlovid cannot be used, other antiviral options may include:

• Veklury (remdesivir), an antiviral given by infusion into a vein
• Lagevrio (molnupiravir), an oral antiviral authorized for certain high-risk adults when other approved or authorized COVID-19 treatments are not accessible or clinically appropriate

People with myeloma should coordinate COVID-19 treatment with their oncology team to make sure it is appropriate alongside their cancer treatment. An oncologist may recommend pausing myeloma treatment during a symptomatic infection and restarting it after symptoms resolve.

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