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What Vaccines Do Myeloma Patients Need?

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Published on March 18, 2020

Key Takeaways

  • The zoster vaccine (Shingrix) has been shown to be highly safe and effective. It’s recommended for all adults over 50, not just myeloma patients.
  • Dr. Vogl advises patients to be on anti-shingles medications like acyclovir or valacyclovir while on any proteasome inhibitors, monoclonal antibodies or after a stem cell transplant.
  • Influenza and pneumococcal vaccines are also encouraged post-transplant and even during your regular treatment.

Leading expert Dr. Dan Vogl, from the University of Pennsylvania’s Abramson Cancer Center, discusses which vaccines are recommended for multiple myeloma patients.

Watch as Dr. Vogl shares information regarding the shingles, influenza and pneumococcal vaccines and whether it’s worth getting the extra strength dosage of these vaccines.

This program is sponsored by GSK. This organization has no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | What Vaccines Do Myeloma Patients Need?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:           

Hello, I am Andrew Schorr with Patient Power, and we are in Orlando, Florida for this live Myeloma Ask the Expert program

Let me introduce our guests, so two wonderful guests: immediately to my right is Dr. Frits van Rhee, he is the Director of the Myeloma Program at the University of Arkansas Medical Sciences in Little Rock, did I get it right?

Dr. van Rhee:              

You got it right, thank you.

Andrew Schorr:           

Okay, thank you. And to his right is Dr. Dan Vogl, who is a myeloma specialist at the University of Pennsylvania, Penn Medicine. Thank you both for being with us. I should mention that Dr. Vogl is also the specialist who treats our dear friend Cindy Chmielewski, many people know, Myeloma Teacher on the Internet. And fortunately, I have to say Cindy’s doing well, so we’re really delighted. Okay, gentlemen, are you ready for some questions from the patients? 

Dr. van Rhee and Dr. Vogl:       

Yes.

Andrew Schorr:           

Here’s a question, Dr. Vogl, we got from Susan, “Is there a standard of care regarding antivirals?” I’m a CLL—chronic lymphocytic leukemia patient, so I take acyclovir (Sitavig or Zovirax) to avoid shingles; and she says, “Acyclovir  or valacyclovir (Valtrex) administration after a stem cell transplant, I’m 20 months post-transplant, and my multiple myeloma doctor wanted to discontinue the valacyclovir. But I’ve not received the zoster vaccine (Shingrix) in fear I could develop shingles, so I refused. What do you suggest?” So, nobody wants shingles.

Dr. Vogl:                      

So, I think there’s one really easy answer to this question, which is that the new shingles vaccine—which has the brand name Shingrix—has been shown to be highly effective. It’s not a live virus vaccine, so it’s safe to use including in patients with myeloma. And there’s a clinical trial that we participated in at the University of Pennsylvania that showed that it was effective at inducing anti-shingles immune responses even in people who were early after a stem cell transplant for myeloma, so whose immune systems were really severely affected by their treatment.

And so, I do think that getting this new shingles vaccine—which is a series of two shots given once—it’s approved for anyone over the age of 50, not just people with myeloma. But I recommend it for all of my patients. The more difficult question that we really don’t have a clear answer to is: how long do you need to stay on antiviral medications while you’re either on myeloma treatment, or off myeloma treatment, and how does the new shingles vaccine play into that?

My own personal practice is to have patients on anti-shingles medications like acyclovir (Sitavig or Zovirax) or valacyclovir (Valtrex) while they’re on any proteasome inhibitor, which would be like bortzomib (Velcade), carfilzomib (Kyprolis) or ixazomib (Ninlaro), or on monoclonal antibody like daratumumab (Darzalex) or elotuzumab (Empliciti)—and for at least a couple of weeks after the proteasome inhibitors, at least for a few months after the antibody therapies, and for at least six months  after a stem cell transplant. And my own usual practice is that once patients are out past those thresholds, their risk of getting shingles just isn’t that high anymore.

The downside to continuing the oral medications is relatively low, so if somebody really wants to continue on the medicine, I don’t think there’s a big reason that they have to stop it, but I’m just not sure that it’s necessary anymore. 

Andrew Schorr:           

Okay. I’m sure you’re asked 20 times a day about flu shots, what do you say about that?

Dr. Vogl:                      

I am also a big proponent of influenza vaccines, and also of pneumococcal vaccines, which are vaccines against the most common bacterial cause of pneumonia. Probably you don’t want to do those in the very early period after a stem cell transplant, because they’re not really effective. But once you get at least a few months out from a stem cell transplant, or in the course of your regular treatment, none of those vaccines have the ability to cause an infection. 

And even though they won’t work as well for people with myeloma because their immune systems won’t respond as well as healthy people’s immune systems, any little additional protection that we can get from potentially deadly infections is really important.

Andrew Schorr:           

So, there’s sort of a stronger dose of the flu shot, so should myeloma patients who are often older get that?

Dr. Vogl:                      

So, we don’t really know whether that higher dose influenza vaccine truly provides more protection. And in general, it’s paid for by insurance companies primarily for people over the age of 65, and I usually tell my patients that if they have it available to them, sure, go head and choose the stronger or high-dose influenza vaccine. But if it’s just not available, to not worry about it, because they still probably get good protection from the standard dose.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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