From the Guidelines
Myeloma patients should receive inactivated vaccines, including the pneumococcal vaccine (both PCV13 and PPSV23), annual inactivated influenza vaccine, and COVID-19 vaccine, to protect against common infections, while avoiding live vaccines due to their compromised immune system. Key recommended vaccinations also include the Tdap (tetanus, diphtheria, pertussis) vaccine and the recombinant zoster vaccine for shingles prevention 1. These vaccines should be administered at least two weeks before starting myeloma treatment or three months after completing treatment, if possible. However, the influenza and COVID-19 vaccines can be given during treatment if necessary. It's crucial to avoid live vaccines such as the measles-mumps-rubella (MMR) vaccine or the live zoster vaccine, as these could potentially cause infections in immunocompromised patients.
The timing and specific vaccines may need to be adjusted based on the patient's current treatment regimen and overall health status. Pneumococcal vaccines are particularly important as myeloma patients are at increased risk for pneumococcal infections 1. The influenza vaccine helps protect against seasonal flu, which can be severe in immunocompromised individuals. Always consult with your oncologist before receiving any vaccinations, as they can provide personalized recommendations based on your specific situation and current treatment plan. They may also recommend additional vaccines based on your individual risk factors and exposure history.
Some key points to consider:
- Inactivated vaccines are recommended for myeloma patients to reduce the risk of infections 1
- Live vaccines should be avoided due to the risk of infection in immunocompromised patients 1
- Pneumococcal vaccines (PCV13 and PPSV23) are important for preventing pneumococcal infections 1
- Influenza vaccine is recommended annually to protect against seasonal flu 1
- COVID-19 vaccine is recommended for myeloma patients without a history of transplant 1
- Consult with an oncologist before receiving any vaccinations to determine the best approach for individual patients 1
From the Research
Immunization Recommendations for Multiple Myeloma Patients
- Influenza vaccination is recommended for multiple myeloma (MM) patients, as it has been shown to impact overall survival (OS) and reduce the risk of infections 2.
- Pneumococcal vaccination is also recommended for MM patients, as it has been found to reduce the risk of pneumococcal disease and improve OS 2, 3.
- The 13-valent pneumococcal conjugate (PCV13) vaccine has been shown to be effective in reducing the incidence of pneumonias in MM patients receiving novel target agents 3.
- MM patients may exhibit a suboptimal response to pneumococcal polysaccharide vaccine (PPV23), but PCV13 elicits a T cell dependent response and is recommended for these patients 4.
- Daratumumab-treated MM patients may face increased seasonal influenza risk due to weakened postvaccination immune responses, and a booster vaccine injection may be beneficial for specific strains (A-H3N2) 5.
Vaccination Schedules and Response
- A 3-dose vaccination regimen with PCV13, given with a minimum of 1 month interval between the courses of novel agents, has been shown to be effective in MM patients 3.
- The response to PCV13 vaccination may wane over time in MM patients, and the durability of the response may be shorter compared to healthy controls 4.
- Seroprotection rates after influenza vaccination may be low in MM patients, especially in those treated with daratumumab, and alternative vaccination and prophylaxis strategies may be necessary 5.
Safety and Efficacy
- No serious adverse events have been reported for influenza and pneumococcal vaccines in MM patients 6.
- Vaccination is important in MM and should be encouraged, as it may affect survival and reduce the risk of infections 2.
- The efficacy and safety of vaccines in MM patients should be further studied to optimize vaccination strategies and improve patient outcomes.