Safety of MMR Vaccination in Multiple Myeloma Patients Receiving Maintenance Lenalidomide or Bortezomib after Autologous Stem Cell Transplantation.

Background: 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 immunosupression.

Methods: We conducted a retrospective study of multiple myeloma patients seen at Dana-Farber Cancer Institute, Boston, MA between May 2007 and January 2014 who met the following criteria: received an auto-HSCT, were receiving lenalidomide, bortezomib or both after HSCT, and received the MMR vaccine. Adverse events were recorded until 42 days after vaccination.

Results: 136 patients met the study criteria. The median age was 64 years (29-79), 56.6% were male. 123 (90.4%) of these patients were on lenalidomide maintenance, 7 (5.2%) were on bortezomib, and 6 (4.4%) were on both. The median time between transplant and vaccination was 25 months (18-39). Adverse events are listed in the table.

AEs up to Day 42		n (%)
Rash*		5 (3.7)
	on lenalidomide	4
Fever		2 (1.5)
	on lenalidomide	2
URI±		17 (12.5)
	on lenalidomide
Hospitalization	up to day 42	0 (0)
Death	up to day 42	0 (0)

n= number of patients

*non-specific rash: groin rash (2), urticarial rash with known prior history (1), dry patches of skin (1), rash not otherwise characterized (1).

^±Upper respiratory tract infection

Conclusion: In this small cohort of multiple myeloma patients on maintenance lenalidomide and or bortezomib after auto-HSCT, MMR vaccine administered around 24 months after auto-HSCT was safe and well tolerated.