Hi, my name is Maximilian Merz. I'm from Roswell Park in Buffalo, New York. And I just presented data on vaccination after transplantation for newly diagnosed myeloma. And basically, all transplantation guidelines recommend vaccination against most of the most common pathogens in myeloma. But until now, nobody has ever tested serologically response to these vaccines. So basically, nobody knows whether vaccination is successful after transplantation. So there might be patients who are susceptible to infections, severe infections, who do not respond to vaccination. So in our trial, we investigated vaccine titers before and after transplantation, as well as after vaccination under linearly the might maintenance therapy. And there were several things that we found out. First of all was that transplantation alone restores seropositivity against most pathogens. So we saw in 20% of our 139 patients that transplantation basically restored immunity against pathogens. And further on, we saw that vaccination after transplantation is very successful. So 60% of patients after vaccination who were transplanted for newly diagnosed myeloma showed positive titers after vaccination. And 20% of patients did not. So basically, our conclusion from that was that we have to check for titers after vaccination, because not everybody responses as the usual community does. So that's the first consequence from our from our results. And lastly, we performed a survival and an assistant could basically show that patients who converted from negative to positive titers had a severe benefit concerning progression-free survival and also overall survival. So that's very interesting. And we have to go into detail on that because we have to identify which patients are prone for positive seroconversion. And what's the reason for this survival benefit that we observed? And it was pretty astonishing because 70% of patients were in ISS stage three in our analysis. Overall survival in these seropositive conversion patients was 100% at three years. So these have a really great outcome. We are not sure what's the biological basis of this right now. And we integrate also MRD diagnostics and uniprofiling from peripheral blood and also bone marrow for future analysis to decipher why these patients converted and why the outcome was so excellent. But taken together, we have to say that vaccination is very successful in myeloma patients after transplantation. But 20% of patients do not respond to vaccination. So therefore, it's very important to check serum titers against the different pathogens. And lastly, of course, we have to investigate why the survival benefit was so significant in the patients with positive seroconversion. That's an excellent question. So usually, most of the European and American transplantation guidelines say six to 12 months after transplantation. And that's the common practice. So usually if you start your maintenance therapy, that's about the time when you start your inactivated vaccines. A bit more complicated are the life vaccines. So for example, measles, you should wait two years after transplantation to start these life vaccines, because there might be some reasons for side effects due to life vaccines if you go too close to the transplant. I think there are two or three points that might be a reason for that. First of all, I mean, the vaccinations that everybody of us receives as a child are sometimes not very common infections among myeloma patients. For example, I never saw, also Dr. McCarthy maybe never saw a patient with pertussis or so after transplantation. But there are some vaccinations that are very, very helpful in myeloma patients, for example, against meningococci or pneumococcal pathogens. So I'm not sure why there are different opinions about that, because there I think and also the guidelines are very strict about it, that you should recommend revaccination six to 12 months after regardless whether you ever had any kind of vaccines or this is the first time, because it's very, very helpful for the patient. Also seasonal influenza, it's another very, very important. We lose a lot of patients due to seasonal influenza, a lot of myeloma patients. Therefore, there shouldn't be any consideration why we shouldn't recommend it.
HealthTree • November 12, 2021
