What should I know about vaccinations after transplant?

Are post transplant vaccinations effective?

All transplantation guidelines recommend vaccination against most of the most common pathogens in myeloma. But, until now, nobody has ever tested serologic response to these vaccines. Antibody serology tests look for antibodies and can help determine if a patient has developed immunity from a previous vaccine. Basically, nobody knows whether vaccination is successful after transplantation. So there might be patients who are susceptible to infection, 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 lenalidomide maintenance therapy. And there were several things that we found out. First of all, was that transplantation alone restores the serum positivity 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 new 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, this is the first consequence from our, from our results. And lastly, we performed a survival analysis and 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. And that's because we have to identify which patients are prone for positive seroconversion. And what's the reason for this survival benefit that that we observed. And what's pretty astonishing because 70% of patients were in ISIS, stage three no analysis, no more survival in this seropositive conversion patients was 100%. at three years. So these have a really great outcome. We are not sure what, biological basis of this right now. And we, we integrate also MRD diagnostics and immuno profiling 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. And 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. We have to investigate, why the survival benefit was so significant in the patients with positive zero.

When should revaccination start after a transplant?

Usually most of the, European and American transplantation guidelines say 6 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, Bit complicated about the live vaccines. So for example, measles, you should wait two years after transplantation to start these live vaccines, because there might be some reasons for side effects due to live vaccines. If you go too close to the transplant,

What should I know about vaccinations after transplant?

Vaccinations after transplant are a critical part of teaching your new immune system how to protect you. every institution has their own protocol in terms of a timelineof how those vaccinations are administered and the after your transplant. Some may be in the first couple of months and many times those vaccinations will continue several years after your transplant is over, as we, kind of continue on the timeline of vaccinations. Some of the most critical vaccinations that we know are influenza or your standard flu shot every year, pneumococcal or pneumonia vaccines are absolutely important. But some of the other vaccinations that will routinely be included as part of the post-transplant vaccination series include things you never would have imagined you'd need again. Measles or polio or tetanus, things like that. Hepatitis is a common one. We do as well. Obviously, Covid is an important part of this. We follow CDC instructions and recommendations in terms of the frequency of that and try to incorporate it into our, standard vaccination timelines. Shingles vaccination is another important part of this. I think overall it's important to recognize that even though you may have had many of these vaccinations before your transplant, whatever immunity you once had is now gone. And we have to start over again. So you're like a brand new baby. We're going to start do those vaccinations all over again. Make sure we can build up your immunity again in terms of the vaccination after the stem cell transplant. S

o, you know, we always warn our patients ahead of the time that after the stem cell transplant that the patients will be like a new born baby. So we completely wipe out their immune system. So we completely wipe out their immune system. So and that means that we have to re vaccinate our patients. So what that means is that they have to receive all the baby shots that they have received as they when they were babies. Right. And we use a little bit different schedule for that, given the fact that we just reset the whole immune system. And usually we require for the immune system to mature and be able to build a response, against the vaccines that we're giving to the patients, because vaccines are bits and pieces of the, bacterial viruses. Right. And in order for us to administer them, we want to make sure that we create the memory cells again. And since we just to reset the whole bone marrow, we need about 3 to 6 months for that immune system to mature enough. So they learn and they kind of understand what they supposed to do. It's like you ask the kindergarten kid to do, high intensity high school math, and they probably can't, right. So you want them to grow, you want them to mature. And that usually happens in 3 to 6 months after the stem cell transplant. And, there are certain sets of vaccinations we prefer to do first. If we are in a flu season. We certainly would like to give the flu and Covid vaccines right away as soon as we can. And the rest of the baby shots, like DTaP, the steroid pertussis shots, then Haemophilus influenza shots. Pneumococcus. We try to save the life of vaccines for, two years after the transplant or even beyond the two years, and we sometimes might even shy away if patients are still considered to be more like immunocompromised. For example, the MMR and the varicella shots, I would prefer to give a 2 or 2 and a half years for some stem cell transplant and sometimes if someone requires a really high intensity, let's say, God forbid someone progressed during that time, we might even shy away of giving the life vaccines, given the fact that this patient's going to be immune compromised.