Worldwide Influenza and Pneumococcal Vaccination Rates in Patients with Multiple Myeloma, and the Impact of Vaccination on Infection, Hospitalization, and Death

Presenter: Michael Thompson, MD, PhD, FASCO, Medical Co-Director, Oncology Precision Medicine Program, Aurora Cancer Care, Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI

Co-Authors: Caitlin L. Costello, Department of Medicine, Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, CA; Jesus G. Berdeja, Department of Hematology, Tennessee Oncology and Sarah Cannon Research Institute, Nashville, TN; Faith Davies, Perlmutter Cancer Center, NYU Langone, New York, NY; Jeffrey A. Zonder, Department of Malignant Hematology, Barbara Ann Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI; Hans C. Lee, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX; Jim Omel, The Central Nebraska Myeloma Support Group, Grand Island, NE; Andrew Spencer, Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia; Evangelos Terpos, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Vania T.M. Hungria, Department of Hematology, Clinica São Germano and Santa Casa Medical School, São Paulo, Brazil; Noemi Puig, Department of Hematology, Hospital Universitario de Salamanca, Salamanca, Spain; Cheng-Cheng Fu, First Affiliated Hospital, Soochow University, Suzhou Jiangsu, China; Tomas Skacel, Millennium Pharmaceuticals, Cambridge, MA, a wholly owned subsidiary of Takeda; Renda H. Ferrari, Millennium Pharmaceuticals, Cambridge, MA, a wholly owned subsidiary of Takeda; Kaili Ren, Millennium Pharmaceuticals, Cambridge, MA, a wholly owned subsidiary of Takeda; Dawn Marie Stull, Millennium Pharmaceuticals, Cambridge, MA, a wholly owned subsidiary of Takeda; Ajai Chari, Department of Hematology-Oncology, Mount Sinai School of Medicine, New York, NY

Background: Multiple myeloma is a cancer of the immune system. Infections are common reasons for hospitalization and death in multiple myeloma. As life expectancy increases in patients with multiple myeloma, with prolonged exposure to systemic therapy there is a need to vaccinate patients and to determine the effectiveness of these vaccines. A study of vaccination patterns in a large health system¹ and data collected via a patient self-report online portal,² suggest that vaccination in patients with multiple myeloma is underutilized.

Objective: To analyze influenza vaccination (FV) and pneumococcal vaccination (PV) patterns and associated outcomes in INSIGHT MM (NCT02761187), the largest global, prospective, observational study in multiple myeloma to date.

Methods: The INSIGHT MM study is investigating multiple myeloma disease characteristics at diagnosis and at disease relapse, treatment patterns, clinical outcomes, and treatment-associated tolerability, effectiveness, quality of life, and healthcare resource utilization. The INSIGHT MM study has enrolled 4311 multiple myeloma patients from 15 countries worldwide; patients are being followed prospectively for ≥5 years. Vaccination status is collected at study entry and yearly. We analyzed FV and PV patterns and associated outcomes of patients enrolled between July 2016 and June 2019.

Results: At data cutoff (September 1, 2019), 2562 and 2523 patients had study-entry data on FV and PV status, respectively. Overall vaccination rates were low (FV 40%; PV 30%) and varied by region (United States, Europe, Latin America, Asia; FV: 56%, 38%, 27%, 4%; PV: 43%, 28%, 21%, 5%, respectively). In evaluable patients, lack of vaccination was associated with numerically higher infection-related exposure-adjusted event rates per 100 patient-years (pneumonia, 7 vs 4; other infections, 6 vs 3) and overall hospitalization rates (36% vs 31%) for FV. Increased risk of death among nonvaccinated versus vaccinated patients was seen for FV (68% vs 32% deceased) and for PV (71% vs 29% deceased). Infections, including influenza and pneumonia, were the cause of death in 19% (43/226) of patients who did not receive FV versus 8% (9/108) of patients who received FV (P = .018) in the past 2 years, and 19% (46/236) of patients who did not receive PV versus 9% (9/100) of patients who received PV (P = .027) in the past 5 years. In addition, influenza and pneumonia infections were the cause of 7%, 15%, 20%, and 40% of patients who died in the United States, Europe, Latin America, and Asia, respectively (P <.0001).

Conclusion: Global vaccination rates in patients with multiple myeloma were low and varied by region. Lack of vaccination correlated with increased rates of infection (influenza), hospitalization (influenza), and death (influenza and pneumonia). Further multiple myeloma data sets should be analyzed to confirm the findings. Vaccination status should be collected in prospective clinical trials, because it may affect survival. Vaccination is important in multiple myeloma and should be encouraged.

1. Alemu A, Singh M, Blumberg C, et al. Multiple myeloma vaccination patterns in a large health system: a pilot study. J Patient Cent Res Rev. 2017;4:53-59.
2. Thompson MA, Ahlstrom J, Sweeney NW. HealthTree Patient Portal mediated myeloma patient-reported vaccination and antibiotic use. J Clin Oncol. 2020;38(15_suppl):Abstract e20567.