[Blackbird]

One year post transplant - immunization

by Blackbird on Thu Nov 13, 2014 12:59 pm

I have been debating whether or not to post this and where. I had originally considered posting it in my initial introductory post from back in June (in fact I started to) but then I thought it may get better exposure here since it is part of one of the treatment paths for treating this disease.

Anyway, as of this past Saturday (Nov. 8), it has been 1 year since my stem cell transplant that was done at, of all places, Motts Children's Hospital on the campus of the University Of Michigan Medical Center. The seventh floor of the building is dedicated solely to adult bone marrow transplants (BMTs) and stem cell transplants (SCTs). It is a wonderful facility and I would have no qualms in recommending it to anyone for this procedure. The only shortcoming is that there are no multiple myeloma specialists on the staff. That isn't to say that my doctor there isn't qualified in this area, since he is very knowledgeable on the subject matter, just that he doesn't specialize in just this one area. Still, I'm in complete remission, which was the best possible outcome, so I have no regrets.

But I digress. On with the reason for this post. So, this past Monday (Nov. 10) I had my one year anniversary visit. The reason for this post isn't to talk about the results of my visit (which were very good) but more so to give anyone who is interested information on the immunization process. I was somewhat surprised because I never really received a great deal of information about what it entailed other than the fact that I would receive them on my 1 year anniversary visit.

I received 6 shots this past Monday (3 in each arm and my arms STILL ache a little), one of which was a standard flu shot. Here are the shots that I received:

Hepatitis B (adult)
Hib (PedvaxHIB) - This protects against Haemophilus influenzae type b
Influenza, quadrivalent, (P-FREE)(3 yrs and older)(Inject) - Seasonal
Pneumococcal conjugate 13 (Prevnar 13) - This protects against bacteria Streptococcus pneumoniae
Polio (IPV)
Tetanus+Diphtheria+Pertussis (age 11 - 64)

Going in on Monday, I thought that I would receive a few shots and I would be done. Nope. It turns out that the entire vaccination process takes about a year to complete. Here is the rest of my schedule which will be completed by my PCP:

On or around 12/10/14
- A second shot of Pneumococcal conjugate 13 (Prevnar 13)

On or around 1/10/15
- A third shot of Pneumococcal conjugate 13 (Prevnar 13)
- A second shot of Tetanus+Diphtheria+Pertussis (age 11 - 64)
- A second shot of Hib (PedvaxHIB)
- A second shot of Polio (IPV)
- A second shot of Hepatitis B (adult)

On or around 5/10/15
- Pneumococcal polysaccharides vaccine (PPV), 23-valent (aka PPV23) - protects against Pneumococcal disease

On or around 11/10/15
- A third shot of Tetanus+Diphtheria+Pertussis (age 11 - 64)
- A third shot of Hib (PedvaxHIB)
- A third shot of Polio (IPV)
- A third shot of Hepatitis B (adult)
- And, finally, the MMR shot (measles, mumps, rubella)

There you have it. The immunization process that commences one year post SCT. Ouch! No wonder kids don't like going to their pediatricians. When I was a kid we just lived through most of these ailments (except for polio).

One more piece of good news from the visit is that I no longer have to take any acyclovir (I've been taking it twice a day). Any time I can get off of a prescription drug it's a good thing.

Hope this helps any of you who are or will be coming up on your one year anniversary.

Rick

[kullybunnny1]

Re: One year post transplant - immunization

by kullybunnny1 on Thu Nov 13, 2014 6:45 pm

Rick, my ASCT was done at Roswell Park in Buffalo, NY. My post-transplant course of treatment had me start immunizations at day 180. Other than a stiff neck for a couple of weeks after the first 5 shots and an issue with my insurance denying my polio (outside of normal age range) shot cost, it's going well.

Thanks for sharing your experience!

Kully

[Mister Dana]

Re: One year post transplant - immunization

by Mister Dana on Fri Nov 14, 2014 1:16 am

Thanks for the info, Rick. It is a good topic. I am past my 100 days post-SCT, and got my flu shot for the year. But I have to wait for my one-year anniversary next summer to get the shots like you did. I am not sure they will give me all the shots that you got, though.

[Blackbird]

Re: One year post transplant - immunization

by Blackbird on Fri Nov 14, 2014 7:23 am

Kully,
That is interesting. I was wondering if there were different schedules for giving these. My doctor mentioned that, yes, my immune system was functioning well at the 180 day mark but they never gave the shots before the 1 year mark. He didn't offer an explanation as to why.

Mister Dana,
I thought the same as you. Don't be surprised if you get at least 5. I never got my flu shot last year since my SCT was in November. Fortunately I was able to avoid any major sicknesses over the past 12 months (other than a really nasty sinus infection this past spring which is almost an annual event. ).

[Mary Degenkolb]

Re: One year post transplant - immunization

by Mary Degenkolb on Fri Nov 14, 2014 4:17 pm

Rick,

Great information for those who have reached the one-year mark. I am sure that most do not realize that with a stem cell transplant, your childhood immunizations are wiped out. That is why it is so important to have a good verbal relationship with your doctor! I got my work sheet with the schedule of shots I needed to retake when I had my 3-month check up after SCT. It had the list of each immunization, the dose, and the time frame I was due to get it.

Like you, I think I got 5 or 6 shots and then had to come back for a few more. Then there is a time period I have to wait to get the "boosters" done. I had my vaccinations done at the same interval except the Mumps, Measles and Rubella. Since I was still on Revlimid, I was not able to get that one. My transplant team had specified that the only way to get that shot was if I was off of all immuno-suppressive treatment, and 2 years post transplant. I have been off the Revlimid for 4 months and so was able to get that vaccination.

I now know what my grandchildren have been going through to get ready for this past school year. But I am of an age that I remember getting my smallpox vaccination. I am not sure if that needs to be addressed? I know it is a live virus and we with multiple myeloma should avoid live virus at all costs. And I also realize that smallpox has been obliterated in most countries but is making a come back. What has anyone heard about that vaccine?

The last one is the pneumococcal pneumonia that is being touted on TV. The one that they say is an "old people disease". I have had the pneumonia shot last year and still got double pneumonia. But per my doctor, it was a lot less than it could have been. Per my vaccination clinic, you only get the pneumonia shot once each 5 years. But I wonder if this one is different.

[NStewart]

Re: One year post transplant - immunization

by NStewart on Fri Nov 14, 2014 4:46 pm

Be sure to ask your oncologist if re-immunization is done after your ASCT in their protocol. I asked my oncologist because I was still working in healthcare at the time. It isn't a practice for the cancer center where I am treated. My oncologist said that since we received our own stem cells the antibodies that we had should still be there. He also said that it is questionnable whether the vaccines actually take. Has anyone had titers done for antibodies either after the ASCT and before re-immunization and then again after all of your immune shots are completed? He does tell me to get the flu shot annually in case immunity results and to get the pneumonia shot every 5 years. I don't know if the one that is being advertised on TV is the same, or different, from the one I have received.

I know as part of the bloodwork that was done prior to the ASCT that all of my antibodies were tested for. It was interesting to see what was included. I asked about this, too. My oncologist said that it is part of the protocol required to maintain certification at the hospital to do transplants which is given by some licensing agency. He also said that if I tested positive for any of the diseases that are communicable through bodily fluids that they would know to take extra precautions. But, he also said that if everyone is practicing universal precautions like they are supposed to be doing that handling bodily fluids wouldn't be a problem.

Interestingly I had had the hepatitis B vaccinations about 10 years prior to my diagnosis of myeloma. Titers were done when I finished the series to see if I had developed antibodies for it. When I was doing my pre-employment testing for working at a different health system, they did titers on hepatitis B and a number of other diseases. I had no antibodies for the hepatitis B and had to re-do the series before I could begin employment. After that series they checked my levels again and I did have the antibodies. That was 3 years before I was diagnosed. I always wonder how these things fit together, if at all.

Nancy in Phila

[Blackbird]

Re: One year post transplant - immunization

by Blackbird on Fri Nov 14, 2014 4:59 pm

Interesting about the MMR and Revlimid. I had not heard that from either the transplant doctor or my oncologist. I'll need to make a note to ask my oncologist about it on my next visit.

[June]

Re: One year post transplant - immunization

by June on Fri Nov 14, 2014 8:35 pm

I am almost 3 years post transplant and complete remission. I take Revlimid as maintenance. I get my annual flu shot and had a pneumonia vaccine before SCT. My specialist at Barnes said re-vaccination was not necessary. This troubles me with conflicting information.

[Multibilly]

Re: One year post transplant - immunization

by Multibilly on Sat Nov 15, 2014 9:30 am

June,

I may be wrong, but I thought it was pretty much standard procedure to get re-vaccinated after a transplant. You might want to touch base with your transplant doctor?

Per the CDC:

http://www.cdc.gov/vaccines/pubs/hemato-cell-transplts.htm

[kullybunnny1]

Re: One year post transplant - immunization

by kullybunnny1 on Sat Nov 15, 2014 11:50 am

Multibilly,

Thanks for pointing out the CDC immunizations guidelines after a hematopoietic transplant. I find it funny that my insurance denied my polio shot stating that I fell outside the CDC recommended age group.

The more I endure in this new fight the more I get frustrated by communication breakdown and how much falls on the patient to point out such matters.

Thanks again!

Kully