Requiring Immunization After Rescue Autologous HSCT

  • Darko RichterEmail author


    • Patients with successful autologous or allogeneic hematopoietic stem-cell therapy should get booster courses of previous vaccinations

    • Additionally, the patient should get inactivated Inf, PCV and Men vaccine

    • Inactivated vaccines can generally be started at 6 months post HSCT, provided the child has no immunosuppression for the past 3 months, a lymphocyte count >1200/μL, and endogenous IgG > 500 mg/dL

    • Live vaccines are strictly contraindicated. Only MMR and Var can be considered in select well engrafted cases, no sooner than 24 months after HSCT. Requirement is CD4+ count >700/mL, endogenous IgG >500 mg/dL, and adequate serological response to inactivated vaccines, no immunosuppression and no GVHD

    • Passive immunoglobulin prophylaxis is established for measles by IVIG and for chickenpox by VZIG

    • Chemoprophylaxis with valacyclovir is available for chickenpox, in intramuscular and subcutaneous forms

    • The 16% HNIG concentrate can provide passive protection for measles, and to some extent hepatitis A and chickenpox


Hematopoietic stem-cell therapy Booster immunization Inactivated vaccines Live attenuated vaccines 


  1. 1.
    Tomblyn M, Chiller T, Einsele H et al. Guidelines for preventing infectious complications among hematopoietic stem cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15(10):1143.Google Scholar
  2. 2.
    Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309–18.CrossRefGoogle Scholar
  3. 3.
    Patel SR, Ortin M, Cohen BJ, Borrow R, Irving D, Sheldon J, Heath PT. Revaccination with measles, tetanus, poliovirus, Haemophilus influenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation. Clin Infect Dis. 2007;44(5):625–34.CrossRefGoogle Scholar
  4. 4.
    Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R, Ribaud P, Ward K, Cordonnier C. Vaccination of stem cell transplant recipients: recommendations of the infectious diseases working party of the EBMT. Bone Marrow Transplant. 2005;35(8):737–46.CrossRefGoogle Scholar
  5. 5.
    Shetty AK, Winter MA. Immunization of children receiving immunosuppressive therapy for cancer or hematopoietic stem cell transplantation. Ochsner J. 2012;12(3):228–43.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Richter D, Anca I, Andre FE, Bakir M, Chlibek R, Cizman M, Mangarov A, Meszner Z, Pokorn M, Prymula R, Salman N, Simurka P, Tamm E, Tesovic G, Urbancikova I, Usonis V, Wysocki J, Zavadska D, Central European Vaccination Awareness G. Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations. Expert Rev Vaccines. 2014;13(6):801–15.CrossRefGoogle Scholar
  7. 7.
    Sung L, Heurter H, Zokvic KM, Ford-Jones EL, Weitzman SS, Freeman R, Dupuis LL, Scheifele DW. Practical vaccination guidelines for children with cancer. Paediatr Child Health. 2001;6(6):379–83.CrossRefGoogle Scholar
  8. 8.
    Cesaro S, Giacchino M, Fioredda F, Barone A, Battisti L, Bezzio S, Frenos S, De Santis R, Livadiotti S, Marinello S, Zanazzo AG, Caselli D. Guidelines on vaccinations in paediatric haematology and oncology patients. Biomed Res Int. 2014;2014:707691.CrossRefGoogle Scholar
  9. 9.
    Patel NC, Hertel MP, Estes MK et al. Vaccine-Acquired Rotavirus in Infants with Severe Combined Immunodeficiency. N Engl J Med 2010; 362:314–9.Google Scholar
  10. 10.
    McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(Rr-04):1–34.PubMedGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention (CDC). FDA approval of an extended period for administering VariZIG for postexposure prophylaxis of varicella. MMWR Morb Mortal Wkly Rep. 2012;61(12):212.Google Scholar
  12. 12.
    Marin M, Guris D, Chaves SS et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56:1.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Pediatric Allergy and Clinical ImmunologyUniversity Hospital Center ZagrebZagrebCroatia
  2. 2.Outpatient and Emergency Service, Department of PediatricsUniversity Hospital Center ZagrebZagrebCroatia

Personalised recommendations