Infection and vaccination in myeloma: staying safer during treatment | CION Cancer Clinics

Myeloma and its treatment both weaken your defences, so infections are more common and can become serious quickly. Most inactivated vaccines are safe and recommended, live vaccines are usually avoided, and a fever always needs a same-day call.

What is going on in the immune system

Myeloma starts in plasma cells, the cells that make antibodies. The myeloma cells make one useless antibody in huge amounts and crowd out the healthy plasma cells that make the useful ones. So even before treatment, the body has fewer working antibodies to fight bacteria and viruses.

Why vaccines still matter

Because antibodies are low, vaccines may work less strongly in myeloma than in a healthy person. Some protection is still far better than none, and it lowers the chance of a serious chest infection, flu or shingles. Timing matters, which is why the team plans vaccines around treatment rather than leaving it to chance.

What this page cannot tell you

It cannot give you your personal vaccine schedule. That depends on your treatment, your blood counts, whether a transplant is planned and which vaccines you have already had. Use it to prepare questions, and let your haematologist set the plan.

Alongside vaccines, your team may suggest preventive medicines and everyday precautions. None of these should be started or stopped on your own.

Preventive tablets

Many people on bortezomib or after a transplant take an antiviral such as aciclovir to stop shingles returning. An antibiotic such as co-trimoxazole, or other antibiotics in the early months of treatment, may be added for some. Keep taking them for as long as the team advises, even when you feel well.

Antibody drips

People who keep getting serious infections despite these measures may be offered immunoglobulin, antibodies collected from donated blood and given through a drip. It does not suit everyone, supply and cost can be limiting, and your team will explain whether it is worth it for you.

Everyday precautions

Wash hands often, keep away from people with coughs or fever, and prefer freshly cooked, hot food and safe drinking water. Wear a mask in crowded places such as buses and hospital waiting areas, and look after teeth and gums, since mouth infections are common.

When the risk is highest

Infections are most common in the first few months after diagnosis, when the myeloma is most active and treatment is most intense, and in the weeks after a transplant. The risk often eases once the myeloma is under control, but it rarely returns fully to normal. If the myeloma becomes active again, take extra care, because the risk tends to rise with it.