General Colin Powell’s death from complications of COVID-19 likely resulted from a weakened immune system caused by multiple myeloma, medical experts say. He had undergone treatment for multiple myeloma, a common blood cancer, and seemed to be responding well, according to news reports. A family aide said Mr. Powell was fully vaccinated with two doses of the Pfizer-BioNTech vaccine in February. He had been scheduled for an additional dose last week, but he had to postpone it after he contracted COVID-19.
Memorial Sloan Kettering Cancer Center medical oncologist and hematologist Sham Mailankody explains what multiple myeloma is, how it makes a person especially vulnerable to infection, and why COVID-19 vaccines provide crucial protection for people with the disease.
What is multiple myeloma?
Multiple myeloma is a kind of blood cancer that develops when a normal white blood cell called a plasma cell changes into a myeloma cell. Healthy plasma cells help the body to make antibodies.
Myeloma cells are cancerous cells that can multiply uncontrollably. The disease is called multiple myeloma because you can develop tumors in more than one location in the bone marrow and sometimes outside the bone marrow.Back to top
Who is at risk for multiple myeloma?
Most people with multiple myeloma do not have clearly identifiable risk factors. Multiple myeloma is more common in men than women, and more common in Black people than in those of other ethnicities. Black Americans have nearly twice the risk of developing the disease. It usually occurs in people over 60, with the average age of diagnosis being 70. Exposure to some chemicals, such as pesticides and fertilizers, may slightly increase the risk of the disease.Back to top
How is multiple myeloma treated?
Treatment may include chemotherapy, steroids, drugs that modify the immune system, or a bone marrow transplant. People can respond well to treatment and live for many years, although the disease is not considered curable. At MSK, we are currently investigating the use of a new immunotherapy called chimeric antigen receptor (CAR) T cell therapy for multiple myeloma. This treatment involves removing immune cells called T cells from a patient, arming them with synthetic proteins that allow them to recognize and attack cancer, and then returning them back into the patient.Back to top
How does multiple myeloma and its treatment make someone vulnerable to COVID-19 infection?
People with cancer often have weakened immune systems. Multiple myeloma cells are less able than normal plasma cells to make antibodies to fight infections. People with multiple myeloma also have defects in other immune cells that make it harder to mount an immune response. In addition, treatments (such as chemotherapy and bone marrow transplant) can damage immune cells. Not only are people with multiple myeloma more vulnerable to infection, they also are more likely to develop severe COVID-19 when they do get infected.Back to top
Why would someone with multiple myeloma get severe COVID-19 despite being vaccinated?
There is evidence that shows COVID-19 vaccines are not as effective in people with certain blood cancers. A vaccine must activate your immune system to protect you. In an immunocompromised patient, this ability is impaired.
We’ve done studies here at MSK showing this to be the case. One study led by MSK medical oncologist David Chung found that people with blood cancers have a weakened response to the vaccines, both due to the cancer itself and because of treatments for the disease. Another study, led by MSK hematologic oncologists Roni Tamari and Gunjan Shah, found that people who had received bone marrow transplants or other treatments for their cancer within the previous year also got less protection from the vaccines.
That’s why doctors recommend additional vaccine doses for people with cancer to boost the immune response. No vaccine is 100% effective, but the COVID-19 vaccines have been shown to greatly reduce risk of infection and death. In some people, even the additional doses may not do enough to strengthen the immune response if someone is infected.
That’s why it’s critical for everyone to get vaccinated. You are not only protecting yourself and your family, but you are protecting people with cancer and other diseases that make them especially vulnerable to COVID-19. It is also important for cancer patients — particularly those on active treatment — to continue masking, social distancing, and washing their hands often.
October 19, 2021