Revaccination after Autologous Hematopoietic Stem Cell Transplantation Is Safe and Effective in Patients with Multiple Myeloma Receiving Lenalidomide Maintenance

Abstract

Guidelines recommend vaccination starting 12 months after autologous hematopoietic stem cell transplant (aHCT), but there is varying practice for patients on maintenance therapy, with some centers not immunizing at all. Because of decreased vaccine rates among the general population causing loss of herd immunity, we aimed to establish the safety and efficacy of revaccinating multiple myeloma patients on lenalidomide maintenance (LM). Of the 122 patients who were vaccinated after aHCT between 2010 and 2014 at Memorial Sloan Kettering Cancer Center, 91 (75%) were on LM. Vaccine responses were defined by increases between pre- and postvaccination titers. Reponses varied by vaccine type with 76% responding to pertussis, 70% diphtheria, 60% tetanus, 71% Haemophilus influenzae, and 58% pneumococcal. All patients retained minimal levels of polio immunity, but 27% responded with increased titers. Fewer patients received hepatitis A and B, but of those who did, 30% responded to hepatitis A and 40% to hepatitis B. No differences were seen in rates of response for those on LM at time of vaccination compared with those who were not. There were no vaccine-related adverse effects. Reimmunization with inactivated vaccines in patients on LM is therefore both safe and effective, offering this population immunity to vaccine-preventable diseases.

Szczepienia ochronne u dorosłych chorych na nowotwory hematologiczne oraz u chorych z asplenią – zalecenia PTHiT i sekcji do spraw zakażeń PALG

“…do kilkudziesięciu procent chorych na MM[25,26]. Szczepienia mogą być przeprowadzone u chorych leczonych lenalidomidem, który może zwiększać ich skuteczność[27].…”

Poor response to hepatitis A vaccination in hematopoietic stem cell transplant recipients

“…Another recent study conducted by Palazzo et al included 56 autologous HSCT recipients. Two doses of HAV vaccine were administered, and seroconversion rate was 30% …”

“…In the present study, we did not observe the occurrence of noteworthy adverse events. Although safe and well tolerated in transplant populations as demonstrated in this and previous studies, the serological response to the inactivated HAV vaccine was poor.…”

The role of high‐dose melphalan with autologous stem‐cell transplant in multiple myeloma: is it time for a paradigm shift?

“…71 Lastly, current re-immunisation programmes for melphalaninduced inactivation of prior vaccines recommend that vaccination (including pertussis, diphtheria, tetanus, haemophilus influenzae, pneumococcal, and hepatitis A and B) begin 12 months after HDM-ASCT. 72 When a safe and efficacious SARS-CoV-2 vaccine becomes available, it will need to be added to these re-immunisation programmes accordingly.…”