Which Vaccines are Safe for Multiple Myeloma? | Inciteful Med

To protect yourself from infections, inactivated vaccines—like the flu shot, COVID-19 vaccines, pneumococcal vaccines, and the Shingrix shingles vaccine—are safe and highly recommended for individuals with multiple myeloma ^[1]. You must avoid all live vaccines, such as the MMR (measles, mumps, rubella), yellow fever, and the older Zostavax shingles vaccine ^[1]. Live vaccines contain weakened germs that can cause the very infections they are meant to prevent in someone with a compromised immune system ^[2].

Why Your Immune System Needs Extra Support

Multiple myeloma and its treatments—including chemotherapy, immunomodulatory drugs, and monoclonal antibodies—significantly weaken your immune system ^[3][2]. This state of being immunocompromised (having a weakened immune system) increases your risk for catching infections ^[1]. To help keep you healthy, international experts strongly recommend a robust vaccination strategy ^[1]. However, because your immune system works differently right now, the exact type of vaccine you receive is critical.

The Danger of Live Vaccines

Live-attenuated vaccines contain a weakened, but living, form of a virus or bacteria. In a healthy person, this weakened germ safely triggers an immune response without causing illness ^[4][5]. But if you have multiple myeloma, your immune system—specifically your T-cells and antibody levels—may not be strong enough to control even a weakened germ ^[6][7]. As a result, the germ can multiply and cause a severe, potentially life-threatening infection ^[2][8].

For this reason, live vaccines are dangerous and contraindicated (must be avoided) while you are immunocompromised ^[9][1].

Examples of live vaccines you must avoid include:

• MMR (measles, mumps, rubella)
• Yellow fever
• FluMist: The nasal spray flu vaccine ^[1]
• Oral typhoid or rotavirus vaccines ^[1]
• Zostavax: The older live shingles vaccine. Note: This vaccine was discontinued in the US in 2020, but you must avoid it if it is offered internationally ^[1].

Safe, Highly Recommended Inactivated Vaccines

Inactivated and recombinant vaccines are safe for you. These vaccines use dead germs, or just small pieces or proteins from the germ, to teach your body how to fight it ^[4][10]. Because there is no live pathogen, these vaccines cannot multiply and are physically incapable of causing the disease ^[11][12].

Highly recommended safe vaccines include:

• Flu shot: The injectable form, not the nasal spray.
• COVID-19 vaccines: Both the mRNA vaccines and protein-based vaccines are safe because they do not contain live virus. Periodic booster doses are necessary to help you maintain your antibody levels ^[13][14].
• Pneumococcal vaccines: Protects against pneumonia.
• Shingrix: This is the recombinant (inactivated) shingles vaccine. It is the preferred, safe way to prevent shingles in adults with multiple myeloma ^[15][1].
• RSV vaccine: Newer vaccines that protect against Respiratory Syncytial Virus are inactivated and have been shown to prevent complications in older adults, though your doctor will decide the best time for you to receive it ^[16].

A Note on Vaccine Side Effects

Because these vaccines are teaching your immune system, you may experience temporary side effects like a sore arm, low-grade fever, or feeling extra tired for a day or two. This is a normal immune response, not a multiple myeloma flare-up or an infection. However, always ask your care team what specific symptoms should prompt a call to their office.

What About Your Family?

It is highly encouraged for your close contacts to be fully vaccinated, a strategy known as cocooning ^[17]. This creates a protective shield around you. In general, your household members can safely receive most routine vaccines, including the live nasal flu spray and the MMR, as the risk of them passing the weakened virus to you is extremely low ^[17][18]. One exception is the oral rotavirus vaccine given to infants; careful handwashing and diaper hygiene are required to prevent transmission to you ^[17].

Timing Matters

While inactivated vaccines are safe, your multiple myeloma treatment can still lower how well they work ^[19][20]. If you are receiving newer therapies like CAR-T cell therapy or bispecific antibodies, or if you recently had an autologous stem cell transplant (ASCT), vaccines are usually delayed for a few months until your immune system recovers enough to respond ^[1].

Talk to your doctor about the best time in your treatment cycle to get your vaccines so you get the maximum protection ^[1].

Pro Tip: Always inform the pharmacist that you have multiple myeloma and are immunocompromised before receiving any shot. This provides an extra layer of safety to ensure you are given the correct inactivated formulation.