Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Safety of live-attenuated measles-mumps-rubella and herpes zoster vaccination in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic cell transplantation


Attenuated live virus vaccinations are generally recommended 24 months following hematopoietic cell transplantation (HCT) in patients not receiving immunosuppressive therapy. To date, there are no data regarding the safety of live-attenuated herpes zoster or measles-mumps-rubella (MMR) vaccinations in multiple myeloma patients on maintenance lenalidomide or bortezomib following autologous HCT. One hundred thirty-seven multiple myeloma patients on maintenance lenalidomide or bortezomib post-auto-HCT who received either MMR or herpes zoster vaccine were analyzed and any adverse events documented in the medical record in the 42 days following vaccination were recorded. Patients were vaccinated a median of 25 months (range, 18–62) post transplant. The most common post-vaccination adverse event was upper respiratory tract infection (18/137 patients); no rash attributed to vaccine strains or other adverse outcomes potentially related to the vaccines were identified. MMR and herpes zoster vaccination were safe and well-tolerated in this cohort.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout


  1. Ljungman P, Lewensohn-Fuchs I, Hammarström V, Aschan J, Brandt L, Bolme P, et al. Long-term immunity to measles, mumps, and rubella after allogeneic bone marrow transplantation. Blood. 1994;84:657–63.

    PubMed  CAS  Google Scholar 

  2. Kaplan LJ, Daum RS, Smaron M, McCarthy CA. Severe measles in immunocompromised patients. JAMA. 1992;267:1237–41.

    Article  PubMed  CAS  Google Scholar 

  3. Pauksen K, Duraj V, Ljungman P, Sjölin J, Oberg G, Lönnerholm G, et al. Immunity to and immunization against measles, rubella and mumps in patients after autologous bone marrow transplantation. Bone Marrow Transplant. 1992;9:427–32.

    PubMed  CAS  Google Scholar 

  4. Adell C, Bayas JM, Vilella A, Perales M, Vidal J, Bertran MJ, et al. Post-transplantation vaccination of bone-marrow transplant recipients. Med Clin. 2002;119:405–9.

    Article  Google Scholar 

  5. Inazawa N, Hori T, Nojima M, Saito M, Igarashi K, Yamamoto M, et al. Virus reactivations after autologous hematopoietic stem cell transplantation detected by multiplex PCR assay. J Med Virol. 2017;89:358–62.

    Article  PubMed  CAS  Google Scholar 

  6. Han CS, Miller W, Haake R, Weisdorf D. Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Bone Marrow Transplant. 1994;13:277–83.

    PubMed  CAS  Google Scholar 

  7. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–84.

    Article  PubMed  CAS  Google Scholar 

  8. Erard V, Guthrie KA, Varley C, Heugel J, Wald A, Flowers MED, et al. One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation. Blood. 2007;110:3071–7.

    Article  PubMed  CAS  Google Scholar 

  9. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58:309–18.

    Article  PubMed  Google Scholar 

  10. Noonan K, Rudraraju L, Ferguson A, Emerling A, Pasetti MF, Huff CA, et al. Lenalidomide-induced immunomodulation in multiple myeloma: Impact on vaccines and antitumor responses. Clin Cancer Res. 2012;18:1426–34.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Obeng EA, Carlson LM, Gutman DM, Harrington WJ, Lee KP, Boise LH. Proteasome inhibitors induce a terminal unfolded protein response in multiple myeloma cells. Blood. 2006;107:4907–16.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. McCarthy PL, Holstein SA, Petrucci MT, Richardson PG, Hulin C, Tosi P, et al. Lenalidomide maintenance after autologous stem-cell transplantation in newly diagnosed multiple myeloma: a meta-analysis. J Clin Oncol. 2017;35:3279–89.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Issa NC, Marty FM, Leblebjian H, Galar A, Shea MM, Antin JH, Soiffer RJ, Baden LR. Live-attenuated varicella zoster vaccine in hematopoietic stem-cell transplantation recipients. Biol Blood Marrow Transplant. 2014;20:285–7.

    Article  PubMed  CAS  Google Scholar 

  14. Parkman R, Weinberg KI. Immunological reconstitution following bone marrow transplantation. Immunol Rev. 1997;157:73–8.

    Article  PubMed  CAS  Google Scholar 

  15. Chanan-Khan A, Sonneveld P, Schuster MW, Stadtmauer EA, Facon T, Harousseau JL, et al. Analysis of herpes zoster events among bortezomib-treated patients in the phase III APEX study. J Clin Oncol. 2008;26:4784–90.

    Article  PubMed  CAS  Google Scholar 

Download references


This research was presented in part at IDWeek on October 25-30, 2016 in New Orleans, LA, as posters #2327 and #2328.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nicolas C. Issa.

Ethics declarations

Conflict of interest

PGR has received research funding from Takeda, BMS, and Celgene; serves on advisory boards for Takeda, Janssen, and Celgene. FMM has received research funding from Astellas, Chimerix, Merck, and Shire; and consulting honoraria from Alexion, Chimerix, LFB, Roche Molecular Diagnostics, and Shire. NCI has received research funding from Astellas and Merck and consulting honoraria from Akros Pharma. The remaining authors AP, HL, SPH, JPL, and LRB declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pandit, A., Leblebjian, H., Hammond, S.P. et al. Safety of live-attenuated measles-mumps-rubella and herpes zoster vaccination in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic cell transplantation. Bone Marrow Transplant 53, 942–945 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links