Table 1.
Results of studies of the efficacy of influenza, pneumococcal, and Hib vaccination in multiple myeloma.
| Vaccine | Study | Study design number of patients | Myeloma treatment | Measure of efficacy | Response | Conclusion |
|---|---|---|---|---|---|---|
| Influenza | Robertson et al. (156) | MM (n = 48) | IFNα/chemotherapy/high-dose MP/total body radiation + autologous stem cell transplantation 6 months before | GMT, titers ≥1: 40 | Poor response. 19% achieved seroprotection and 59% had no seroprotective levels to any of the three strains | Poor responses and patients are susceptible to infections with influenza |
| Rapezzi et al. (160) | MM (n = 6) CLL (n = 13) NHL (n = 7) HD (n = 8) | MP + prednisone/MP + prednisone + VAD | GMT, titers ≥1: 40 | Seroprotection rates achieved by more than 60%. Of the patients, three of six MM achieved seroprotection rates | Vaccination is well-tolerated and safe in CLPD and MM | |
| Stadtmauer et al. (181) | MM (n = 21) | High-dose MP + autologous stem cell transplantation | GMT, ≥4-fold rise in titers | Primed subjects had significantly higher GMT at all times | Transfer of influenza-primed autologous T cells after transplantation improves subsequent vaccine responses | |
| 73% of primed subjects had seroconversion to any of the three vaccine strains and only 30% of unprimed subjects | ||||||
| Pneumococcal | Lazarus et al. (165) | MM (n = 13) | BCNU + adriamycin/MP + prednisone/cyclophosphamide/BCNU + prednisone + cyclophosphamide/MP + adriamycin + vincristine | GMT, ≥2-fold rise in titer | Poor response. 30% achieved protective response to six or more serotypes | Antibody response is depressed. Advisable to vaccinate patients as response was highly variable |
| Schmid et al. (163) | MM (n = 37) HC (n = 10) | MP + prednisone/vincristine + cyclophosphamide + prednisone (and doxorubicin/MP), or another combination of three or more/no chemotherapy for at least 3 months before vaccination | GMT ≥2-fold rise in titers | At least twofold increase in titers to at least eight antigens in 43% compared to 100% HC. Poorer response in those receiving multi-agent (≥3) chemotherapy | Very low antibody titers before and after vaccination but as response was heterogeneous vaccination can be offered | |
| Hargreaves et al. (166) | MM (n = 41) HC (n = 62) | MP/MP + adriamycin + BCNU + cyclophosphamide/vincristine + cyclophosphamide + MP + prednisone/vincristine + BCNU + adriamycin + prednisone/vincristine + adriamycin + dexamethasone/vincristine + adriamycin + MP + prednisone | GMT, ≥2-fold rise in titer | Poor response 45% achieved protective titers | Poor response associated with increased risk of septicemia | |
| Robertson et al. (156) | MM (n = 48) | IFNα/chemotherapy/high-dose MP/total body radiation + autologous stem cell transplantation 6 months before | GMT titers ≥1:640 | 39% Achieved protective titers | Poor responses, likely to be poorly sustained. Repeat vaccination is desirable | |
| Rapoport et al. (180) | MM (n = 42) | High-dose MP + autologous stem cell transplant | GMT | 60% of pre-transplant vaccination+ post-transplant T cell infusion recipients achieved protective titers. | Early adoptive T cell transfer followed by post-transplant booster immunization improves immunodeficiency. Pre-transplant vaccination regime superior to post-transplant vaccination regime | |
| 18% of post-transplant vaccine & pre-transplant+ late T cell infusion recipients achieved protective titers | ||||||
| Hinge et al. (177) | MM (n = 60) | High-dose MP + autologous stem cell transplantation | GMT titers ≥1: 40 | Poor response. 33% responded | Reasonable to vaccinate patients with disease control (responding well to induction therapy) as they have higher response rate | |
| Hib | Robertson et al. (156) | MM (n = 46) | IFNá/chemotherapy/high-dose MP/total body radiation + autologous stem cell transplantation 6 months before | ≥1.02 μg/L | 75% protective titers and 41% had a ≥4-fold increase in titers | Specific immunity comparable to HC. |
| Nix et al. (167) | MM (n = 20) | Intermittent chemotherapy | >0.15 μg/mL | 45% MM achieved titers that correlate to natural protection in comparison to 97% HC | Lack of protective immunity against Hib in MM. Increased risk of invasive disease is a rationale for immunization | |
| Chronic renal failure (n = 59) | ||||||
| Diabetes mellitus (n = 30) | ||||||
| HC (n = 32) |
CLPD, chronic lymphoproliferative disorders; HC, healthy controls; HD, Hodgkin disease; MP, mephalan; NHL, non-Hodgkin lymphoma; VAD, vincristine–adriamycin–dexamethasone.