There are theoretical reasons why people on anti-CD20 therapies may be at increased risk of developing cancers such as cervical cancer. This has implications for vaccination.
Really interesting to hear about this case study. Having had HPV infection and smear abnormalities in the past (CIN 1) and had recurrence with associated diathermy treatments I have luckily had clear smear tests (including a recent test showing no HPV) for a number of years. However my husband was diagnosed and successfully treated for intra-epithial penile neoplasia a while ago, suggesting that any HPV infection I might have had may be of one of the higher risk types of HPV.
However, I am now on Tysabri, but at no stage during choice of treatment options was the potential for activation of HPV discussed as a risk factor. As I might have to consider a change to another immune-suppressive DMT at some point then being aware of potential impact of previous HPV infection is worth knowing and I would certainly consider getting a polyvalent vaccine if I could.
I have had 3 ceravix vaccinations in childhood and currently have been HPV positive for 2-3 years. Do you recommend having a Gerasil-9 booster vaccination before starting my cladribine treatment and can this be given as a one off vaccination, or does it need to be administered as a series of 3 again?
This booster is said to delay starting my treatment by 4 weeks (being as a single dose of Gerasil-9). I am unsure whether to risk delaying my treatment by having the booster. I was diagnosed with RRMS in May 2022.
I had two courses of alemtuzumab in 2013 and in 2014. On the advice of my neurologist I have had annual smears ever since but going forward now after 7 years it is going to revert back to every 3 years.
I do actually think the recommendation for annual smears was only for 4 years after the final course of alemtuzumab but would you be concerned and try and carry on having annual smears?
I I have not had any DMT since finishing alemtuzumab in 2014.
Another option here is potentially the use of cladribine. The level of immunosuppression post-cladribine is relatively low, it does not block vaccine responses and with immune reconstitution, anti-viral or anti-HPV responses should be fine long-term.
Hi, I had CIN 3, with subsequent LLETZ, over 10 years ago. I am now 6 months post HSCT. When would you advise I get the vaccine? I've never had it and there's been no discussion about me getting it. I'm in the process of revaccinating for my other childhood vaccines. I think also I should book a smear yearly now - do you agree?
Re. the case study, some questions-
1. How long should she wait once off of ocrelizumab & starting on teriflunomide / interferon before taking the first dose of the vaccine ?
2. Can she change back to ocrelizumab 4 weeks after receiving the third dose of the vaccine?
Really interesting to hear about this case study. Having had HPV infection and smear abnormalities in the past (CIN 1) and had recurrence with associated diathermy treatments I have luckily had clear smear tests (including a recent test showing no HPV) for a number of years. However my husband was diagnosed and successfully treated for intra-epithial penile neoplasia a while ago, suggesting that any HPV infection I might have had may be of one of the higher risk types of HPV.
However, I am now on Tysabri, but at no stage during choice of treatment options was the potential for activation of HPV discussed as a risk factor. As I might have to consider a change to another immune-suppressive DMT at some point then being aware of potential impact of previous HPV infection is worth knowing and I would certainly consider getting a polyvalent vaccine if I could.
Hello! Very interesting article!
I have a question about boosters.
I have had 3 ceravix vaccinations in childhood and currently have been HPV positive for 2-3 years. Do you recommend having a Gerasil-9 booster vaccination before starting my cladribine treatment and can this be given as a one off vaccination, or does it need to be administered as a series of 3 again?
This booster is said to delay starting my treatment by 4 weeks (being as a single dose of Gerasil-9). I am unsure whether to risk delaying my treatment by having the booster. I was diagnosed with RRMS in May 2022.
Any advise would be hugely appreciated!
Thank you,
Fatma
What DMT would could one use as a maintenance therapy post Cladribine ?
I had two courses of alemtuzumab in 2013 and in 2014. On the advice of my neurologist I have had annual smears ever since but going forward now after 7 years it is going to revert back to every 3 years.
I do actually think the recommendation for annual smears was only for 4 years after the final course of alemtuzumab but would you be concerned and try and carry on having annual smears?
I I have not had any DMT since finishing alemtuzumab in 2014.
All of my smears have been clear.
Many thanks
Another option here is potentially the use of cladribine. The level of immunosuppression post-cladribine is relatively low, it does not block vaccine responses and with immune reconstitution, anti-viral or anti-HPV responses should be fine long-term.
Hi, I had CIN 3, with subsequent LLETZ, over 10 years ago. I am now 6 months post HSCT. When would you advise I get the vaccine? I've never had it and there's been no discussion about me getting it. I'm in the process of revaccinating for my other childhood vaccines. I think also I should book a smear yearly now - do you agree?