With recent measles outbreaks occurring in the US, would you consider offering multiple myeloma patients s/p ASCT on maintenance treatment vaccination, or an alternate means of immunity?  

Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on safety of live vaccines in MM patients on long term maintenance treatment is scarce. A recent small retrospective study  (Pandit A et al BMT 2018 ref below) reported on safety outcomes of live-inactivated vaccines (MMR/VZV) in MM patients post-auto on lenalidomide or bortezomib maintenance suggesting one in specific situations might could consider live-attenuated vaccination in MM patients in select circumstances. 

In light of the current measles outbreak, what are you doing in practice?

References: 

Pandit A. 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 stem cell transplantation. Bone Marrow Transplant. 2018 Jul;53(7):942-945. doi: 10.1038/s41409-018-0112-x ; <https://www.ncbi.nlm.nih.gov/pubmed/29426830 >

CDC/ACIP and IDSA guidelines

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

https://academic.oup.com/cid/article/58/3/e44/336537