Michael J. Fallon, MD, radiation oncologist, University of Wisconsin Carbone Cancer Center, discusses guidelines for the use and administration of infection prophylaxis in relapsed/refractory multiple myeloma, as well as the future role of prophylactic immunization in this landscape.

When integrating infection prophylaxis with other agents in the myeloma space, most clinicians will reference the National Comprehensive Cancer Network (NCCN) guidelines for multiple myeloma and hematopoietic stem cell transplantation, Fallon begins. It is important to note that NCCN recommendations currently address specific patient features or conditions, and are being adjusted to account for newer additions to the armamentarium, such as CAR T-cell therapies and bispecific antibodies, Fallon notes. Additionally, the NCCN has begun to incorporate specific recommendations for these therapies into their Cancer-Related Infection Guidelines, which can be an additional tool for navigating the use of prophylactics, Fallon explains.

Moreover, treatment with vaccination is a particularly useful tool for patients with multiple myeloma, as these patients are known to have an increased risk of developing infection due to immune dysregulation at the time of diagnosis, or treatment-related immune suppression. Additionally, appropriate supportive care for patients who received an autologous or allogeneic stem cell transplant is even more vital. These patients may require more vaccinations after undergoing transplant due to low antibody levels.

Currently, the coadministration of conventional prophylaxis is recommended when using certain vaccinations to further reduce risk. However, the use of vaccinations will continue to evolve in this space, and may eventually replace supplemental infectious medication prophylaxis, Fallon states. For example, vaccinations could reduce the need for patients to continue taking oral medications that prevent infection after receiving CAR T-cell therapy, he explains.

Although the use of vaccinations in this space represents an additional potential treatment option, more research is needed to identify which specific vaccinations may be needed after a given therapeutic agent, and their impact on T-cell responses, Fallon concludes.

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Michael J. Fallon, MD, discusses guidelines for the use and administration of infection prophylaxis in relapsed/refractory multiple myeloma, as well as the future role of prophylactic immunization in this landscape.
 

​​Dr Fallon on Guidelines for the Administration of Infection Prophylaxis in R/R Multiple Myeloma

Michael J. Fallon, MD, radiation oncologist, University of Wisconsin Carbone Cancer Center, discusses supportive care considerations for patients with relapsed/refractory multiple myeloma.

The use of infection prophylaxis continues to evolve with the addition of new therapies, such as anti-BCMA CAR T-cell therapies and bispecific T-cell engagers, since these agents have different effects on the immune system that clinicians are still working to understand, Fallon says. Although the National Comprehensive Cancer Network guidelines have started to integrate the use of infection prophylaxis with these agents; however, the current recommendations only fit specific conditions for a patient, and more clarity is needed to know when this intervention is appropriate, Fallon explains. In the past, supportive care considerations for patients who received an autologous stem cell transplant were well defined, and improvements to guidelines will be made for newer therapies, according to Fallon, who adds that, in general, patients have less infections with T-cell redirecting therapies compared with other treatments.

Immunizations continue to be a cost burden to patients. For example, patients within the Medicare population are only allowed 2 lifetime doses of a pneumococcal injection, and patients with relapsed/refractory multiple myeloma will likely need up to 4 injections, Fallon explains. For patients who are post transplant, they may require up to 6 injections, and oftentimes, these patients will need to pay out of pocket for these vaccines, Fallon says.

Additionally, tertiary centers will provide some of these injections; however, patients must also rely on the local community hospitals and clinics to provide the injections, Fallon explains. Coordinating these series of vaccines between different health-care systems can also present a challenge for patients with multiple myeloma, Fallon adds.

Bone health remains the most impactful adverse event (AE) for patients with relapsed/refractory multiple myeloma, as they can experience walking difficulties, pain, and numbness, Fallon says. These AEs can be detrimental to a patient's quality of life. It is important that clinicians remain vigilant with medications to maintain bone health medications and ensure fractures do not happen, Fallon concludes.

Michael J. Fallon, MD, discusses supportive care considerations for patients with relapsed/refractory multiple myeloma.

Michael J. Fallon, MD

Articles

Dr Fallon on Guidelines for the Administration of Infection Prophylaxis in R/R Multiple Myeloma

Dr. Fallon on Supportive Care Considerations in R/R Multiple Myeloma

Michael J. Fallon, MD

Articles

​​Dr Fallon on Guidelines for the Administration of Infection Prophylaxis in R/R Multiple Myeloma

Dr. Fallon on Supportive Care Considerations in R/R Multiple Myeloma

Dr Fallon on Guidelines for the Administration of Infection Prophylaxis in R/R Multiple Myeloma