The European Myeloma Network has released new recommendations for vaccination of patients with multiple myeloma.

Vaccines are particularly important in patients with multiple myeloma because of increased risk for infections due to disease-inherent immune suppression, and the immunosuppressive effects of many of the disease’s treatments.

The European Myeloma Network reviewed relevant literature published after 2000 and examined the risk for infections in patients with myeloma that are possibly preventable by vaccinations, the vaccines that are available, and the benefits and limitations of vaccination within this patient cohort.

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The recommendations stated that patients with myeloma should receive 2 doses of the trivalent or quadrivalent vaccine influenza vaccine and vaccinations should continue annually.

Hepatitis A and B vaccines are both recommended in certain situations. For hepatitis A, patients traveling to areas of high endemicity should receive 2 doses of the inactivated vaccine. For hepatitis B, patients traveling to areas of high endemicity, those with behavioral/occupational exposure, or hemodialysis should receive 3 doses of recombinant hepatitis B vaccine.

All patients with multiple myeloma should receive:

  • Pneumococci PCV13 vaccination. PPV23 vaccination should be given more than 2 months or 6 to 12 months after PCV13
  • Hemophilus influenzae vaccination
  • One of the 2 available herpes zoster vaccines.

Patients with myeloma and asplenia, complement deficiency, or recurrent episodes of bacterial infections should receive a single dose of the meningococci vaccine.

“Common reasoning suggests that patients should be vaccinated before transformation into active myeloma at MGUS or SMM stage, or during remission when there is no or only minor immune suppression by active disease, but scientific support for this notion is available in CLL patients only,” the researchers wrote. “Patients with scheduled chemotherapy should be vaccinated at least 2 weeks before initiation of chemotherapy, upon achievement of best response, 3–6 months after completion of chemotherapy or

autologous transplantation, and 6–24 months after allogeneic transplantation.”

Finally, family members, close patient contacts, and health care workers should receive all the normal age-specific and exposure-appropriate vaccines, according to the recommendations. Specifically, they should received influenza vaccinations and those 65 years or older should receive pneumococci vaccination.


Ludwig H, Boccadoro M, Moreau P, et al. Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network. Leukemia. Published online August 19, 2020. doi:10.1038/s41375-020-01016-0