What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?

We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule

Post autologous SCT vaccine

Interval Date Vaccine

Yearly Flu Vaccine

3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix

6 months post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix

9 months post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap

12 months post-transplant Pneumovax 24

24 months post-transplant MMR

30 months post SCT MMR

We do not check titers pre or post vaccination.

The important thing re: the monoclonal antibodies is checking the IgG and replacing with IVIG if <500 at our institution. Some institutions use 400 mg/dl as the cutoff.

Thanks

YE
Yvonne Ef...

The BMT/CTN schedule has not been re-examined, unfortunately. Hib & polio are thankfully not a risk in the U.S. for now, and so these vaccinations do not have an appealing benefit:risk ratio - similar to MenACWY, MenB, and HPV.

Hepatitis A and B have individualized risk factors per the previous ACIP. Hepatitis A makes sense in travelers to countries with high or intermediate HAV endemicity, close contact with international adoptees, men who have sex with men, injection drug users, chronic liver disease, clotting factor disorders, homeless. Hepatitis B makes sense in those at risk for infection through sexual exposure, injection drug use, percutaneous or mucosal exposure to blood, hep C positive, chronic liver disease, HIV+, travel to high o...

We follow TCT guidelines and avoid live vaccines.