Infections and Vaccinations in Multiple Myeloma

Multiple myeloma is a cancer affecting plasma cells, a type of immune cell that circulates in the blood. Plasma cells make antibodies that help to protect the body against infection. In myeloma, the number of normal functional antibodies is greatly reduced. Moreover, myeloma cells make abnormal antibodies, called M proteins, which are not useful in fighting infection—making patients more vulnerable to infection.

Patients with myeloma have a deficient immune system, and the myeloma itself or the treatment used to fight it can put patients at greater risk of infection—indeed, the risk of infection may be 7 to 10 times higher for myeloma patients than in the general population. Types of infections a patient may get include urinary tract infections, pneumonia (an infection of the lungs), septicemia (blood infection), fungal infections, and viral infections such as influenza and varicella zoster (shingles).

To manage this infection risk, preventive strategies (called prophylaxis) are recommended. Prophylaxis is usually recommended for patients receiving corticosteroids, high-dose therapy, and stem cell transplant. Patients with recurrent life-threatening infections should also receive prophylaxis. Strategies for prophylaxis include using intravenous immunoglobulin (IVIG), antibiotics, growth factors, and vaccines.


Myeloma patients are also 10 times more likely to get influenza, with one in five getting sick from the flu every year. Annual influenza vaccination is therefore recommended for myeloma patients.


Two in three infection-related deaths in myeloma patients are caused by pneumonia. The Centers for Disease Control and Prevention (CDC) and the National Comprehensive Cancer Network (NCCN) recommend vaccinating myeloma patients with a pneumococcal vaccine.


Shingles (also called herpes zoster)—a painful rash—is caused when the virus that causes chicken pox (varicella zoster) is reactivated. Shingles occurs with decreased immunity, for example in patients with multiple myeloma receiving certain treatments – like the proteasome inhibitors (Velcade, Kyprolis, and Ninlaro) and the monoclonal antibody Darzalex—and in those undergoing stem cell transplant. Antiviral agents such as acyclovir or valacyclovir can protect against shingles. And a vaccine to prevent shingles is also available.

Your health care team will outline the appropriate preventive strategies for you.

Nurse Patient Navigators in the MMRF Patient Support Center are always available at 866-603-6628 or to help answer any questions you have or to help you find the right resources to help in your fight against myeloma.


Additional Resources

Disease Overview.

Symptoms, Side effects and Complications.

Proteasome Inhibitors.