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Evaluation of vaccine dosing in patients with solid tumors receiving myelosuppressive chemotherapy

Division of Pharmacy, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

Brandi K Wachel, APN

Department of Gynecologic Oncology, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

Judith A Smith, PharmD, FCCP, BCOP

Division of Pharmacy, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA, Department of Gynecologic Oncology, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA, Department of Obstetrics and Gynecology, University of Texas, Health Sciences Center at Houston Medical School, Houston, TX, USA

Objective. To provide oncology healthcare providers with information on current vaccine recommendations and discuss the proper timing of vaccination in relation to chemotherapy, to allow for an adequate, protective antibody response.

Data sources. In this review, we have attempted to include all available literature as well as the current recommendations. The National Library of Medicine, PubMed online database was searched using the keywords: chemotherapy, influenza, vaccine, cancer, immunosuppression. In addition, the Center for Disease Control (CDC) guidelines were reviewed and incorporated into the recommendations.

Data synthesis. There were several limitations to the literature available. To date, most of the literature was completed in the 1970s and 1980s, and definitions of protective immunity regarding influenza vaccines have changed over time, as well as improved study design. These studies have also been completed in a variety of disease states, hence, it is difficult to make comparisons between trials. The recommendations in this review are consistent with the current CDC Guidelines and, until further clinical trials are carried out, are the most conservative recommendations in favor of patient safety, health care costs, and resource utilization.

Conclusion. Patients on cancer chemotherapy should receive vaccination at least 2 weeks before initiation of treatment. Providers should avoid administering vaccination during chemotherapy or active radiation treatment because of suboptimal responses to vaccines. Active immunization has been shown to confer protective immunity to several infections in cancer patients at similar rates to healthy individuals.

Key Words: cancer • chemotherapy • immunosuppression • influenza • vaccine

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