Should myeloma patients get revaccinated after stem cell transplants?

If a myeloma patient's body is "reset" during the stem cell transplant, should they get revaccinated? The answer from the experts is YES, but when the timing is right.

Vaccines can be activated (live but weak) or inactivated (killed) micoorganisms. Live vaccines can include measles, mumps, and rubella (MMR), chicken pox (Varivax), shingles (Zostavax), typhoid (oral vaccine), yellow fever, the flu, and polio (oral vaccine). Inactive vaccines can be given for the flu, polio and typhoid. Because myeloma patients have compromised immune systems, it is generally recommended that they avoid live vaccines until their immune systems have sufficiently recovered and in some cases, like the live shingles virus, avoided completely. Those with MGUS and smoldering myeloma could consider live vaccines.

Dr. Tricot, MD, PhD at the University of Iowa noted his vaccination strategy for patients after transplant. 

"My practice is to wait with revaccination until the immune system has sufficiently recovered. This happens when the absolute CD4 count is > 400. At that time, I revaccinate for tetanus and pneumococcal pneumonia. The tetanus vaccine is once and thereafter repeated every 5 years. The pneumococcal vaccine is twice, three months apart and then repeated every 5 years. Vaccination for Hepatitis B is optional."

Dr. Elias Anaissie from UAMS recommended that if  you are a myeloma patient in close proximity to someone who has recently had a live vaccines, be aware that live vaccine-strain viruses can sometimes be transferred from person to person. Myeloma patients should avoid those who have received live vaccines for four to six weeks after vaccination and follow good hand hygiene. For more a detailed vaccination presentation for myeloma patients, click the link.