How can vaccinations prevent infections? Which vaccinations should myeloma patients consider receiving?

How can vaccinations prevent infections? Which vaccinations should myeloma patients consider receiving?

So vaccinations, as we know, are such an important, protective measure from some of these infections, particularly with the COVID-19 pandemic that we've had over the last few years. Now we're entering that season again, you know, the flu season where we start to see more infections. And we've just had the recent approval for the new COVID-19 booster which is going to hopefully cover some of the new strains that have come up since the last time they updated it. So what we typically encourage patients is to get all the vaccines that are available. That includes COVID, that includes the flu shot. And it also now includes the RSV vaccine, which was just come out. RSV was a virus that we saw a lot of actually the previous spring and late part of winter, which, you know, led to quite symptomatic patients, you know, a lot of cough that was very much prolonged. And people can get pretty sick from that as well. To have a vaccine against that, I think is great.

So we do typically encourage patients to get all three. They don't have to get all three at the same exact day or same exact time. So we do stagger it, it doesn't have to be staggered by more than a few days, etc. so whatever you're able to accommodate with your schedule, that would be okay. But we do encourage you to get it. Furthermore, like where that fits into your treatment, you know, what we typically recommend is do not get it the day of your treatment when you're getting dexamethasone or other therapies that are going to block, you know, your immune system. So we typically want patients to get it on kind of in the middle part of their cycle or during their off week from some of the therapy. So some of it is, you know, very much depending on what regimen they're on. But we do typically want patients to get all the vaccines and try to do it, if you can, in the middle of your cycle, just not in the day of the actual treatment.

Vaccination is very important for patients with multiple myeloma. So this is important to clear up.

The response of patients with multiple myeloma to vaccination is reduced compared to somebody who does not have multiple myeloma. That's particularly true, as I previously mentioned, for patients getting those classes of drugs. CD38 targeted therapy, B-cell maturation antigen targeted therapy. However, just because the benefit is reduced does not mean that the benefit is outweighed by the risk. The risk to patients with multiple myeloma getting infections that are preventable by vaccination is also higher. So it's very important to get your regularly scheduled vaccinations. Always consult with your hematologist and transplant physician, sometimes those are the same doctor, sometimes those are different doctors,about whether or not you are up to date on vaccinations and after an autologous transplant or treatment with CAR-T, oftentimes childhood vaccinations will need to be readministered. So make sure you stay up to date on that.

Definitely should be asking about being up to date on influenza vaccinations this time of the year. It's almost time to protect ourselves from the flu season.mI'll also mention the coronavirus vaccinations. Those are the two most salient this time of year. Pneumonia definitely should- is concordant to get with age appropriate vaccination guidelines and vaccinating against pneumonia is standard following an autologous transplant. So making sure that you get that if you've not gotten that already. Shingles also we advise patients get if it's age appropriate, which it is for the majority of patients with multiple myeloma. The caution there is that, one should not get the live shingles vaccine. Some vaccines are attenuated live viruses, meaning their weakened but still living viruses. Most patients with multiple myeloma should not be getting such vaccinations.

So, to my knowledge, we, I mean, we mostly switched to the Shingrix vaccine,which is an inactivated, virus vaccine, which does not contain any viable virus. And therefore is not in any way harmful for our patients because there's no viable virus material in the vaccine that potentially could reactivate and potentially cause virus infection. It's also being used in a tandem fashion that we use one vaccination, and then it's recommended after two to six months to do a second vaccination to further increase the immunity against the herpes virus.