Presenting Author: James A. Davis, PharmD, BCOP, The Medical University of South Carolina, Charleston, SC
BACKGROUND: Antibodies for vaccine-preventable infections are significantly reduced after autologous stem-cell transplantation (ASCT). However, because of the risk of infection, live-attenuated vaccinations, such as the measles-mumps-rubella (MMR) vaccine, are contraindicated in immunocompromised patients, including patients with multiple myeloma who have undergone ASCT within the previous 2 years or those who are receiving antibody-based treatment. As data from the PERSEUS, SWOG 1803, and GMMG-HD7 trials mature, incorporation of anti-CD38 antibodies after ASCT may become increasingly adopted into practice.
OBJECTIVE: We conducted a multicenter, retrospective study to evaluate the safety of MMR vaccination in patients with multiple myeloma receiving daratumumab after ASCT.
METHODS: A total of 5 academic centers contributed data on patients who received MMR vaccination while receiving daratumumab after ASCT. MMR vaccinations were administered at the discretion of the treating oncologist. Vaccine titers were not checked as this is not routine practice at participating centers. Safety outcomes included adverse events after vaccination, such as infectious complications, confirmed infections, and general malaise.
RESULTS: Of the 41 patients included, the median age was 65 years (range, 47-85 years). The median previous lines of therapy was 1 (range, 1-3). The median IgG level was 482 mg/dL, and 26% of patients received intravenous immunoglobulin at the time of vaccination. All patients received a previous ASCT at a median of 4.4 months before starting daratumumab. Most patients (59%) received daratumumab combined with lenalidomide (52%) or pomalidomide (7%), with the remaining patients receiving in combination with a proteasome inhibitor (7%) or as monotherapy (34%). In all, 95% of patients received monthly daratumumab at the time of vaccination. Initial MMR vaccination was administered at a median of 20.2 months of daratumumab after ASCT. The median time from ASCT to vaccination was 25.2 months. The most common adverse events were acute sinusitis (5%) and COVID-19 (5%), which occurred at a median of 8 days after vaccination. Rash, headache, and arthralgias were each reported in 1 patient. None of the patients had an active MMR infection after vaccination. There were no hospitalizations or deaths after vaccination.
CONCLUSION: Our findings suggest MMR vaccination in immunocompromised patients with multiple myeloma receiving daratumumab 24 months after ASCT is safe. Although this was a limited sample size, there were no vaccine-related MMR infections after vaccination. MMR vaccination is important for these patients because of the rising rates of vaccine hesitancy in the general population and the recent increase in confirmed measles cases in the United States.
- Pandit A, Leblebjian H, Hammond SP, et al. Safety of live-attenuated measles-mumps-rubella and herpes zoster vaccination in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic cell transplantation. Bone Marrow Transplant. 2018;53:942-945.