Updated 19 March 2009
Immunizations for Patients With Lymphoma, Hodgkin Lymphoma, Myeloma and Leukemia
Patients who have lymphoma, Hodgkin lymphoma, myeloma, chronic lymphocytic leukemia or related conditions should receive certain immunizations to help boost or maintain their immunity. However, a few types of immunizations (those using live organisms) are theoretically dangerous and should be avoided. Please keep one copy of these recommendations with your own health records and take a copy to your family physician or local Health Unit Immunication Clinic. Patients who are currently receiving chemotherapy or radiation should wait until six months after treatment before receiving immunizations except for influenza vaccine which should be taken every year. If you have any questions about these recommendations discuss them with your oncologist. Recommendations for special revaccinations after hematopoietic stem cell transplant (bone marrow or peripheral blood stem cell transplant) are shown in Table 4 below.
|
Type of Immunization |
When Should it be Given? |
|
Influenza vaccine |
Every year, in the autumn |
|
Pneumococcal vaccine |
At the time of diagnosis of the lymphoma-type illness and then once again 5 years later |
|
Tetanus/diphtheria |
Every 10 years |
|
Meningococcal types A and C vaccine and Hemophilus influenza type b vaccine |
Once only, if the spleen is to be or was removed or treated with radiation. (Note: these vaccines are given free of charge at the local Health Unit Immunization Clinic for patients planned for splenectomy) |
|
Polio vaccine |
Oral polio vaccine should never be taken by patients with lymphoma-type illness. It has been replaced by inactivated polio vaccine, which is safe for patients with lymphoma-type illness |
|
Measles |
Never (exception: see hematopoietic stem cell transplant guidelines, link above) |
|
Mumps |
Never (exception: see hematopoietic stem cell transplant guidelines, link above) |
|
Rubella |
Never (exception: see hematopoietic stem cell transplant guidelines, link above) |
|
Yellow fever |
Never (exception: see hematopoietic stem cell transplant guidelines, link above) |
For Travel to Developing Countries
|
Less than 4 weeks |
No immunization |
|
Greater than 4 weeks
|
Hepatitis A |
|
Inactivated typhoid injectable vaccine (note: oral typhoid vaccine is a live bacteria and should not be given) |
|
Hepatitis B |
References:
Excellent lay language information sheets for each type of vaccine are available at http://www.immunize.org/vis/
An overview of adult immunization recommendations is available at http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/06-07/adult-schedule.pdf
Table 4
BCCDC Communicable Disease Control Immunization Program
Section III - Immunization of Special Populations (http://www.bccdc.org/)
January 2009
Worksheet for Immunization of Adult Hematopoietic Stem Cell Transplant (HSCT) Recipients (those ≥ 18 years of age)
Client name: ________________________________ Date of birth: ____________
(Given Name) (Surname) (yyyy/mm/dd)
allogeneic recipient Personal Health Number: ______________
autologous recipient Date of transplant: ___________________
(yyyy/mm/dd)
|
1st set of vaccines (12 months after HSCT) |
1 month after 1st set of vaccines |
2 months
after 1st set
of vaccines |
7 months after 1st set of vaccines |
12 mos. after 1st set of vaccines (24 mos. after HSCT) |
|
Date Given |
Date Given |
Date Given |
Date Given |
Date Given
|
|
Tdap(ADACEL®) |
|
Td/IPV |
|
Td/IPV |
|
IPV |
|
|
|
|
|
Act-HIB® |
|
Act-HIB® |
|
Act-HIB® |
|
|
Hepatitis A |
|
Hepatitis A |
|
|
|
Hepatitis B1 |
Hepatitis B1 |
Hepatitis B1,2 |
|
|
Pneumococcal
Polysaccharide3 |
|
|
Pneumococcal
Polysaccharide3 |
|
|
Menactra™ (Meningococcal quadrivalent conjugate -
Groups
A, C, Y, W-135) |
|
|
|
|
|
|
|
|
|
MMR4,5,7
Varicella5,6,7,8 |
|
Influenza
(≥ 6 months after HSCT and yearly) |
|
|
|
|
- Administer double μg dose for age.
- One month after third dose of hepatitis B vaccine, perform serology for anti-HBs. If testing indicates inadequate protection, provide an additional 3 doses of hepatitis B vaccine. Retest anti-HBs one month after the second series of hepatitis B vaccine.
- Two doses of pneumococcal polysaccharide vaccine are indicated due to the possibility of a blunted immune response.
- MMR with specialist written approval. Give a second MMR dose 6-12 months after the first dose.
- Wait at least 24 months after ablative therapy before administering live vaccines and then only if there is no ongoing immune suppressive treatment or chronic graft-versus-host disease (GVHD) Separate the administration of MMR and Varilrix® by at least 4 weeks.
- Give two doses, one month apart. Obtain medical specialist written approval. Use Varilrix®.
- Use either Referral Form for MMR Vaccination or Referral Form for Varicella Vaccination.
- One month after receipt of second Varilrix dose test for VZV antibody. Send sample to BCCDC Laboratory Services and specify that client is immunocompromised.