A friend recently asked if monoclonal antibody therapy such as daratumumab would have a deleterious effect on receiving a COVID vaccination. Would he still be able to formulate an antibody response? He specifically asked:
“Are monoclonal antibodies changing a patient’s antibodies in such a way that the patient’s ability to produce T Cells is severely limited”?
My answer was…….No. The immune system is quite capable of recognizing more than one antigen (bacteria? Rhino Virus? COVID virus? Respiratory Syncytial Virus? Cancer cell? Fungal element?) at a time and responding to all of them. Undoubtedly everyone’s immune system is recognizing and responding to countless antigens each day. Giving a monoclonal antibody is an artificial boost against just one miserable little antigen (CD38 on the surface of cancerous plasma cells). Monoclonal antibodies help direct our immune system to attack the CD38 site, but the process surely does NOT overwhelm the immune system’s ability to also function to produce anti-COVID antibodies if/when we get a COVID immunization.
“Would this therefore limit the ability of a Covid vaccine to work on these patients (and in addition, is this why CAR-T hasn’t yet shown durability in myeloma patients)”?
I answered, “In the whole realm of activity occurring continuously in our immune system, the COVID vaccination is hardly even noticed. It is just another antigen requiring attention. Regarding the second question, there are many reasons why CAR-T stops working. The target may have changed or evolved. The artificial infused T cells may fail to replicate and just die of old age. The originally-infused T Cells may have been of poor killing quality in the first place”.
A question I have noticed on Twitter the last few days regards the safety of Pfizer and Moderna’s vaccinations for myeloma patients. Please understand that it is OK to receive these shots, and in fact it is highly encouraged. The antigen being injected is NOT a virus. It is a fragment of messenger RNA, just a bit of genetic material derived from the coronal spike of the virus particle. It is not infectious. Our immune system recognizes that bit of viral RNA as foreign material which needs to be eliminated. The first immunization prompts an antigen response. A second shot three weeks later is a “booster” which makes the immune system much more responsive. This second shot will bring about significant immunity which, hopefully, will still be present when the real thing (COVID19 virus) enters our body. Its deadly infectious corona spikes will be immediately recognized by memory T Cells because they have seen it twice before. This invader, now agitating the immune system for the third time, will be vigorously attacked by natural killer cells and regulatory T cells (T regs).
I highly encourage myeloma patients to get the COVID shots as soon as they possibly can. If they are taking daratumumab or elotuzumab or isatuximab it will not have an adverse effect on a COVID vaccination or vice versa. The final decision is always YOURS to make on every treatment decision, made in concert with your doctor. He/she is your explainer; you are the decider. Personally, my COVID vaccination cannot come quickly enough!
about the author
Jim Omel, MD is a retired family physician who has lived with myeloma since 1997. He has been actively involved in myeloma research and patient support for over 20 years.