​​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 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.