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Is the COVID-19 Vaccine Safe for Myeloma Patients?

Is the COVID-19 Vaccine Safe for Myeloma Patients? from Patient Empowerment Network on Vimeo.

 Should myeloma patients get the COVID-19 Vaccine? Dr. Joshua Richter encourages all patients to get the vaccine but notes important considerations around treatment.

Dr. Joshua Richter is director of Multiple Myeloma at the Blavatnik Family – Chelsea Medical Center at Mount Sinai. He also serves as Assistant Professor of Medicine in The Tisch Cancer Institute, Division of Hematology and Medical Oncology. Learn more about Dr. Richter, here.

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Transcript:

Katherine:

Is the COVID-19 vaccine safe for patients with myeloma?

Dr. Richter:

Absolutely, 100 percent yes. Everybody with myeloma should absolutely get the vaccine. What’s a little more complicated is the timing of it. So, one is in relation to stem cell transplant or CAR T-cell therapy. If you’ve had one of these, obviously, consult with your provider. But the general recommendation is to wait about 60 to 90 days after a high-dose therapy like that. And it’s not a question of safety, it’s a question of efficacy. Vaccines are like vegetables, seeds, you have to put them in the ground to grow. If you give yourself a vaccine right after a stem cell transplant, well, your bone marrow is not ready to work with it. It’s like planting a seed in the desert.

You want to make sure your immune system can take in that vaccine and give you immunity. So, you have to wait at least 60 to 90 days. The other question is, what happens if you’re getting continual therapy? And we don’t know the answer for most of these drugs, but one of the things is dexamethasone (Decadron), which is a steroid. Almost all myeloma therapy comes with some steroids. And we like to separate the vaccine from the steroid dose by a little bit if we can. Again, always important to talk with your care team as to risk/benefit about holding certain treatments.

Notable News March 2021

While we’ve heard a lot about the vaccine for Covid-19, vaccines for cancer have been in development behind the scenes, and they show a lot of promise. Traditional treatments, like surgery, are still helpful as well, and early screenings are key to better survival rates. However, cancer survivors need to pay attention to their hearts, and young men need to be aware of any changes to their skin.

Melanoma is on the rise among younger men, and doctors aren’t quite sure why, reports menshealth.com. It is the fifth most common cancer for men and one of the top three among young adults. Research shows that young, non-Hispanic white men make up more than 60 percent of melanoma-related deaths. Doctors have some theories about why younger men are particularly at risk for melanoma, but the reasons aren’t entirely clear. One theory is that men could be biologically prone to developing melanoma because of their sex hormones. It’s thought that testosterone may cause melanoma to spread quickly and grow faster. Learn more here.

Cancer survivors have a higher risk of heart disease, reports pharmacytimes.com. A new study shows that 35 percent of Americans who have had cancer have an elevated risk of heart disease, compared to 23 percent of those who have never had cancer. Some of the treatments that cancer patients receive, such as radiation and chemotherapy, can affect cardiovascular health, and researchers hope that more attention will be paid to those risk factors. Read more here.

There are new lung cancer screening guidelines that increase the recommended number of people who get yearly CT scans for lung cancer, including more African Americans and women, reports nytimes.com. The new guidelines, which were previously established based on data for white males, reduce the age and smoking history requirements, and now include people, aged 50 to 80, who have smoked at least a pack a day for 20 years or more, and who still smoke or quit within the past 15 years. The goal is to detect lung cancer early in people who are at high risk due to smoking. By reducing the age and smoking history requirements for screening, more women and African Americans will likely benefit from the new guidelines as they tend to develop cancer earlier and from less tobacco exposure than white males. CT scans can reduce cancer death risk by 20 to 25 percent. Learn more here.

A Global Breast Cancer Initiative was introduced this month by the World Health Organization, says www.who.int. The initiative seeks to reduce global breast cancer mortality by 2.5 percent each year until 2040. Breast cancer has surpassed lung cancer as the most commonly diagnosed cancer worldwide. Survival rates have increased in high-income countries, but in low-income countries less progress has been made. To implement the initiative, global partners will use strategic programs that include health promotion, timely diagnosis, and comprehensive treatment and supportive care. Read more about the global initiative here.

Researchers have developed a vaccine that uses tumor cells in a patient to train the immune system to find and kill cancer, reports news.uchicago.edu. The vaccine is injected into the skin and has shown that it stopped melanoma tumor growth in mice. The vaccine is a new, and potentially safer and less expensive, way of using immunotherapy to treat cancers. It works as a therapeutic vaccine, activating the immune system to kill cancer cells. Researchers are planning to test the method on breast and colon cancers, as well as other types of cancers, and eventually plan clinical trials. Learn more here.

A Phase 1 trial is showing incredible promise for a brain tumor vaccine, reports newatlas.com. Research shows that the vaccine is safe and that it triggers an immune system response that slows tumor progression. The vaccine targets a gene mutation common in gliomas, which are a hard-to-treat type of brain cancer. The trial showed that 93 percent of patients had a positive response to the vaccine, and no tumor growth was seen in 82 percent of patients after three years. While the results are promising, researchers are cautious and say larger studies need to be done. A Phase 2 trial is being planned. Find more information here.

New treatments are exciting, but some traditional treatments might need more consideration in some cancers. Surgery, after chemotherapy, increases lifespan of pancreatic cancer patients, reports eurekalert.org. A new study shows that stage II pancreatic cancer patients who are treated with chemotherapy and then surgery to remove the cancerous area, live almost twice as long as patients treated only with chemotherapy. The data also shows that patients live longer even if the cancerous area isn’t completely removed. The study reveals that surgery is helpful in treating more pancreatic cancer patients than was previously believed. Learn more here.

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know?

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know? from Patient Empowerment Network on Vimeo.

Is it safe to get the COVID-19 vaccine if you have breast cancer? Dr. Halle Moore of Cleveland Clinic provides valuable insight, including a discussion of side effects and the importance of staying up-to-date with visits and screenings.

Dr. Halle Moore is Director of Medical Breast Oncology at the Cleveland Clinic. Learn more about Dr. Moore, here.

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Transcript

Dr. Halle Moore:

For most adults with cancer or with a history of cancer, vaccination against COVID-19 with one of the newly approved vaccines is definitely recommended.

Common side effects after the COVID vaccinations are a sore arm, which is probably one of the most common side effects that we see. Fatigue and muscle aches can occur. Also, some patients will experience fever and chills, and that seems to be especially after the second dose of the vaccine. Rarely, severe allergic reactions can occur. And also, some people will experience enlargement of lymph nodes, typically in the underarm area or in the neck on the side of the vaccination.

This is particularly important for cancer patients to be aware of since enlarged lymph nodes could also be seen with cancer, and that might be alarming to some patients if they experience this side effect without knowing that that is a normal immune response to the vaccine.

In addition, cancer patients who are getting imaging, either a CAT scan or even a routine mammogram, if they get that imaging soon after the vaccine, the lymph nodes could be seen on imaging, and that might raise a concern as well. So, it’s important that patients let their provider know if they’ve had a recent vaccine and they’re getting any kind of imaging or mammogram.

So, breast cancer patients who are on chemotherapy or other treatments that could affect the immune system should definitely discuss with their oncology team the timing of vaccination with respect to their treatments.

This often needs to be individualized based on the planned duration of the cancer treatment as well as how much that treatment actually affects the immune system. In general, it is safe to get the vaccine during chemotherapy. It’s just that there may be a potential for reduced immune response during certain types of chemotherapy.

On the other hand, some chemotherapies are given more long term. And we don’t generally advise interrupting the chemotherapy for vaccination. So, oftentimes, we will recommend vaccination even in the setting of cancer treatment. Certainly, anti-estrogen treatments, hormonal treatments for breast cancer, or radiation treatment for the breast cancer should not alter either the safety or the effectiveness of these vaccines.

So, some of the ingredients in the various vaccinations that have led to these allergic reactions that we’ve heard about are also present in certain chemotherapy drugs. So, for people who have had a life-threatening reaction to chemotherapy, for instance, an anaphylactic reaction, it would be a good idea to discuss with your oncologist whether you should see an allergist prior to vaccination. This is something that we’re recommending for patients who’ve had severe allergic reactions to try to determine what component the reaction was to and whether vaccination with any of the individual vaccines might be safest.

Delaying care for non-COVID-related health concerns has been a major concern over the past year. It’s important for people to know that hospitals and medical clinics have numerous safety precautions in place. And we are really strongly encouraging everyone to continue to address all of their healthcare needs and to receive important treatments, particularly cancer treatments.

A New “New Normal”: COVID-19 Vaccine Guidelines and Cancer Patients 

As we enter the 1-year mark of living in a pandemic, there have been a lot of changes in a world that has seemed stagnant, void of time. The inadequacies in healthcare that have been hiding behind the transparent curtain are now front and center, including health disparities, as well as access to and quality of care. We have also witnessed an influx of information about COVID-19 and the vaccine, and as cancer patients, it makes everything that much more complicated. 

Luckily, there are trusted resources we can turn to for guidance on our most pressing questions: 

What are the current vaccines? What age groups are eligible to receive them? 

  • Moderna: Ages ≥ 18 years 
  • Pfizer-BioNTech: Ages ≥ 16 years
  • Janssen (Johnson & Johnson): Ages ≥ 18 years 

How many doses of each vaccine are given and how far apart? 

  • Moderna: 2 shots, 28 days apart 
  • Pfizer-BioNTech: 2 shots, 21 days apart 
  • Janssen (Johnson & Johnson): 1 shot  

If I am currently undergoing treatment, can I get the vaccine? 

Yes, as long as components of that vaccine are not contraindicated. Contraindications include: 

  • Severe allergic reaction after a previous dose of an mRNA or viral vector COVID-19 vaccine or any of its components 
  • Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19 vaccine (both Moderna and Pfizer-BioNTech) or any of its components 
  • Immediate allergic reaction of any severity to polysorbate
  • Immediate allergic reaction of any severity to any ingredient in the Janssen (Johnson & Johnson) vaccine such as polysorbate

If I am not currently undergoing treatment and still have cancer, can I get the vaccine? 

Yes, as long as components of that vaccine are not contraindicated. See contraindications above. 

If I no longer have cancer, should I get the vaccine? 

Yes, as long as components of that vaccine are not contraindicated. See contraindications above. 

Does it depend on when I get the vaccine based on what type of cancer I have/had? 

Yes, for guidelines on specific cancers, visit this link. 

Should my caregiver and/or people whom I live with also receive the vaccine? 

Yes, when the option becomes available to them. 

If I have previously had COVID-19 (tested positive), can I get the vaccine? 

Vaccination should be offered to persons regardless of history of prior symptomatic or asymptomatic COVID-19 infection. 

Am I fully protected after receiving the vaccine? 

At this time, researchers are unsure of how much protection the vaccine provides. Therefore, it is still recommended to wear a mask, wash yours hands for at least 20 seconds, and practice social distancing. 

However, vaccinated patients who are exposed to someone with suspected or confirmed COVID-19 aren’t required to quarantine if they: 

  • Are fully vaccinated (i.e., ≥ 2 weeks after receiving the second dose in a 2-dose series, or ≥ 2 weeks after receiving one dose of a single-dose vaccine) AND 
  • Are within 3 months after receiving the last dose in the series AND 
  • Have remained asymptomatic (without symptoms) since the current COVID-19 exposure 

What are common side effects of the vaccine and how long do they last? 

Side effects can include: 

  • Pain and swelling on the arm where you received the shot 
  • Fever, chills, fatigue, and headaches 
  • Most post-vaccination symptoms are mild to moderate in severity, occur within the first three days of vaccination, and resolve within 1–3 days 

Of course this list is non-exhaustive, and there are a lot more questions to be asked and more answers to be found as frontline workers continue to study the virus and its variants. For the latest updates, follow the Centers for Disease Control and Prevention (CDC) website, as well as American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). We’re in this together, one day at a time. 


Sources:  

  1. https://www.ama-assn.org/system/files/2020-12/covid-19-vaccine-patient-faqs.pdf 
  2. https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
  3. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html
  4. https://www.onclive.com/view/nccn-releases-covid-19-vaccination-guidance-for-patients-with-cancer 

Cancer-Specific Resources:

  1. Is the COVID-19 Vaccine Safe for Myeloma Patients?
  2. What AML Patients Should Know About the COVID-19 Vaccines
  3. COVID-19 Vaccination: What Do Myelofibrosis Patients Need to Know?
  4. COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know?

January 2021 Notable News

What do cancer cells and bears have in common? How is artificial intelligence changing cancer? How do ovarian cancer cells survive in hostile environments? Can CML patients stop taking their medication? Why are cancer death rates continuing to decline? What should cancer patients know about the Covid-19 vaccines? There are a lot of questions to answer this month. Fortunately, we have the answers.

COVID-19 Vaccine

Some of the most pressing questions cancer patients have are about the Covid-19 vaccines. Some of the answers can be found at curetoday.com, which has put together a list of some things you should know. There are currently two Covid-19 vaccines available in the United States. They were authorized by the Food and Drug Administration (FDA) in late 2020. The two vaccines made by Pfizer-BioNTech and Moderna both require two doses, and both have an over 90 percent efficacy rate after both doses are administered. Both vaccines trigger the immune system to react defensively to the SARS-CoV-2 virus without causing the virus. There are common side effects seen as a result of the vaccines that include tiredness, pain at the injection site, headache, muscle ache, and fever. The side effects can last for several days or a week. While cancer patients should discuss the vaccine options with their doctors, it’s important to note that getting the vaccine should not affect most cancer treatments. Find the complete comparison of the two vaccines, which includes an explanation of how each vaccine works and the common side effects specific to each vaccine, here. There is also a helpful and easy-to-read infographic.

Declining Cancer Death Rates

There’s no question that declining death rates are good news. As of 2018, cancer death rates are continuing to decline in the United States, reports abcnews.go.com. The rate has been falling since 1991, and from 2017 to 2018, it fell 2.4 percent. In the past five years, almost half of the decline in cancer deaths was attributed to lung cancer. With fewer people smoking, the rates of lung cancer illness and death have declined, and due to better treatments and diagnostics, people with lung cancer are living longer. While cancer remains the second leading cause of death, it’s encouraging that the death rates are continuing to decline. Learn more here.

CML News

A question CML patients could be asking their doctors is whether or not they can stop taking their medication. Some chronic myelogenous leukemia (CML) patients may not have to, reports cancer.gov. The tyrosine kinase inhibitors (TKIs) CML patients take to make the disease manageable are taken every day and they come with some disruptive side effects, which affect the quality of life for patients. However, a new clinical study shows that patients who were in remission for at least two years, and stopped using nilotinib, imatinib, and two other TKIs, had an improved quality of life, and about two thirds of the patients remained in remission three years after stopping treatment. Find more information about the study results and which patients could be eligible to stop taking their CML medications here.

Ovarian Cancer

Researchers have long been questioning how ovarian cancer cells survive in hostile environments, but now have an understanding of how ovarian cancer cells survive and grow in the fluid of the abdomen, which should be a hostile environment of low nutrients and oxygen, reports eurekalert.org. The study looked at the structures inside the cells during different stages of ovarian cancer and found that one of the structures, the mitochondria, changed shape and function in the peritoneal cavity, the space in the abdomen that contains the intestines, liver, and stomach, which made it possible for aggressive cancer cells to flourish. Knowing how the cells are able to survive and thrive in the abdomen could help develop better treatments for the disease that may prevent the spread of cells from the original tumor to the peritoneal cavity. When ovarian cancer cells spread through the peritoneal cavity, a patient’s survival rate is just 30 percent. Learn more about the findings here.

AI Being Used in Cancer Care

Some researchers are answering the question of how artificial intelligence will play a role in the future of treating cancer. A new telescope developed at Rice University could be a game changer for cancer surgeries, says texasmonthly.com. Using artificial intelligence, it can take a lot of the guess work out of analyzing tissue and could save valuable time during surgeries. Find out how here.

Artificial intelligence is also being used to develop a technique to diagnose prostate cancer, reports phys.org. The technique is almost 100 percent accurate and can diagnose prostate cancer from urine within 20 minutes. This new technique is less invasive and much more accurate than current prostate cancer testing. Learn more about the development of the new technique here.

Cell Hibernation

Finally, who isn’t asking what bears and cancer cells have in common? It’s hibernation, of course! Cancer cells can go into a type of hibernation as a means of surviving chemotherapy, reports scitechdaily.com. Research shows that cancer cells have the ability to become sluggish and enter a slow-dividing state of rest to protect themselves when threatened by chemotherapy or other targeted therapies. They hibernate, just like bears, until the threat is gone, and they can resume their normal state of growth. The information helps look at chemotherapy-resistant cancers and how to better treat them. The study also showed that cancer regrowth can be prevented when therapies target cancer cells in their slow-dividing state of rest. Learn more about hibernating cancer cells here.