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Vaccinations Post Stem Cell Transplant?
Getting all of the vaccinations that you had before your autologous stem cell transplant is a component of the standard-of-care therapy plan for all newly diagnosed multiple myeloma patients.
Unfortunately, many MM survivors are conflicted about getting the many vaccinations that they got over a lifetime. More importantly, the possible side effects of vaccinations are in the public’s mind these days.
The question below is a common one I receive from MM survivors who have recently completed an autologous stem cells transplant. The studies linked and excerpted below my exchange with Miquel document oncologies thinking.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Hi David- I was diagnosed with MM exactly a year ago. (I’m currently 70 yrs old.} At the time 95% MM cells were found in my bone marrow. I never had any bone lesions or bone pain…every PET scan was normal.
The oncologist/hematologist started me on
- Velcade,
- Darzalex,
- Revlimid, and
- Dexamethasone.
In 3 months my bone marrow biopsy results were down to less than 5%. The doctor was amazed at the response. I stayed on the chemo regimen until I underwent a ASCT at Mayo in January. In April a follow up biopsy at Mayo showed .0003…( 3 suspect cells in a million) which is considered close to MRD (minimal residual disease).
I am currently receiving maintenance chemo (10mg Revlimid 2 weeks a month and a Velcade injection twice a month). I feel I am back to 100%… feel really good. My blood work twice a month shows all pretty much back to normal.
Now the decision I’m facing is the recommendation that I get all my childhood vaccinations over again which I am not comfortable with. I have never had a Covid vaccination and will never take it… and I’m not a believer in the efficacy of flu shots either.
My oncologist at Mayo strongly recommended all the vaccinations as did my oncologist here at home. They say my immune system is still somewhat compromised. Any recommendations would be appreciated. Miguel
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Hi Miguel-
I am sorry to learn of your MM diagnosis but will offer my congratulations on reaching MRD status. Not only did you respond well to your induction therapy and ASCT but you seem to be experiencing few if any side effects.
As for your question about having to have all of your vaccinations post ASCT, the issue, as far as my experience and research goes, is about risk. By this I mean that vaccines, on average, reduce your risk of contracting the sickness in question- MMR, shingles, SARs, etc. I agree that there are risks to you just by taking a given vaccine. The issue is to weigh the pros and cons.
I did not get re-vaccinated for all of my vaccinations after my own ASCT either. I do not get an annual flu shot but I did get the sars-covid vaccine. I do believe that the benefits outweigh the risks when it comes to MM and the sars vaccine. I agree however that this is a difficult debate for the MM survivor to think through.
Research does show that MM patients have a somewhat compromised immune system following the standard-of-care therapy plan that you have completed.
I can’t offer you a yes or no answer. This is the kind of question that you have to decide for yourself.
Let me know if you have any questions.
Good luck,
David Emerson
Immunizations in hematopoietic cell transplant candidates and recipients
“INTRODUCTION- Prevention of infection is of paramount importance to the ever-increasing population of patients who have impaired immunity, such as those who have undergone hematopoietic cell transplantation (HCT).
Infection in these patients often results in excessive morbidity and mortality, and antimicrobial therapy is typically less effective than in the immunocompetent host [1]. Although immunization appears to be an obvious way to prevent infection, many patients with impaired immunity are unable to mount a protective immune response to active vaccination.
Furthermore, immunization with live virus vaccines may result in unchecked proliferation of attenuated strains.
Other issues related to infections in HCT recipients are reviewed separately. (See “Evaluation for infection before hematopoietic cell transplantation” and “Overview of infections following hematopoietic cell transplantation” and “Prevention of infections in hematopoietic cell transplant recipients” and “Prevention of viral infections in hematopoietic cell transplant recipients” and “Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients”and “Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults”.)
RISK OF INFECTION- The risk of acquiring infection and the inability to prevent infection by immunization are directly related to the patient’s “net state of immunosuppression” or severity of disease. The greater the degree of immunosuppression, the less likely the patient is to respond to immunization. Although certain vaccines provide some benefit to the immunocompromised patient, an adequate response cannot be assumed.
Successful protection of the immunocompromised adult may require the use of vaccines and/or passive immunization (ie, immune globulin) as well as adjunctive measures, such as antiviral drug prophylaxis during influenza A outbreaks. (See “Seasonal influenza in adults: Role of antiviral prophylaxis for prevention” and “Seasonal influenza in children: Prevention with antiviral drugs”.)
Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network
“…Patients after autologous, and specifically after allogeneic transplantation have severely reduced antibody titers, and therefore require a broader spectrum of vaccinations. Response to vaccination in myeloma often is less vigorous than in the general population, mandating either measurement of the postvaccination antibody titers and/or repeating the vaccination. Here, we compile the existing data on vaccination in multiple myeloma and provide recommendations for clinical practice…”