Vaccinations After Hematopoietic Cell Transplant

Routine administration of vaccinations is vital for prevention of infectious complications in hematopoietic cell transplant recipients.

Consensus Guidelines

Hematopoietic cell transplant recipients may remain immunocompromised far beyond 2 years post-transplant, especially individuals with chronic graft-versus-host disease (GVHD). Therefore, post-transplant patients should be routinely revaccinated after transplant until they regain immune competence.

The vaccination schedule below is based on international consensus guidelines for preventing infectious complications among all transplant recipients and is recommended for both autologous and allogeneic hematopoietic cell transplant (HCT) recipients. [1,2,3]

These recommended vaccinations are also included in our HCT Guidelines.

• View Post-Transplant Care Guidelines (PDF)
• Order a print version or access HCT Guidelines mobile app

Recommended Vaccinations/Schedule^a

• Recommended for use after HCT: Yes
• Time post-HCT to initiate vaccine: 3-6 months
• No. of doses: 3-4^b

• Recommended for use after HCT: Yes
• Time post-HCT to initiate vaccine: 3-6 months
• No. of doses: 3^d

• Recommended for use after HCT: Yes
• Time post-HCT to initiate vaccine: 6-12 months
• No. of doses: 3

• Recommended for use after HCT: Follow country recommendations for general population
• Time post-HCT to initiate vaccine: 6-12 months
• No. of doses: 1

• Recommended for use after HCT: Yes
• Time post-HCT to initiate vaccine: 6-12 months
• No. of doses: 3

Recombinant Hepatitis B

• Recommended for use after HCT: Follow country recommendations for general population
• Time post-HCT to initiate vaccine: 6-12 months
• No. of doses: 3

• Recommended for use after HCT: Measles: All children and seronegative adults
• Time post-HCT to initiate vaccine: 24 months
• No. of doses: 1-2^h

Notes:

a) A uniform specific interval between doses cannot be recommended, as various intervals have been used in studies. As a general guideline, a minimum of 1 month between doses may be reasonable.

b) Following the primary series of three PCV doses, a dose of the 23-valent polysaccharide pneumococcal vaccine (PPSV23) to broaden the immune response might be given. For patients with chronic GVHD who are likely to respond poorly to PPSV23, a fourth dose of the PCV should be considered instead of PPSV23.

c) DTaP (diphtheria tetanus pertussis vaccine) is preferred, however, if only Tdap (tetanus toxoid-reduced diphtheria-toxoid reduced acellular pertussis vaccine) is available (for example, because DTaP is not licensed for adults), administer Tdap. Acellular pertussis vaccine is preferred, but the whole-cell pertussis vaccine should be used if it is the only pertussis vaccine available.

d) See references for consideration of an additional dose(s) of Tdap for older children and adults.

For children <9 years of age, two doses are recommended yearly between transplant and 9 years of age.

f) Measles, mumps and rubella vaccines are usually given together as a combination vaccine. In females with pregnancy potential, vaccination with rubella vaccine either as a single or a combination vaccine is indicated.

g) Not recommended <24 months post-HCT, in patients with active GVHD, and in patients on immune suppression.

h) In children, two doses are favored.

See reference [2] for vaccinations considered optional or not recommended for transplant recipients and for vaccinations for family, close contacts and health care workers.

References

1. Majhail NS, Rizzo JD, Lee SJ, et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation; Center for International Blood and Marrow Transplant Research (CIBMTR), American Society for Blood and Marrow Transplantation (ASBMT), European Group for Blood and Marrow Transplantation (EBMT), Asia-Pacific Blood and Marrow Transplantation Group (APBMT), Bone Marrow Transplant Society of Australia and New Zealand (BMTSANZ), East Mediterranean Blood and Marrow Transplantation Group (EMBMT) and Sociedade Brasileira de Transplante de Medula Ossea (SBTMO). Co-published in Biol Blood Marrow Transplant, 2012, 18(3): 348-371; Bone Marrow Transplant, 2012, 47(3): 337-341; and Hematol Oncol Stem Cell Ther, 2012, 5(1): 1-30. Access
2. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: A global perspective. Biol Blood Marrow Transplant. 2009; 15(10): 1143-1238. Access
3. Ljungman P, Cordonnier C, Einsele H, et al. Vaccination of hematopoietic cell transplant recipients. Bone Marrow Transplant. 2009; 44(8): 521-526. Access