Table 3 Recommended vaccination schedule after autologous or allogeneic HCT (with permission of the NCCN^®).

Inactivated vaccines^a	Recommended timing after HCT	Number of doses
DTaP (diphtheria/tetanus/acellular pertussis)	6–12 months	3
Pneumococcal vaccination
• Conjugated 13-valent vaccine	6–12 months	3
• Upon completion of PCV13 series, then PPSV23	≥12 months	1
Hepatitis A^b (Hep A)	6–12 months	2
Hepatitis B^b (Hep B)	6–12 months	3
Meningococcal conjugate vaccine^c	6–12 months	1–2
Influenza (injectable)^d	4–6 months	1^d, annually
Inactivated polio vaccine	6–12 months	3
Recombinant zoster vaccine	50–70 days after autologous HCT May be considered after allogeneic HCT^e	2
Human papillomavirus (HPV) vaccine	>6–12 months For patients up to age 26, consider up to age 45	3
Live vaccines	Recommended timing after HCT	Number of doses
Measles/mumps/rubella (MMR)^f	≥24 months (if no GVHD or ongoing immunosuppression and patient is seronegative for measles, mumps, and/or rubella)	1–2
Varicella vaccine^f	≥24 months (if no GVHD or ongoing immunosuppression and patient is seronegative for varicella)	1
Zoster vaccine^f,g (category 3)	May be considered at ≥24 months (if no GVHD or ongoing immunosuppression)	1

Reproduced with permission from the NCCN Guidelines^® for prevention and treatment of cancer-related infections V.1.2020. ^©2019 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written.
^aInactivated vaccines may be given as a combined vaccine. Vaccination may be postponed for patients receiving >20 mg of prednisone.
^bStrongly consider if clinically indicated. May consider Hep A and B combined vaccine if immunization for both is needed.
^cMeningococcal B vaccine should be considered for high-risk patients such as patients with asplenia or complement deficiency or patients receiving eculizumab.
^dAs antibody response may be suboptimal, EMN recommends a second administration, or confirmation of antibody response by adequate testing.
^eEfficacy in allogeneic HCT, in the presence of GVHD, or ongoing immunosuppression has not been established (Bastidas A, et al. JAMA. 2019;322:123–33).
^fMMR and varicella/zoster vaccines may be given together or 4 weeks apart.
^gBecause of insufficient data on safety and efficacy of live zoster vaccine among HCT recipients, physicians should assess the immune status of each recipient on a case-by-case basis and determine the risk for infection before using the vaccine. Randomized data exist for use of the recombinant zoster vaccine in patients receiving autologous HCTs but not for the live zoster vaccine.

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