Topics:
Hematologic Malignancies • Medical Oncology • Myeloma • Hematology • Infectious Disease • Vaccines • Transplant Infectious Disease
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody response to TDAP?
Answer from: at Academic Institution
It depends on the vaccine and prior immunization history. Not all vaccines require an antibody response to be at least partially efficacious.
In addition, with any immunocompromised host, reduced effectiveness for all vaccines is expected, but is not a reason to not vaccinate. Serologic testin...
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Answer from: at Academic Institution
I think it’s reasonable to try revaccination. However, if the patient is developing infections and the quantitative immunoglobulins are low enough to meet the criteria, the oncologist should be perfectly competent to prescribe IVIG instead of involving another specialist. It’s pretty sta...
Answer from: at Academic Institution
This depends on the treatment course and the vaccine being administered. If the initial response to something like TdaP or the pneumococcal vaccine is poor, it is reasonable to repeat the vaccine 6 months to 1 year later, particularly if immunosuppression is reduced during that time period. If, at t...