A panel of international experts in multiple myeloma and malignant haematological diseases have drawn up consensus recommendations on vaccinating patients against COVID-19, including the routine monitoring of vaccine immune responses.

The overarching recommendation, developed for the for the European Myeloma Network, is that all patients with monoclonal gammopathy of unknown significance, smouldering multiple myeloma, multiple myeloma, and clinically significant monoclonal gammopathies should be vaccinated against SARS-CoV-2.

Vaccination should preferably take place before the onset of active multiple myeloma, or during well controlled disease, when there is minimal residual disease negativity, a complete response, or a very good partial response.

Patients should also ideally be vaccinated before start of therapy or before stem-cell collection, during periods without therapy (with the exception of lenalidomide maintenance therapy, and more than three months following autologous haematopoietic stem-cell transplantation.

According to the international panel, patients with a previous, confirmed COVID-19 infection should also be vaccinated, though they note that in such cases one dose of vaccine might be sufficient.

They also advise that physicians consider patients’ risk factors for a sub-par immune response, including uncontrolled disease, immunoparesis, treatment and age, and routinely evaluate patients’ immune responses to vaccination – despite this not currently being supported by the Centers for Disease Control and Prevention and other organisations, largely because of the lack of a validated test system – to identify those who might benefit from a third vaccine dose.

“Monitoring the immune response to vaccination in patients with multiple myeloma might provide guidance for clinical management, such as administration of additional doses of the same or another vaccine, or even temporary treatment discontinuation, if possible,” the panel said.

Should the immune response be impaired, then a third vaccine dose should be considered, and so-called ‘ring vaccination’ of partners and social contacts is advised to foster herd immunity. Infection-reduction principles should also be followed for such patients.

If immunocompromised patients contract or are exposed to SARS-CoV-2, physicians should consider treatment with protective monoclonal antibodies to reduce the risk of severe disease and death, according to the recommendations.

The recommendations are published in full in  The Lancet Haematology.