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Winter 2002/2003 Volume 5, Issue 4:
Did You Know?
Immunizations in myeloma patients
By Claire Pomeroy, MD
Martin M. Oken, MD
Vaccination can help reduce the risk of some infections in individuals with multiple myeloma.
Vaccination can help reduce the risk of some infections in individuals with multiple myeloma. Patients should receive the vaccines that the CDC's Advisory Committee on Immunization Practices and the American Academy of Family Physicians have recommended for immunocompromised adults. Tetanus-diptheria vaccine should be current, influenza vaccine should be administered annually, and pneumoccal vaccine should be provided. Revaccination with pneumoccal vaccine is recommended after 5 years. Live vaccines should not be administered.

Myeloma patients who undergo stem cell/bone marrow transplantation may experience a decrease in antibody titers to vaccine-preventable diseases such as tetanus, polio, and encapsulated organisms during the first 4 years after transplantation. Therefore, revaccination of transplant recipients is routinely recommended.

At the present time, vaccine recommendations for recipients of allogeneic and autologous transplants are the same (see CDC guidelines and European Group for Blood and Marrow Transplantation guidelines). Current guidelines suggest tetanus-dipheria, H. Influenza, and hepatitis B vaccine at 12, 14, and 24 months after stem cell transplant. The hepatitis B vaccine may be omitted in adult patients with no risk factors for this virus. Influenza vaccination should be given before the transplant and then annually starting 6 months after the transplant. Pneumococcal vaccine should be given 12 and 24 months after transplant. Measles, mumps, and rubella is a live vaccine and should be avoided for at least 24 months and should only be given if the patient is thought to be immunocompetent.

Physicians caring for patients with multiple myeloma can get further information about vaccine recommendations by calling the National Immunization Hotline at (800) 232-2522 or by accessing the CDC website at www.cdc.gov/nip.

Note: Myeloma patients must keep in mind two concepts when reaching a decision about vaccination.

  1. Reduced benefit – All myeloma patients have reduced immunity and ability to respond to and therefore benefit from any vaccination.
  2. Increased risk – The reduced immunity also means that live vaccinations must be avoided (including smallpox), and that other risks must be balanced against realistic benefits. This usually means that hepatitis, polio, and possibly other vaccinations are not required or recommended. Each patient must discuss pros and cons with his/her personal physician.

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