Table 3.
Recommended vaccination for adults after HSCT
| Type of vaccine | Doses | Timing | Comments |
|---|---|---|---|
| Allogeneic HSCT | |||
| PCV | 3 (second and third at least 4 weeks after the previous one) | First 3–6 months after HSCT | Fourth dose 6 months after the third one in case of chronic GVHD |
| PPV | 1 | 12 months after HSCT and at least 8 weeks after last PCV |
Only in absence of GVHD Booster dose 5 years after PPV |
| MenACWY | 2 (at least 8 weeks apart) | 6–12 months after HSCT | Recommended in case of anatomical/functional asplenia, complement deficiency |
| MenB | 2 (at least 4 weeks apart) | 6–12 months after HSCT | Recommended in case of anatomical/functional asplenia, complement deficiency |
| Hib | 3 (second and third at least 4 weeks apart) |
3–6 months after HSCT In case of simultaneous administration of dTpa-IPV, first dose 6–12 months after HSCT |
– |
| Inactivated influenza vaccine | Seasonal vaccination | 6–12 months after HSCT | During outbreaks start 3 months after HSCT (± dose after 4 weeks) |
| dTpa | 3 (0, 1, 6 months) | 6–12 months after HSCT | If no antibody titre 36 months after HSCT, booster dose |
| IPV | 3 (0, 1, 6 months) | 6–12 months after HSCT | – |
| HBV | 3 (0, 1, 6 months) | 6–12 months after HSCT |
Unvaccinated or anti-HBsAb < 10 IU/L or previous infection with HBsAb < 10 IU/L Revaccinate if at risk/not protective anti-HbsAb after 1–2 monthsc of a 3-dose schedule |
| VZVa | 2 (at least 4 weeks apart) | 24 months after HSCT | Seronegative without GVHD; at least 6 months after CT discontinuation; at least 8 months after Ig discontinuation |
| HPV | 3 doses | 6–12 months after HSCT | If at risk |
| Yellow fever | 1 dose | 5 years after HSCT | No if chronic GVHD or CT |
| HZ (live), MMR, BCG, typhoid (oral) are contraindicated | |||
| Autologous HSCT | |||
| dTpa | 3 with booster based on antibody titre | 6–12 months after HSCT |
Tetanus: antibody titre evaluation Pertussis: if never vaccinated, 1 dose of DTaP and 2 doses of dT |
| Inactivated influenza vaccine | Seasonal vaccination | 4–6 months after HSCT | – |
| HBV | 3 (0, 1, 6 months) | 6–12 months after HSCT | Unvaccinated or anti-HBsAb < 10 IU/L or previous infection with anti-HBsAb < 10 IU/L; revaccinate if at risk/not protective anti-HbsAb after 1–2 monthsb of a 3-dose schedule |
| PCV | 3 (second and third at least 4 weeks apart) | 3–6 months after HSCT | – |
| PPV | 1 | 12 months after HSCT and at least 8 weeks after PCV | Booster dose 5 years after PPV |
| MMRb | 2 doses (at least 4 weeks apart) | 24 months after HSCT | No protective titre for measles and/or rubella 24 months after HSCT and at least 6 months after CT and at least 8 weeks after Ig |
| VZVa | 2 doses (at least 4 weeks apart) | 24 months after HSCT |
Seronegative and at least 6 months after CT and at least 8 months after Ig Evaluate antibody titre between first and second dose |
HZ (live), BCG, typhoid (oral) are contraindicated
HSCT haematopoietic stem cell transplantation, GVHD graft versus host disease, CT chemotherapy, Ig immunoglobulin, PCV pneumococcal conjugate vaccine, PPV polysaccharide pneumococcal vaccine, Hib, H. influenzae type b conjugate vaccine, MenACWY, conjugate vaccine against N. meningitidis A, C, W, Y, MenB conjugate vaccine against N. meningitidis B, DTaP diphtheria tetanus acellular pertussis for adults, dT diphtheria tetanus vaccine, dTpa diphtheria tetanus pertussis vaccine, IPV inactivated anti-polio vaccine, HBV hepatitis B vaccine, VZV varicella vaccine, HPV papillomavirus vaccination, MMR mumps, measles, rubella vaccination, HZ live herpes zoster vaccine, BCG tuberculosis vaccination, HBsAb hepatitis B surface antibody
a Live vaccines are contraindicated in subjects with chronic GVHD, receiving CT and with disease recurrence
b If on intravenous Ig, evaluate specific antibody titre 3 months after its discontinuation