Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?

This comes up from time to time, but especially in 2025 with the multistate outbreaks and the rising adoption of bispecific antibodies (e.g., teclistamab, talquetamab, elranatamab) for multiple myeloma. Would you ever consider live vaccines? If so, what parameters would you set? E.g., CD4 counts, interval between bispecific doses, presence/absence of IVIG?

Answer from: Medical Oncologist at Academic Institution

The truth is that if a patient is receiving immunoglobulin replacement, they are probably protected. There isn't much utility in checking titers either, because they will be reactive when receiving IVIg. I do like CD4 counts to be above 200 to give live vaccines, and would apply the same principles ...

Answer from: Medical Oncologist at Academic Institution

I agree with the answer here by Dr. @Derman. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, including...

Comments

Medical Oncologist at Winship Cancer Institute of Emory University
I had never seen this data that using IVIG in Kawa...

Medical Oncologist at Loyola University Medical Center
Thanks for sharing @Craig. I was not aware of the ...

Medical Oncologist at University of Chicago
Great discussion, and I look forward to seeing mor...

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Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?

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