For patients who are s/p melphalan auto SCT and in need of post-transplant vaccinations, if their serum immunoglobulins remain low at the 6 month point when vaccinations would be due (less than 500), would you delay their vaccinations until their levels got to a point where they would be more likely to have a proper immune response with the vaccines, or would you give them now anyway? The patients are otherwise asymptomatic and levels are slowly rising, just still fairly low (in the case of one of my patients, in the 300s)
I would proceed with vaccinations as scheduled (starting 6 months post transplant). Acknowledging that this is based on opinion rather than high quality data, but thinking of how the benefits of some protection in the months to come outweigh the benefit of waiting for an unspecified period of time for the immunoglobulin levels to rise to an arbitrary cut-off
