BMT vs Vaccines?

Hi @dorim, welcome to Connect. Having had an allogenic transplant at Mayo, my suggestion is for you and your husband to have a consult with a transplant doctor early in the game. They will give you all the details so that your husband can make an informed decision.

From experience, there are protocol, post transplant, which we are expected to adhere to for our continued health and well-being. With the chemo your husband is currently taking, his immune system is already compromised but it is still functioning in a diminished capacity. He still has some acquired immunity from illnesses he’s had in the past and if he’s had vaccinations he still has those antibodies.
However, the preconditioning chemo before a BMT is more aggressive, with the end goal of clearing out the existing bone marrow, making room for the new cells to engraft. His old immune system will be gone and he’ll have no acquired immunity.

He’ll receive someone else’s immune system with the transplant but he won’t receive their acquired immunity. Because the new immune system will be strong and foreign to his body, he’ll be on anti-rejection meds (anti-inflammatory meds) for several months so that the new immune system can acclimated to its new host, your husband’s body.

About a year or so post transplant or until he’s off immunosuppressants, your husband, according to protocol, will be encouraged to start his vaccinations. Until that time he’ll be on medications to give him an interim immune system with antibiotics, anti-fungal, and anti-viral meds. Yes, he’ll have a new immune system that will adapt and build new immunities to diseases but it will never be as robust as his original ‘factory installed’ immune system.
So he would remain extremely vulnerable to viruses such as CMV, influenza, Covid, influenza, childhood illnesses such as measles, chicken pox, RSV and adult issues such as shingles and pneumonia.
It’s not only that he could contract these illnesses but with a BMT we don’t really know how we’ll respond to the diseases. Things can escalate quickly or become more difficult to treat with the lower level of immunity. Another concern is causing a graft vs host reaction from the immune response.

Basically, your husband’s immune system will be that of an infant. So he would have to build immunity from scratch with unpredictable results or he could do it the easy way with vaccinations. I wish you good luck with this. ☺️

If this helps, here is the vaccination schedule for post SCT from theNational Inst. of Health https://pmc.ncbi.nlm.nih.gov/articles/PMC6814287/

Again, I’d really suggest a consult with a BMT speciliast at Mayo way before hand so that you have all the information. Have you spoken with anyone at Mayo?

Hi dorim,
Regarding the vaccines post transplant, first I’d like to say that Lori’s information is very helpful so please make sure your husband reads all of that so he makes an informed decision and discusses everything with his doctor.

There is a lot of fear mongering on both sides of the vaccine conversation so it’s important your husband considers all sides and his highly vulnerable state after a transplant.

My story - I am 61 and had an allogeneic transplant in November 2024 for CEL. I also have a history of a bad reaction to my third covid vaccine so I had some concerns about vaccines. I discussed this with my doctors and they were ok with me delaying my flu and not getting my Covid vaccine at all. When I say “ok with it” - they did not recommend what I was doing but they understood my reasoning and didn’t think I was at extreme risk. Please note that if my doctors had a strong reason I was open to listening to them so I would encourage your husband to always keep an open mind. Also, my husband and I were super isolated during the first 6 months. As to the other more “important” vaccines - These 5 were supposed to be given all 5 together but my doctors agreed to give me 3 first and then the remaining 2 a few weeks after so I don’t get 5 at once (Polio, Diptheria/ pertussis/tetanus, HIB (haemophilus B), Hepatitis B, Pneumococcal). . But the reality is that our new immune systems are like a newborn- and I’ve always been of the opinion that I certainly didn’t want to be taken down from an infection after going through the transplant to kill the cancer. I hope this helps your husband a bit, and I hope he keeps an open mind to do all he can to protect himself.