Immune Reconstitution and Vaccination session was chaired by Dr. Noopur Raje. Dr. Paola Neri provided an overview on the immune status in myeloma. Immune function is markedly suppressed in MM by the tumor itself, through inhibitory interactions with immune cells, and by recruitment of immune suppressor cells (e.g. regulatory T cells, regulatory B cells, and myeloid-derived suppressor cells) to the bone marrow microenvironment. She also discussed the anti-myeloma therapies administered to patients that may impair immune function. Dr. Niels van de Donk provided an overview of how therapies have an impact on immune function. Examples include the eradication of normal B cells by IMiDs, elimination of NK cells by CD38 antibodies, and T-cell exhaustion with bispecific antibodies.
Due to impaired immune function, there is an increased risk of infections, Professor Heinz Ludwig discussed which infectious prophylaxis should be considered with specific anti-MM regimens. Finally, the impaired immune status may also lead to suboptimal vaccination responses, including those to COVID-19, as discussed by Dr. Evangelos Terpos.
Although the function of immune cells is hampered by the disease and by treatment, the immune system can also be used to kill myeloma tumor cells. One approach is to generate myeloma-specific T-cell responses by vaccination strategies, touched upon by Dr. David Avigan.