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CSC BMT SC Immunizations Post Hematopoietic Stem Cell Transplant VER 11-20-17 (HL 1961)

CSC BMT SC Immunizations Post Hematopoietic Stem Cell Transplant VER 11-20-17 (HL 1961) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Supportive Care


CSC BMT SC IMMUNIZATIONS POST HEMATOPOIETIC STEM CELL TRANSPLANT VER: 11-20-17 –  Properties
6 Months Post BMT –  11/22/2017 through 2/19/2018 (90 days), Planned
Day 1, 6 Months Post BMT –  Planned for 11/22/2017
Treatment Conditions
Treatment Condition A
Adult patients who have received an allogeneic or autologous stem cell transplant should be immunized according to
Policy F2.200 Immunizations Post Hematopoietic Stem Cell Transplant - see reference link for this supportive care plan.
Treatment Condition B
ADD influenza immunization yearly during flu season.
Treatment Conditions (delete all that do not apply)
Treatment Condition C
HPV vaccine can be considered for patients age 9-26. Delete if this does not apply.
Treatment Medications
pneumococcal 13-valent vaccine (diphtheria conj) (PREVNAR 13) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Treatment Medications (delete all that do not apply)
human papilloma recombinant vaccine (GARDASIL 9) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Shake well before use
9 Months Post BMT –  2/20/2018 through 5/20/2018 (90 days), Planned
Day 1, 9 Months Post BMT –  Planned for 2/20/2018
Treatment Conditions (delete all that do not apply)
Treatment Condition A
HPV vaccine can be considered for patients age 9-26. Delete if this does not apply.
Treatment Medications
pneumococcal 13-valent vaccine (diphtheria conj) (PREVNAR 13) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Treatment Medications (delete all that do not apply)
human papilloma recombinant vaccine (GARDASIL 9) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Shake well before use
12 Months Post BMT –  5/21/2018 through 6/17/2018 (28 days), Planned
Day 1, 12 Months Post BMT –  Planned for 5/21/2018
Treatment Conditions (delete all that do not apply)
Treatment Condition A
HPV vaccine can be considered for patients age 9-26. Delete if this does not apply.
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Zztestonc,Fiona F [2462287]
11/22/2017 3:36:08 PM Page 1 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Treatment Medications
diphtheria-tetanus-pertussis vaccine (DTaP PEDS-INFANRIX) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
pneumococcal 13-valent vaccine (diphtheria conj) (PREVNAR 13) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
meningococcal conjugate vaccine (MENVEO) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Treatment Medications (delete all that do not apply)
human papilloma recombinant vaccine (GARDASIL 9) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Shake well before use
13 Months Post BMT –  6/18/2018 through 7/15/2018 (28 days), Planned
Day 1, 13 Months Post BMT –  Planned for 6/18/2018
Treatment Medications
poliovirus vaccine (inactivate) (POLIOVAX) injection 0.5 mL
0.5 mL, Subcutaneous, ONCE, 1 dose Starting when released
haemophilus B conjugate vaccine (PEDVAXHIB) injection 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
hepatitis B vaccine (ENGERIX-B) vial 20 mcg
20 mcg, Intramuscular, ONCE, 1 dose Starting when released
14 Months Post BMT –  7/16/2018 through 8/12/2018 (28 days), Planned
Day 1, 14 Months Post BMT –  Planned for 7/16/2018
Treatment Conditions
Treatment Condition A
A fourth dose of Prevnar (pneumococcal 13-valent) should be given in place of Pneumovax (pneumococcal 23-valent) if
the patient has active GVHD. All other patients should receive pneumococcal 23-valent.
Treatment Medications
diphtheria-tetanus-pertussis vaccine (DTaP PEDS-INFANRIX) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
meningococcal conjugate vaccine (MENVEO) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
Treatment Medications (delete all that do not apply)
pneumococcal 23-valent vaccine (PNEUMOVAX) vial 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
For patients WITHOUT active GVHD.
pneumococcal 13-valent vaccine (diphtheria conj) (PREVNAR 13) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
For patients WITH active GVHD.
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Zztestonc,Fiona F [2462287]
11/22/2017 3:36:08 PM Page 2 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

15 Months Post BMT –  8/13/2018 through 4/21/2019 (252 days), Planned
Day 1, 15 Months Post BMT –  Planned for 8/13/2018
Treatment Medications
poliovirus vaccine (inactivate) (POLIOVAX) injection 0.5 mL
0.5 mL, Subcutaneous, ONCE, 1 dose Starting when released
haemophilus B conjugate vaccine (PEDVAXHIB) injection 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
hepatitis B vaccine (ENGERIX-B) vial 20 mcg
20 mcg, Intramuscular, ONCE, 1 dose Starting when released
24 Months Post BMT –  4/22/2019 through 5/19/2019 (28 days), Planned
Day 1, 24 Months Post BMT –  Planned for 4/22/2019
Treatment Medications
diphtheria-tetanus-pertussis vaccine (DTaP PEDS-INFANRIX) injection susp 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
poliovirus vaccine (inactivate) (POLIOVAX) injection 0.5 mL
0.5 mL, Subcutaneous, ONCE, 1 dose Starting when released
25 Months Post BMT –  5/20/2019 through 8/11/2019 (84 days), Planned
Day 1, 25 Months Post BMT –  Planned for 5/20/2019
Treatment Conditions
Treatment Condition A
Varicella live vaccine (Varivax) can be used for all patients who meet criteria for live virus vaccination: at least two years
post-transplant, off immunosuppressive medications, no active graft versus host disease.
Treatment Medications
haemophilus B conjugate vaccine (PEDVAXHIB) injection 0.5 mL
0.5 mL, Intramuscular, ONCE, 1 dose Starting when released
hepatitis B vaccine (ENGERIX-B) vial 20 mcg
20 mcg, Intramuscular, ONCE, 1 dose Starting when released
Treatment Medications (delete all that do not apply)
varicella virus vaccine (live) (VARIVAX) vial 0.5 mL
0.5 mL, Subcutaneous, ONCE, 1 dose Starting when released
May be administered if immunocompetent to receive live vaccines
28 Months Post BMT and Post-Immunization Titers –  8/12/2019 through 10/6/2019 (56 days), Planned
Day 1, 28 Months Post BMT and Post-Immunization Titers –  Planned for 8/12/2019
Treatment Conditions
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Zztestonc,Fiona F [2462287]
11/22/2017 3:36:08 PM Page 3 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Treatment Condition A
Post-immunization titers may be considered 2 to 4 years post-transplant for all patients to see if
patients are maintaining their titers and re-immunize if low. This is particularly important for patients
receiving long-term immunosuppression for chronic GVHD.
Pre-Labs
TETANUS AB, IGG
Expires: S+365
POLIOVIRUS AB
Expires: S+365
HEPATITIS B SURFACE AB
Expires: S+365
H INFLUENZAE B, IGG
Expires: S+365
RUBELLA AB, IGG
Expires: S+365
MUMPS VIRUS AB, IGG
Expires: S+365
RUBEOLA AB, IGG (MEASLES)
Expires: S+365
30 Months Post BMT –  10/7/2019 through 11/3/2019 (28 days), Planned
Day 1, 30 Months Post BMT –  Planned for 10/7/2019
Treatment Conditions
Treatment Condition A
MMR is contraindicated for patients with Chronic GVHD or on immunosuppression. Not generally recommended for all
transplant recipients, although should generally be administered to children. Should be considered on an individual
basis for patients from high-prevalence geographic areas or where risk is increased for these diseases (i.e., travel to
foreign countries). Rubella vaccine should be given to females with potential to become pregnant.
Treatment Medications (delete all that do not apply)
measles, mumps and rubella vaccine (MMR II) vial 0.5 mL
0.5 mL, Subcutaneous, ONCE, 1 dose Starting when released
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Zztestonc,Fiona F [2462287]
11/22/2017 3:36:08 PM Page 4 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org