[Multibilly]

MMR vaccine for smoldering myeloma patient?

by Multibilly on Thu Feb 12, 2015 8:49 pm

I asked my GP to run an MMR (measles/mumps/rubella) and Varicella zoster (shingles / chicken pox) titer. I was surprised to find I didn't have immunity for measles or rubella, since I thought I had been vaccinated for MMR and had rubella as a young child.

Basically, my question is whether I am OK to go ahead and get an MMR vaccine given these titer results and my current immunity levels as a smoldering patient? My GP is not clear on whether I should risk getting the live MMR vaccine, so I will be discussing this with my oncologist, but wanted to hear some inputs in the meantime.

Titer Results:

Rubella: <= 0.90, not consistent with immunity
Measles: <=0.90, not consistent with immunity
Mumps: 1.98 (>= 1.10 is considered positive for immunity)
Varicella Zoster: >=1:4, Antibody detected, evidence for immunity against VZV

My Situation:

58 years old. Smoldering IgG kappa since November 2012. In excellent health and feel fine.
IgG: 3501 mg/dL (ref: 694 - 1618 mg/dL)
M Spike: 2.2 g/dL
Kappa: 0.71 g/dL (ref: 0.33 to 1.94 mg/dL)
Lambda: 13.1 g/dL (ref: 0.57-2.63 mg/dL)
L/K ratio: 20

Thanks in advance!

[mikeb]

Re: MMR vaccine for smoldering myeloma patient?

by mikeb on Fri Feb 13, 2015 11:24 am

Hi Multibilly,

Here's my mental model regarding live vaccines and multiple myeloma, admittedly an over­sim­pli­fication.

If we receive a live vaccine, that's like being exposed to the disease that we would want the vaccine to protect us against. And the concern is that our compromised immune systems, caused by multiple myeloma and / or our therapy, would not be able to fight off the disease.

So I think whether these vaccines would be too risky for you depends on how compromised your immune system is. And I guess another factor to consider is how long the exposure to the live vaccine would make you susceptible to getting the disease before your system builds enough antibodies, etc. That's in case your immune system takes a hit in the near future due to your smoldering myeloma worsening.

And there may be other factors to consider that I don't even know about.

After writing all this, I expect none of this is anything you haven't already thought about. This may be more of an exercise to see if my mental model is close to the mark or not.

Best of luck to you,
Mike

[Multibilly]

Re: MMR vaccine for smoldering myeloma patient?

by Multibilly on Fri Feb 13, 2015 11:39 am

Hey Mike,

We are on the same page. I just don't know how to gauge just how immunocomoromised I really am? My healthy, normal immunoglobulin levels are still at very respectable levels. I'm guessing that might be the most important consideration when it comes to live vaccines, but I really don't know. I put the question to my onc, so I suspect he will respond shortly.

If my onc says I'm OK to proceed, I will trust him....but I just might wait to get the MMR shot until after this ski season is over

[goldmine848]

Re: MMR vaccine for smoldering myeloma patient?

by goldmine848 on Fri Feb 13, 2015 4:30 pm

The link below, which I believe has been posted here before, includes the recommendation that live vaccines be given two years post-transplant. There does not seem to be consideration given to immune system status, although that would seem to be a prudent consideration. I realize that you have not had a transplant, but it seems to me that your situation would not require more caution than the one of a patient who has had a transplant.

http://www.fredhutch.org/en/treatment/long-term-follow-up/FAQs/vaccination.html#3

[Dr. Jatin Shah]

Re: MMR vaccine for smoldering myeloma patient?

by Dr. Jatin Shah on Mon Feb 16, 2015 10:51 pm

I agree. MMR is live virus vaccine and should not be administered within 24 months of stem cell transplant, if there is active GVHD, during immunosuppresive therapy, or during preg­nancy. Also, vaccinations should be deferred if possible until 3 months post IVIG infusion or plasma transfusion.

As a patient with smoldering myeloma, and given your current titers, it is reasonable to receive vaccinations.

[Multibilly]

Re: MMR vaccine for smoldering myeloma patient?

by Multibilly on Mon Feb 16, 2015 11:10 pm

Thank you Dr. Shah!

[Multibilly]

Re: MMR vaccine for smoldering myeloma patient?

by Multibilly on Wed Mar 25, 2015 11:35 am

As a follow-up to this discussion, I talked to my onc today. Although being just slightly concerned, he gave me the go-ahead to get the MMR vaccine, given my current test numbers.

But what was curious is that he said that it could very well have been my smoldering multiple myeloma that caused me to lose my immunity to rubella and measles over time (although I could have just lost it even without having SMM). Moreover, he said that there is also the possibility that the MMR vaccine may still not result in me developing immunity to measles and rubella, again due to the smoldering multiple myeloma. He therefore suggested that I consider getting my titers re-checked down the road.

Immunology continues to amaze me on a daily basis.

[lys2012]

Re: MMR vaccine for smoldering myeloma patient?

by lys2012 on Wed Mar 25, 2015 8:35 pm

Funny, I found out I have no immunity to rubella with my prenatal blood work. So I was told to be careful about rubella, since it can be really harmful to an unborn baby. Luckily it is very rare nowadays. I still have immunity to measles, and I've had shingles twice so I show good immunity to it now, lol. I know I had the extra MMR shot because I was "suspended" in high school to get my vaccinations up to date. I'm 37 years old.

My oncologist says no live vaccines for me, I am 5 years post transplant, but my myeloma is active again, just not enough to start treatment. Plus we are watch and wait status due to my pregnancy anyway, but hoping to "coast" another year or so in a smoldering state.