Hello all,
I am just a year and change out of my autologous stem cell transplant (with great results) and although I have had 2 rounds of other vaccinations complete, I am not scheduled to get the MMR vaccine for another year.
The measles outbreaks are still far from where I live, but I am concerned that I am at risk and not able to do much about it besides avoidance of exposure.
Has anyone else given this issue much thought and been given updated information on what to do about the MMR vaccine post-stem cell transplant, given the current measles thread?
I feel my risk is low, but I do live in a college town, and Florida is a mecca for tourists.
Forums
10 posts
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dbsmithiii - Name: Doug
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept 15, 2017
- Age at diagnosis: 50
Re: Measles threat & post-stem cell transplant MMR vaccine
Great question. I've been wondering the same thing with reports of measles on the news!
I just got out of hospital with septic strep pneumonia infection and will be meeting with infectious disease doctor this week. I looked through my vaccination record and I was never vaccinated for MMR since transplant in 2015. I'm going to ask the infectious disease doctor and will let you know what is said.
I just got out of hospital with septic strep pneumonia infection and will be meeting with infectious disease doctor this week. I looked through my vaccination record and I was never vaccinated for MMR since transplant in 2015. I'm going to ask the infectious disease doctor and will let you know what is said.
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Melpen - Name: Melissa
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Feb 5, 2014
- Age at diagnosis: 57
Re: Measles threat & post-stem cell transplant MMR vaccine
Thank you Melissa! I look forward to hearing what you find.
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dbsmithiii - Name: Doug
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept 15, 2017
- Age at diagnosis: 50
Re: Measles threat & post-stem cell transplant MMR vaccine
I met with the infectious disease doctor and she is testing blood for MMR antibodies to see if I have any immunity against measles, mumps, or rubella. I believe I had measles as a child. I was born in 1956. The doctor said it did not matter, that because of my stem cell transplant, 5 years of treatment for my multiple myeloma, and time itself, I may have no immunity to measles, and yes, measles poses a serious threat to a cancer patient with no immunity to the disease. When I asked if I could be vaccinated, I believe she said that would be difficult. I am not sure why though.
Here are the tests she ordered for MMR: Corvac serologies. Chemistry (MUMG) Mumps IgG Ab, (RSE) Rubella IgG Ab, (MEAS) Rubeola IgG Ab.
I meet with the doctor again the end of May to go over the blood tests (having numerous other tests) and will post again then with results of MMR and what the doctor says can be done if I have no immunity to measles.
Here are the tests she ordered for MMR: Corvac serologies. Chemistry (MUMG) Mumps IgG Ab, (RSE) Rubella IgG Ab, (MEAS) Rubeola IgG Ab.
I meet with the doctor again the end of May to go over the blood tests (having numerous other tests) and will post again then with results of MMR and what the doctor says can be done if I have no immunity to measles.
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Melpen - Name: Melissa
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Feb 5, 2014
- Age at diagnosis: 57
Re: Measles threat & post-stem cell transplant MMR vaccine
Hi Melissa,
You will find different recommendations from different sources on the web regarding whether to get the MMR (measles/mumps/rubella) vaccine post transplant. I'm not sure how easy it is to get the stand-alone measles vaccine.
The CDC, European Group for Blood and Marrow Transplantation and Seattle Cancer Care Alliance all generally recommend getting the MMR vaccine post-transplant, but no sooner than two years after an autologous transplant (which is the type of transplant that I assume you had). See these articles:
https://www.fredhutch.org/en/treatment/long-term-follow-up/FAQs/vaccination.html
https://www.fredhutch.org/content/dam/public/Treatment-Suport/Long-Term-Follow-Up/LTFU_HSCT_guidelines_physicians.pdf
This is also a good, recent meeting abstract on the safety of the MMR vaccine being administered two years after an an autologous transplant for those patients on maintenance therapy.
https://academic.oup.com/ofid/article/3/suppl_1/2328/2636651
You will find different recommendations from different sources on the web regarding whether to get the MMR (measles/mumps/rubella) vaccine post transplant. I'm not sure how easy it is to get the stand-alone measles vaccine.
The CDC, European Group for Blood and Marrow Transplantation and Seattle Cancer Care Alliance all generally recommend getting the MMR vaccine post-transplant, but no sooner than two years after an autologous transplant (which is the type of transplant that I assume you had). See these articles:
https://www.fredhutch.org/en/treatment/long-term-follow-up/FAQs/vaccination.html
https://www.fredhutch.org/content/dam/public/Treatment-Suport/Long-Term-Follow-Up/LTFU_HSCT_guidelines_physicians.pdf
This is also a good, recent meeting abstract on the safety of the MMR vaccine being administered two years after an an autologous transplant for those patients on maintenance therapy.
https://academic.oup.com/ofid/article/3/suppl_1/2328/2636651
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Measles threat & post-stem cell transplant MMR vaccine
Thank you Multibilly, you are so very informative!
The links you posted state:
"The safety of the measles, mumps, and rubella vaccine (MMR) in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic stem cell transplantation (auto-HSCT) is largely unknown. At our institution the MMR vaccine is typically given around 24 months post auto-HSCT provided patients are not on any immunosuppression"
and
“Transplant patients should definitely NOT receive the smallpox vaccine because it is made from a live virus (vaccinia) and can cause vaccinia infection. It is also important that patients NOT receive the measles, mumps, and rubella (MMR) vaccine until two years post-transplant and at least one year after discontinuing immunosuppressive therapy. The same is true for other live-virus vaccines, such as BCG, oral (Sabine) polio, yellow fever, and typhoid. The Varicella-zoster (chickenpox/shingles) vaccine is currently not generally recommended, pending further research. If the benefits outweigh the risks, it may be given to help prevent chickenpox if the patient doesn't already have antibodies to the chickenpox virus.”
So there you go. When I asked the doctor if I could get vaccinated, this is why she said "That would be difficult." I am still undergoing treatment, with Revlimid, Darzalex, and methylprednisolone, and my immune system is very suppressed, so if my blood labs show I have no immunity to measles, I just have to live at high-risk as vaccination is probably out of the question.
The links you posted state:
"The safety of the measles, mumps, and rubella vaccine (MMR) in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic stem cell transplantation (auto-HSCT) is largely unknown. At our institution the MMR vaccine is typically given around 24 months post auto-HSCT provided patients are not on any immunosuppression"
and
“Transplant patients should definitely NOT receive the smallpox vaccine because it is made from a live virus (vaccinia) and can cause vaccinia infection. It is also important that patients NOT receive the measles, mumps, and rubella (MMR) vaccine until two years post-transplant and at least one year after discontinuing immunosuppressive therapy. The same is true for other live-virus vaccines, such as BCG, oral (Sabine) polio, yellow fever, and typhoid. The Varicella-zoster (chickenpox/shingles) vaccine is currently not generally recommended, pending further research. If the benefits outweigh the risks, it may be given to help prevent chickenpox if the patient doesn't already have antibodies to the chickenpox virus.”
So there you go. When I asked the doctor if I could get vaccinated, this is why she said "That would be difficult." I am still undergoing treatment, with Revlimid, Darzalex, and methylprednisolone, and my immune system is very suppressed, so if my blood labs show I have no immunity to measles, I just have to live at high-risk as vaccination is probably out of the question.
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Melpen - Name: Melissa
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Feb 5, 2014
- Age at diagnosis: 57
Re: Measles threat & post-stem cell transplant MMR vaccine
Hello Melpen, This is a good topic since many patients are immune compromised and yet may have lost their immunities from childhood vaccinations through getting a stem cell transplant. i know that there are differences of opinion between doctors about this. I think that most doctors would recommend getting an annual flu shot and a pneumonia vaccine too.
In my case I had all the childhood vaccines again, but I had to be cleared by the bone marrow transplant clinic for that. I had the MMR at two years out from my transplant , but of course not the smallpox vaccine. I don't even know if that is offered now, although it was in my childhood. That disease was pretty much eradicated by global vaccination programs!
Just FYI, and not to criticize your doctors, I have had the following vaccinations from my public health clinic, Diphtheria/Tetanus/Polio (DPT), which are non-live and were given one year post transplant. I also had Varicella, HIpB, Measles , mumps, Rubella, Hepatitits B, which are live vaccines and given two years post transplant. So maybe eventually you could get some vaccinations ! I also had the non-live shingles vaccine last year, 8 years post transplant. AND the pneumonia vaccines and flu shots!! If one is quite immune compromised, it's possible that the vaccines will not 'take' which is another reason they are not always recommended. Hope that helps clarify the situation also, as well as Multibilly getting information from cancer clinics.
In my case I had all the childhood vaccines again, but I had to be cleared by the bone marrow transplant clinic for that. I had the MMR at two years out from my transplant , but of course not the smallpox vaccine. I don't even know if that is offered now, although it was in my childhood. That disease was pretty much eradicated by global vaccination programs!
Just FYI, and not to criticize your doctors, I have had the following vaccinations from my public health clinic, Diphtheria/Tetanus/Polio (DPT), which are non-live and were given one year post transplant. I also had Varicella, HIpB, Measles , mumps, Rubella, Hepatitits B, which are live vaccines and given two years post transplant. So maybe eventually you could get some vaccinations ! I also had the non-live shingles vaccine last year, 8 years post transplant. AND the pneumonia vaccines and flu shots!! If one is quite immune compromised, it's possible that the vaccines will not 'take' which is another reason they are not always recommended. Hope that helps clarify the situation also, as well as Multibilly getting information from cancer clinics.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Measles threat & post-stem cell transplant MMR vaccine
This is quite topical here in New Zealand at the moment as we have had a significant number of cases in the last few months and actually ran out of vaccine for measles in the country at one stage. A group of about 30 myeloma patients in Wellington are waiting for our local hospital myeloma specialists to advise. We have had contradictory advice to date, but have been told in the meantime to definitely not be re-vaccinated if we're less than 2 years past a stem cell transplant. Will update once we know more. (Most of us over 50 hadn't thought about losing through our stem cell transplants the immunity we gained as children.)
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Wainui - Name: Wainui
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2013
- Age at diagnosis: 56
Re: Measles threat & post-stem cell transplant MMR vaccine
I am 3 ½ years post stem cell transplant and have been on Revlimid and dexamethasone since last year. I’ve had flu vaccines every year since my stem cell transplant and I also had the pneumonia vaccine last year. Testing post stem cell transplant showed that I had retained no immunity to measles or rubella, but that I had retained some immunity to mumps and chicken pox. My doctor felt it would be okay for me to have the MMR vaccine now as I’m not immuno-suppressed from my current treatment protocol and I am on a very low dosage of dex (8 mg per week).
Well, I had the MMR vaccine on September 19 and on September 30 I woke up with an itchy measles-like rash covering my torso, legs, and arms and terrific joint pain in what felt like every joint in my body. The joint pain lasted for 5 days and the rash is only now starting to fade. Both rash and joint pain are potential side effects of the MMR vaccine which can show up between 1-2 weeks after vaccination.
Well, I had the MMR vaccine on September 19 and on September 30 I woke up with an itchy measles-like rash covering my torso, legs, and arms and terrific joint pain in what felt like every joint in my body. The joint pain lasted for 5 days and the rash is only now starting to fade. Both rash and joint pain are potential side effects of the MMR vaccine which can show up between 1-2 weeks after vaccination.
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KarenaD - Name: Karen
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: November 4, 2015
- Age at diagnosis: 54
Re: Measles threat & post-stem cell transplant MMR vaccine
Hello!
On Monday I received that last of my immunizations. They are not recommending the MMR. However, I started with a low grade fever (99-100 F, or 37.2 - 37.8 C) on Wednesday, which has me wondering whether I should be concerned.
On Monday I received that last of my immunizations. They are not recommending the MMR. However, I started with a low grade fever (99-100 F, or 37.2 - 37.8 C) on Wednesday, which has me wondering whether I should be concerned.
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Hopeful1 - Name: Hopeful1
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 56
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