Based on studies conducted at the Dana-Farber Cancer Center, researchers concluded that the live-attenuated zoster vaccination and the measles, mumps, and rubella (MMR) vaccination are apparently safe and well-tolerated in patients with multiple myeloma receiving maintenance therapy after autologous hematopoietic stem cell transplant (auto-HSCT). The results were reported in two separate posters sessions at IDWeek 2016.1,2
Patients at Dana-Farber typically receive the zoster and MMR vaccinations approximately two years post auto-HSCT if they are not on any immunosuppressive therapies. Both studies involved patients seen between May 2007 and January 2014.
In the zoster study, the investigators reviewed the medical records of lenalidomide-receiving patients with multiple myeloma who had been given the zoster vaccine after auto-HSCT. Varicella-zoster is a common cause of infection in the period following auto-HSCT.3 The study notes that 30%-52% of patients experience a reactivation within 5 years of transplantation.
Seventy patients (43 male, 27 female, median age 63) met the zoster study criteria. Their records were examined for evidence of skin rash or any clinically significant adverse events (AEs) until 42 days after vaccination, and for prescriptions for antiviral medications (acyclovir, valacyclovir or famciclovir) that could signify treatment of a zoster occurrence. Results indicated that no patients had a vesicular rash characteristic of zoster within that time frame. Upper respiratory tract infections were noted in 10 patients (14.3%); however, the investigators could not determine whether these were vaccine-related or coincidental. “Zoster vaccine administered around 24 months after auto-HSCT appears to be safe and well-tolerated in multiple myeloma patients on maintenance lenalidomide,” the researchers concluded.
Criteria for the MMR study included patients with multiple myeloma on maintenance therapy with lenalidomide, bortezomib or both, who received the MMR vaccine post auto-HSCT; 136 patients (77 male, 59 female, median age 64) were included. The investigators checked their medical records to see if skin rash or other adverse events occurred within 42 days following vaccination. There were no occurrences of skin rash suggestive of measles or rubella in the cohort. Skin rash occurred in 6 patients (4.4%); 4 rashes were non-specific and 2 were associated with herpes zoster. A small proportion of patients (18 patients, 32%) reported upper respiratory tract infections. As in the zoster study, it was unclear to the investigators whether these infections were related to the vaccination or coincidental. Like the zoster vaccine, “MMR vaccine administered around 24 months after auto-HSCT appears to be safe and well-tolerated in multiple myeloma patients on maintenance lenalidomide and/or bortezomib,” the researchers concluded.
- Pandit A, Leblebjian H, Hammond SP, et al. Safety of live-attenuated Zoster vaccination in multiple myeloma patients receiving maintenance lenalidomide after autologous stem cell transplantation. Presented at: IDWeek 2016; October 26-31, 2016; New Orleans, LA. Poster 2327.
- Pandit A, Leblebjian H, Hammond SP, et al. Safety of MMR vaccination in multiple myeloma patients receiving maintenance lenalidomide or bortezomib after autologous stem cell transplantation. Presented at: IDWeek 2016; October 26-31, 2016; New Orleans, LA. Poster 2328.
- Santos KB dos, Souza RS e, Atalla A, Hallack-Neto AE. Herpes zoster after autologous hematopoietic stem cell transplantation. Rev Bras Hematol E Hemoter. 2016 Jul 12. doi:10.1016/j.bjhh.2016.05.015. [Epub ahead of print]