Myeloma, the Flu and You

It’s that time of year again when we start to store away bathing suits and sandals and take our jackets and boots out of hiding. What this also means is that the flu season is upon us. While there are certain precautions everyone should take during flu season, some people are more vulnerable to getting the flu, including those with multiple myeloma and other plasma cell disorders. Myeloma is a blood cancer that forms in the bone marrow in which a type of white blood cells called plasma cells becomes abnormal, impacting the cells’ ability to make antibodies to help fight infections. Additionally, myeloma treatments can further suppress the immune system, which can reduce the body's ability to fight off illnesses and increase severity of common infections, like a cold, the flu or pneumonia.

“Patients with multiple myeloma are about 15 times more likely to get an infection than those without the disease, so there are additional precautions to take during flu season” says Dr. Ruben Niesvizky, Director of the Multiple Myeloma Center at Weill Cornell Medicine and NewYork-Presbyterian.

While people should make an individualized decision with their own healthcare team, as a general rule, people with cancer should get a seasonal flu shot. It is best to get the flu shot as soon as it is available for the upcoming flu season, preferably by October. Each year, getting a flu vaccine allows the body to make antibodies that protect it against the strains of the influenza virus predicted to be the most prevalent and virulent. It can take up to two weeks after receiving the shot for the body to build up immunity, which is why it is recommended that people get the flu shot early on in the season.

“Patients with multiple myeloma sometimes ask why they should get the flu shot if it’s not always foolproof,” says Karen Pekle, nurse practitioner at Weill Cornell Medicine and NewYork-Presbyterian. “In short, it can’t hurt. In severe cases, the flu can cause hospitalization and death and the flu vaccine is a tool to help prevent those things from happening.”

People who live with or care for cancer patients also should be vaccinated against seasonal flu based on Center for Disease Control (CDC) recommendations. Not only is it important so they can protect themselves from getting the flu, but it’s also necessary to prevent them from being a carrier to those who are more susceptible to infection, including people with cancer.

Even after getting the flu shot, some myeloma patients are unable to mount a robust immune response. “For these patients, we often give an infusion of antibodies, also known as intravenous immunoglobulin (IVIg), to help people prevent and fight off infections,” says Dr. Niesvizky. “IVIg reduces the incidence and recurrence of infections in the stable phase of the disease and can help a multiple myeloma patient remain strong to fight infection.”

There are additional precautions people living with multiple myeloma should take to help minimize their risk for infection and to help recognize when symptoms are serious. Dr. Ruben Niesvizky and Karen Pekle, NP share six tips to help multiple myeloma patients get through flu season:

• 1) Know when a cold has turned into something more serious. What may amount to a common cold in an otherwise healthy person can quickly become serious, leading to pneumonia or even death, in patients with compromised immune systems. Some of the symptoms you should watch for include fever, headache, severe aches and pains, shortness of breath, dizziness and persistent coughing. If these occur, it is likely it’s more than just a cold and you should see a doctor.
• 2) Practice good hygiene. Clean and disinfect surfaces and objects in your home on an ongoing basis. Wash your hands frequently with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer. Also, avoid touching your eyes, nose, and mouth.
• 3) Be prepared. In the event you do get sick or feel especially fatigued, stock your pantry and medicine cabinet. Having items, such as food, tissues and hand cleaners is important so that you won’t have to leave your house to get them when you’re not feeling well. Have emergency phone numbers on hand, including all of your doctors.
• 4) Pay attention to your breathing. Approximately 80% of myeloma patients experience bone loss due to the myeloma weakening the bones, making them more prone to fracture. Frequently these bone lesions are located in the spine, ribs and pelvis. This involvement of the skeletal system can impact posture and the ability of multiple myeloma patients to effectively remove secretions from lungs, which is especially important during flu season. If you’re coughing heavily or having difficulty breathing, be sure to call your healthcare team.
• 5) Avoid crowds and others who are sick. Try to stay at least six feet away from people who appear ill. If possible, stay away from small children who spend their days in group settings like daycare or school – since germs spread easily in these places.
• 6) Don’t lose contact with people just because you can’t physically be with them. While it is recommended that you keep your distance from small children while you’re immunocompromised, there are other ways you can stay involved. If you have grandchildren or nieces and nephews, make phone dates to hear about their day at school, or become their pen pal. This will help to continue your relationship while also minimizing the chances of picking up any of the germs they may be carrying.