Patients with multiple myeloma frequently present with substantial immune impairment and an increased risk for infections and infection-related mortality. The risk for infection with SARS-CoV-2 virus and resulting mortality is also increased, emphasising the importance of protecting patients by vaccination. Available data in patients with multiple myeloma suggest a suboptimal anti-SARS-CoV-2 immune response, meaning a proportion of patients are unprotected. Factors associated with poor response are uncontrolled disease, immunosuppression, concomitant therapy, more lines of therapy, and CD38 antibody-directed and B-cell maturation antigen-directed therapy. These facts suggest that 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. In those who do not exhibit a good response, prophylactic treatment with neutralising monoclonal antibody cocktails might be considered. In patients deficient of a SARS-CoV-2 immune response, adherence to measures for infection risk reduction is particularly recommended. This consensus was generated by members of the European Multiple Myeloma Network and some external experts. The panel members convened in virtual meetings and conducted an extensive literature research and evaluated recently published data and work presented at meetings, as well as findings from their own studies. The outcome of the discussions on establishing consensus recommendations for COVID-19 vaccination in patients with multiple myeloma was condensed into this Review.

1st Department of Medicine Center for Oncology Hematology and Palliative Care Clinic Ottakring Vienna Austria

CHU Poitiers Poitiers France

Clínica Universidad de Navarra CIMA CIBERONC IDISNA Pamplona Spain

Department of Clinical Therapeutics School of Medicine National and Kapodistrian University of Athens Athens Greece

Department of Hematology Amsterdam UMC VU University Amsterdam Netherlands

Department of Hematology Ankara University Ankara Turkey

Department of Hematology CHU de Liège Liège Belgium

Department of Hematology University hospital Hotel Dieu Nantes France

Department of Hematooncology University Hospital Ostrava and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Internal Medicine 2 University Hospital Würzburg Würzburg Germany

Department of Medicine 1 and Department of Hematology Oncology and Stem Cell Transplantation Clinical Cancer Research Group University Hospital of Freiburg Freiburg Germany

Department of Oncology and Hematology Kantonsspital St Gallen St Gallen Switzerland

Erasmus Medical Center Cancer Institute Erasmus University Rotterdam Rotterdam Netherlands

European Myeloma Network Italy Torino Italy

Hematology Research Unit Department of Hematology Odense University Hospital and Department of Clinical Research University of Southern Denmark Odense Denmark

Hospital Universitario de Salamanca Instituto de Investigación Biomédica de Salamanca Instituto de Biología Molecular y Celular del Cáncer CIBERONC Salamanca Spain

Inserm Poitiers France

Institut Universitaire du Cancer de Toulouse Oncopole Toulouse France

Institute of Cancer Research London UK

IRCCS Azienda Ospedaliero Universitaria di Bologna Istituto di Ematologia Seràgnoli Dipartimento di Medicina Specialistica Diagnostica e Sperimentale Università di Bologna Bologna Italy

KG Jebsen Center for B Cell Malignancies University of Oslo Oslo Norway

Leeds Institute of Clinical Trial Research University of Leeds Leeds UK

Leuven Cancer Institute Leuven Belgium

Myeloma Unit Division of Hematology University of Torino Azienda Ospedaliero Universitaria Città della Salute e della Scienza Torino Italy

Northern Centre for Cancer Care Freeman Hospital Newcastle Upon Tyne Hospitals trust Newcastle Upon Tyne UK

Oslo Myeloma Center Oslo University Hospital Oslo Norway

Royal Marsden Hospital London UK

Service d'Hematologie Clinique et Therapie Cellulaire Hopital Saint Antoine Assistance Publique Hopitaux de Paris 938 Paris France

Sorbonne Université INSERM UMR S 938 Centre de Recherche Saint Antoine Team Hematopoietic and leukemic development Assistance Publique Hôpitaux de Paris Hôpital Pitié Salpetrière Département d'Hématologie et de Thérapie Cellulaire Paris France

Universitätsklinikum Hamburg Eppendorf 2 Medizinische Klinik und Poliklinik Hamburg Germany

University Hospital Heidelberg Internal Medicine 5 and National Center for Tumor Diseases Heidelberg Germany

University of Lille CHU Lille Service des Maladies du Sang Lille France

Wilhelminen Cancer Research Institute 1st Department of Medicine Center for Oncology Hematology and Palliative Care Clinic Ottakring Vienna Austria

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