Enhancing Anti--Tetanus Vaccine Response After Autologous Stem Cell Transplantation

Inclusion Criteria:

1. Age ≥ 19 years to 70 years old at time of study entry (consent)
2. Diagnosis of Multiple Myeloma as per updated International Myeloma Working Group (IMWG) criteria .
3. Must have measurable disease defined as: for secretory MM, serum monoclonal protein ≥1.0 g/dL, urine monoclonal protein ≥200 mg/24 hrs, and involved free light chain ≥ 10 mg/dL; or in case of non-secretory MM, bone marrow plasma cell percentage ≥30%.
4. Must have standard risk myeloma (see exclusion criterion 4).
5. Must have received bortezomib, lenalidomide and dexamethasone (VRd) as a form of induction therapy pre-AHSCT (use of cyclophosphamide, bortezomib and dexamethasone may be allowed for up to 2 weekly doses before initiation of VRd induction, if necessary clinically for cytoreduction)
6. Able to understand and sign a consent form.
7. Creatinine clearance equal or \> 60 ml/min (calculated)
8. Ejection fraction equal or \> 50% before admission for transplant as per institutional standards. Patients with coronary heart disease (recent myocardial infarctions, angina, cardiac stent, or bypass surgery in the last 6 months or arrhythmia) need to be cleared by cardiology as per institutional BMT standards.
9. Serum bilirubin, ALT, AST less than 3 X upper limit of normal
10. FVC, FEV1 or DLCO \>50% predicted before admission for transplant as per institutional standards. Patients on home oxygen are not allowed on the protocol.
11. No more than 6 months of pre-transplant MM chemotherapy is allowed (from the date of the start of the induction therapy).
12. KPS ≥ 70%or ECOG 0-2.
13. Must be eligible to receive Melphalan dose of 200mg/m2
14. A female of child-bearing potential, must have two negative urine pregnancy test results within 10 to 14 days prior to starting the first dose of vaccine pre-transplant as a way of ensuring safe transplant planning.

Exclusion Criteria:

1. Participation in another clinical study with an investigational product during the last 28 days.
2. Prior stem cell transplant (either autologous or allogeneic)
3. Creatinine clearance \< 60 ml/min (calculated)
4. High risk MM defined as those with the following disease, fluorescence in situ hybridization and/or cytogenetic features: del17p, del1p with 1q gain, t(4;14), t(14;16), t(14;20), \>1 cytogenetic abnormality on karyotype, hypodiploid, plasma cell leukemia (primary or secondary), or subjects who failed to achieve ≥PR to induction therapy (i.e. VRd) and required salvage induction prior to AHSCT.
5. Documented central nervous system or extramedullary disease.
6. Significant organ dysfunction deemed to carry inappropriate risk for AHSCT.
7. Intention or plans for cyclophosphamide mobilization.
8. Known allergic reactions after previous tetanus diphtheria vaccination or had a condition of Guillain Barre Syndrome (GBS)
9. Known active hepatitis B, C or HIV infections on initial assessment.
10. Enrollment on any other transplant related protocols.