{"id":14367,"date":"2022-03-10T11:04:11","date_gmt":"2022-03-10T00:04:11","guid":{"rendered":"https:\/\/mvec.mcri.edu.au\/?post_type=references&p=14367"},"modified":"2025-11-06T10:20:43","modified_gmt":"2025-11-05T23:20:43","slug":"cancer-immunisation-guideline-chemotherapy-and-post-haematopoietic-stem-cell-transplant_2","status":"publish","type":"references","link":"https:\/\/mvec.mcri.edu.au\/zh\/references\/cancer-immunisation-guideline-chemotherapy-and-post-haematopoietic-stem-cell-transplant_2\/","title":{"rendered":"\u764c\u75c7\u514d\u75ab\u6307\u5357\uff1a\u5316\u7597\u548c\u9020\u8840\u5e72\u7ec6\u80de\u79fb\u690d\u540e\u7684\u75ab\u82d7\u63a8\u8350"},"content":{"rendered":"
<\/p>\n

Background<\/strong><\/h2>\n

Cancer (also known as malignancy) is a disease involving the uncontrolled growth of an abnormal group of cells. These abnormal cells can damage organs and blood vessels, spread to other areas of the body, and if left untreated can be fatal.<\/span><\/p>\n

Cancers also impact an individual\u2019s immune function<\/a>, making them more vulnerable to infections. Additionally, treatment of cancers (e.g. chemotherapy, immunosuppressive therapies or haematopoietic stem cell transplants (HSCT)) can cause immune suppression, which may <\/span>result in the loss of <\/span>protection previously gained from past infections or vaccinations.<\/span><\/p>\n

Recommendations<\/h2>\n

Vaccin<\/span>ation is<\/span> generally <\/span>withheld<\/span> during <\/span>cancer <\/span>treatment <\/span>due to an inability to <\/span>mount <\/span>an effective immune response.<\/span> However, <\/span>despite <\/span>anticipating<\/span> a diminished response, <\/span>i<\/span>ndiv<\/span>id<\/span>u<\/span>a<\/span>ls <\/span>are still encouraged to receive<\/span> annual<\/span> influenza<\/span><\/a> vaccines <\/span>and <\/span>COVID<\/span>\u2011<\/span>19<\/span><\/a>\u00a0vaccines<\/span> (if <\/span>indicated<\/span>) <\/span>throughout treatment <\/span>due to the <\/span>high <\/span>risk<\/span> of severe <\/span>disease if infected<\/span>.<\/span><\/span><\/p>\n

Vaccines should be withheld in i<\/span>ndividuals with severe neutropenia <\/span>(neutrop<\/span>enia refers to below normal levels of <\/span>neutrophils\/white blood cells<\/span>; <\/span>severe neutropenia is defined as <\/span>an absolute neutrophil count of <\/span><\/span><0.5 x 109\/L)<\/span> <\/span>due to the risk of febrile neutropenia,<\/span>\u00a0which is <\/span>a medical emergency<\/span>.<\/span><\/span><\/p>\n

Timing<\/h3>\n

Following the completion of treatment, re\u2011vaccination (completion of a full primary course) or booster doses (top\u2011up doses) are recommended to optimise protection. The type of cancer treatment received, the age of the recipient, previous vaccine history, and any other co\u2011morbidities will inform the number of vaccine doses\/schedule required.<\/span><\/p>\n

Vaccines can be administered from 3 months after completion of treatment and when the underlying illness is in remission (in consultation with the treating oncologist). Live-attenuated vaccines may need to be delayed if there is ongoing immune suppression or in instances where blood products or immunoglobulins<\/a> have been administered. Influenza vaccines should continue to be administered annually.<\/span><\/p>\n

Table 1: Immunisation guideline for children (\u2264 <\/span><\/span><\/span><\/span>18 years<\/span><\/span><\/span>) who completed chemotherapy with the last < 2 years<\/strong><\/p>\n<\/div>\n\t

\n\t\t
\n\t\t\t
<\/div>
<\/th><\/th><\/th><\/tr><\/thead>
Inactivated vaccines <\/td><\/td><\/td><\/tr>
Age <\/td>\u2264 9 years*^ <\/td>\u2265 10 years*^ <\/td><\/tr>
Brand and antigen <\/td>Visit 1 <\/td>Visit 1 <\/td><\/tr>
<\/td>Infanrix hexa<\/strong> or Vaxelis<\/strong>#<\/sup> (DTP, polio, hep B, HIB)
Prevenar 20<\/strong> (pneumococcal)
Nimenrix<\/strong> (men ACWY)
Bexsero<\/strong> (men B)
COVID-19<\/strong>\u03a9<\/sup><\/td>		Infanrix hexa<\/strong> or Vaxelis<\/strong> (DTP, polio, hep B, HIB)
Prevenar 20<\/strong> (pneumococcal)
Nimenrix<\/strong> (men ACWY)
Bexsero<\/strong> (men B)
Gardasil 9<\/strong> (HPV)
COVID-19<\/strong>\u03a9<\/sup><\/td><\/tr>
<\/td>Visit 2<\/b> (min. 8 weeks post visit 1) <\/td>Visit 2<\/b> (min. 8 weeks post visit 1) <\/td><\/tr>
<\/td>Bexsero<\/strong> (men B) <\/td>Bexsero<\/strong> (men B) <\/td><\/tr>
Live-attenuated vaccines <\/td><\/td><\/td><\/tr>
Age <\/td>\u2264 3 years <\/td>\u2265 4 years <\/td><\/tr>
Brand and antigen <\/td>Visit 1 <\/td>Visit 1 <\/td><\/tr>
<\/td>Priorix <\/strong>or M-M-R II\u03b2 <\/sup><\/strong> (MMR)
Varilrix or Varivax\u03b2 <\/sup><\/strong> (V) <\/td>		Priorix tetra\u03b2 <\/sup><\/strong> (MMR\/V) <\/td><\/tr>
<\/td>Visit 2<\/b> (min. 4 weeks post visit 1) <\/td>Visit 2<\/b> (min. 4 weeks post visit 1) <\/td><\/tr>
<\/td>Priorix tetra\u03b2 <\/sup><\/strong> (MMR\/V) <\/td>Priorix tetra\u03b2 <\/sup><\/strong>(MMR\/V) <\/td><\/tr><\/tbody><\/table><\/div>WordPress Tables Plugin<\/a>\n\t\t<\/div>\n\t<\/div>\n

* Booster doses for children who received their primary course of vaccines before diagnosis\/treatment. Children who did not previously receive a full primary course should follow a catch up schedule as per the Australian Immunisation Handbook<\/a>.<\/span>
\n<\/span>^ Vaccination can commence > 3 months after completion of treatment and if underlying illness is in remission. Once vaccines are completed, children should continue to be vaccinated as per the <\/span>National Immunisation Program (NIP)<\/a>.<\/span>
\n<\/span># If the child is > 4 years of age but < 10 years of age, they must also complete a single dose of Infanrix<\/span>\u2011IPV\/Quadracel > 6 months later.<\/span>
\n<\/span>\u03a9<\/span>\u00a0<\/span> Administer only once child is > 6 months of age. <\/span>refer to <\/span>MVEC: COVID<\/span>\u2011<\/span>19<\/span><\/a> for age<\/span>\u2011<\/span>appropriate brands. <\/span>Additional<\/span> doses may be considered for individuals with <\/span>ongoing immunocompromise.<\/span>
\n<\/span>\u03b2 <\/span><\/span>There are recommended intervals between the administration of live<\/span>\u2011<\/span>attenuated vaccines and blood products. Please refer to MVEC: Live-attenuated vaccines and immunoglobulins or blood products<\/a><\/span> before administering for more information.<\/span>
\n<\/a>\u00a0shaded boxes indicate\u00a0 live<\/span>\u2011<\/span>attenuated vaccines<\/span><\/a>, which should only be given on consultation with oncologist.<\/span><\/p>\n<\/div>

Table 2: Immunisation guideline for children (\u2264 <\/span><\/span><\/span><\/span>18 years<\/span><\/span><\/span>) who received a HSCT within the last < 2 years<\/strong><\/p>\n<\/div>\n\t

\n\t\t
\n\t\t\t
<\/div>
<\/th><\/th><\/th><\/tr><\/thead>
Inactivated vaccines <\/td><\/td><\/td><\/tr>
Age <\/td>\u2264 9 years*^ <\/td>\u2265 10 years*^ <\/td><\/tr>
Brand and antigen <\/td>Visit 1 <\/td>Visit 1 <\/td><\/tr>
<\/td>Infanrix hexa or Vaxelis<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20 <\/strong>(pneumococcal)
Nimenrix <\/strong>(men ACWY)
Bexsero <\/strong>(men B)
COVID-19\u03a9<\/td>		Infanrix hexa or Vaxelis<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20<\/strong> (pneumococcal)
Nimenrix<\/strong> (men ACWY)
Bexsero<\/strong> (men B)
Gardasil 9<\/strong> (HPV)
COVID-19\u03a9<\/td><\/tr>
<\/td>Visit 2<\/b> (min. 8 weeks post visit 1) <\/td>Visit 2<\/b> (min. 8 weeks post visit 1) <\/td><\/tr>
<\/td>Infanrix hexa or Vaxelis<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20 <\/strong>(pneumococcal)
Nimenrix <\/strong>(men ACWY)
Bexsero <\/strong>(men B)
COVID-19\u03a9<\/td>		Infanrix hexa or Vaxelis<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20<\/strong> (pneumococcal)
Nimenrix<\/strong> (men ACWY)
Bexsero<\/strong> (men B)
Gardasil 9<\/strong> (HPV)
COVID-19\u03a9<\/td><\/tr>
<\/td>Visit 3<\/b> (min. 8 weeks post visit 2) <\/td>Visit 3<\/b> (min. 8 weeks post visit 2) <\/td><\/tr>
<\/td>Infanrix hexa or Vaxelis#<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20 <\/strong>(pneumococcal)
COVID-19\u03a9<\/td>		Infanrix hexa or Vaxelis<\/sup><\/strong> (DTP, polio, hep B, HIB)
Prevenar 20<\/strong> (pneumococcal)
COVID-19\u03a9<\/td><\/tr>
<\/td>Visit 4<\/b> (min. 8 weeks post visit 3) <\/td>Visit 4<\/b> (min. 8 weeks post visit 3) <\/td><\/tr>
<\/td> Prevenar 20<\/strong> (pneumococcal) <\/td> Prevenar 20<\/strong> (pneumococcal)
Gardasil 9<\/strong> (HPV) <\/td><\/tr>
Live-attenuated vaccines <\/td><\/td><\/td><\/tr>
Age <\/td>\u2264 3 years <\/td>\u2265 4 years <\/td><\/tr>
Brand and antigen <\/td>Visit 1 <\/td>Visit 1 <\/td><\/tr>
<\/td>Priorix <\/strong>or M-M-R II\u03b2 <\/sup><\/strong> (MMR)
Varilrix or Varivax\u03b2 <\/sup><\/strong> (V) <\/td>		Priorix tetra\u03b2 <\/sup><\/strong> (MMR\/V) <\/td><\/tr>
<\/td>Visit 2<\/b> (min. 4 weeks post visit 1) <\/td>Visit 2<\/b> (min. 4 weeks post visit 1) <\/td><\/tr>
<\/td>Priorix tetra\u03b2 <\/sup><\/strong> (MMR\/V) <\/td>Priorix tetra\u03b2 <\/sup><\/strong>(MMR\/V) <\/td><\/tr><\/tbody><\/table><\/div>WordPress Tables Plugin<\/a>\n\t\t<\/div>\n\t<\/div>\n

* Regardless of previous vaccine history, re\u2011vaccination with a full primary course is required for children post\u2011HSCT. Following this, the NIP<\/a> should be followed to ensure an individual is up to date with booster doses.
\n<\/span>^ Vaccination can commence > 3 months after completion of treatment and if underlying illness is in remission. Once vaccines are completed, children should continue to be vaccinated as per the NIP<\/a>.
\n<\/span># Dose 3 Infanrix hexa completes the primary schedule. If the child is > 4 years of age but <10 years of age, they must also complete a single dose of Infanrix\u2011IPV\/Quadracel > 6 months later.
\n<\/span>\u03a9<\/span> Administer only once child is > 6 months of age. R<\/span>efer to MVEC: COVID\u201119<\/a> for age\u2011appropriate brands. <\/span>Additional doses may be considered for individuals with <\/span>ongoing immunocompromise.
\n<\/span>\u03b2<\/span> T<\/span>here are recommended intervals between the administration of live\u2011attenuated vaccines and blood products. Please refer to MVEC: Live\u2011attenuated vaccines and immunoglobulins or blood\u2011products<\/a> before administering for more information.
\n<\/a> shaded boxes indicate live\u2011attenuated vaccines<\/a>, which should only be given on consultation with oncologist.<\/p>\n

Considerations<\/h2>\n

Whilst Infanrix <\/span>hexa<\/span>, <\/span>Vaxelis<\/span> and <\/span>Priorix<\/span> tetra are not routinely administered to individuals aged 10<\/span> to <\/span>18 years, they are preferentially used by some immunisation specialists to reduce the number of injections required by children following cancer treatment.<\/span> I<\/span>ndividual vaccines instead of combination vaccines <\/span>may be used so long as all antigens are accounted for.<\/span><\/span><\/p>\n

Household contacts<\/h3>\n

Family members and other household contacts of individuals undergoing cancer treatments should ensure they are up to date with all recommended vaccines, particularly <\/span><\/span>influenza<\/span><\/span><\/span><\/a>, <\/span><\/span>pertussis<\/span><\/span><\/span><\/a> and <\/span><\/span>COVID-19<\/span><\/span><\/span><\/a>.<\/span><\/span><\/p>\n<\/div>

<\/p>\n

Resources<\/h2>\n