CHAPTER 50. Prophylactic Vaccination of Cancer Patients and Hematopoietic Stem Cell Transplant Recipients by William Decker and Amar Safdar

ABSTRACT

Prophylactic immunization in cancer patients is safe and cost-effective in reducing the disease burden and complications arising from vaccine preventable infections. For maximal effectiveness, patients should be vaccinated with inactivated vaccines at least two weeks prior or three months subsequent to myeloablative chemotherapy.  Hematopoietic stem cell transplant recipients should similarly be vaccinated 6-12 months posttransplant, immune reconstitution permitting.  Vaccination of patients with B-cell malignancies is more problematic but difficulties can be somewhat ameliorated by applying higher doses of vaccine in greater frequencies than would be typical for immunocompetent individuals.  Live vaccines are typically considered to be unsafe for oncology patients, but may be safely administered to HSCT recipients who are > 2 years posttransplant.  While many common infections can be managed through a strategy of conscientious vaccination, there are many other serious infections that specifically afflict immunocompromised patients populations and for which effective vaccines do not yet exist.  While vaccines that will address some of these infectious conditions are currently in development, it is unlikely that all important oncological infections will ultimately be addressed by a vaccine approach as market-based development strategies are unlikely to target infections with a negligible impact upon immunocompetent populations.  In this chapter we present an comprehensive review of vaccination in oncology patients.