After stem-cell transplant, re-vaccination is needed

Patients diagnosed with blood-related cancers such as leukemia, lymphoma and multiple myeloma often undergo what is called a hematopoietic, or blood stem cell transplant. In this procedure, patients’ blood-forming stem cells are replaced with new ones that are infused into the patient’s bloodstream.

After undergoing a transplant, patients usually lose some or all of the immunities against contagious diseases they once had or were vaccinated against. The cancer itself, the radiation therapy and chemotherapy conditioning regimens that prepare the patient for transplant, and the immunosuppressive drugs taken after the transplant kill off many or all of the patient’s antibody-producing cells that confer immunity.

Getting new immunizations is advised since many of the childhood diseases patients were vaccinated against years ago could occur in this immunocompromised state.

“It’s standard practice to revaccinate these patients with standard childhood vaccines, the so-called baby shots,” said Ella Ariza-Heredia, M.D., assistant professor of Infectious Diseases, Infection Control, and Employee Health.

Although guidelines exist for vaccinating immunocompromised transplant recipients, many patients fail to receive any or all of the recommended series of vaccinations.

In some patients, vaccination is withheld or delayed intentionally due to graft-versus-host disease treatment with certain drugs that prevent the transplant recipient’s body from viewing a donor’s cells as foreign. But communication breakdowns among clinicians or between clinicians and patients are behind most cases of vaccine noncompliance.

An ongoing initiative between MD Anderson’s Department of Stem Cell Transplantation and Cellular Therapy and the Department of Infectious Diseases, Infection Control, and Employee Health seeks to improve rates of vaccination after a blood stem cell transplant.

Measures include adoption of a streamlined vaccination schedule that makes compliance easier for patients who receive their first round of vaccines at MD Anderson and then return to their primary care physicians for follow-up care, tools such as an immunization tracking card that help patients stay on schedule with their vaccinations, enhanced education-focused communication between nurses and patients, and improved communication between a patient’s referring physician and MD Anderson physicians about appropriate follow-up care.

MD Anderson’s new electronic health record also helps by providing alerts when the patient’s next vaccination is due, and these notifications are sent to referring physicians through the EpicCare Link tool at myMDAnderson for Physicians.

Read more about this initiative in the July issue of OncoLog.