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Live childhood vaccinations when still immunosuppressed

My husband is a few months over 3 years post stem call transplant. He has had acute then chronic GVHD ever since. He is currently on all of the medications he left hospital on, including ciclosporin 125mgs bd and is once again attempting to reduce steroids from a dose 40mgs (this time) now on 10mgs very slowly, as GvHD continues to flare. He has been on fortnightly ECP for over 2.5 years. During lockdown this was reduced to monthly and he worsened with scleroderma and breathlessness.The GvHD is only just being held at bay in terms of developing further but has left potentially active sites in addition to several other problems that he has including DVT & pulmonary embolisms (pre AZ!).
He has had both Covid jabs (AZ) with no problems and has been shown to have some antibodies. In addition he is working through his childhood vaccinations so far with no problems. However the issue of live vaccinations leaves us somewhat concerned. He has been told it is ok to have live MMR. I am concerned it may upset the balance which is somewhat precarious, causing GvHD exacerbation.
Can anyone help with this please?

Answers

  • Hi Gail,

    Coincidentally as one of the Anthony Nolan patient panel I reviewed a new guidance leaflet being developed by Anthony Nolan yesterday, which covers the subject of post transplant vaccinations. You are right that live vaccines are generally avoided until at least 2 years post transplant and that period could be extended due to ongoing treatment that involves continued immuno-suppression. As your husband is still on steroids and Ciclosporin he would certainly fall into this extended category.

    I guess your husband should be able to complete the remaining inactive vaccinations that he has started, and also to have the MMR if his team have told him it should be OK.

    There is a list of live vaccines that should never be given to transplant patients, one of which is the oral Rotavirus vaccine that is on the list of childhood vaccinations. I've checked my own vaccine record and I haven't have that, Meningitis B, or MMR post transplant. I know there was some vaccines on the list that my consultant crossed out when it was referred to my GP. The other live vaccines seem to relate more to travel to exotic locations such as cholera, typhoid, and yellow fever.

    The best people to advise you are probably your husbands medical team as they understand his individual circumstances. Those managing his GvHD and administering his ECP will be able to assess his risk of the MMR jab causing his GvHD to flare.

    I hope this helps but perhaps the Anthony Nolan team can expand on my understanding.

    How has your husband been coping with the ECP? I had the same treatment myself and it did eventually conquer my skin GvHD. It must be frustrating that the frequency had to be reduced due to Covid if it was showing signs of effectiveness. Hopefully the frequency can be adjusted now that restrictions are easing and it will start to get on top of your husbands condition.

    All the best,

    Steve

    Tom_AnthonyNolan
  • Hi Gail,

    Thanks for your message. I’m so sorry to hear GvHD has been such a problem for your husband, this must have been incredibly difficult. I’m glad he’s responding well to his coronavirus vaccination.

    Here’s the latest information we have on MMR vaccination after stem cell transplant:

    Most importantly, as Steve says, your husband should discuss this with his transplant team because specific medical factors will matter in everyone’s individual treatment.

    In general, anyone who:

    • had their transplant more than 2 years ago
    • is not currently on medication that suppresses their immune system (i.e. for GvHD)

    can ask their healthcare team to check their measles antibodies. If these are negative, it may be possible for them to have the MMR vaccine.

    Unfortunately it sounds as if your husband’s current GvHD treatment may mean this is not the right time for him to have the MMR vaccine. But do check with his team as this may be possible for him in future.

    I hope this is helpful Gail. Other Forum members may have further insight for you, and please feel free to call our helpline anytime if we can help any further – we’re on 0303 303 0303 or email us: patientinfo@anthonynolan.org

    All the best,

    Tom

    chelle_16Dieseldrinker62
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