Cancer treatment, chemotherapy, immune-modulating therapy, radiation, stem-cell transplant, changes your immune system in ways that matter for vaccination. Some vaccines you’d normally have are temporarily off the table, some you’ll need again from scratch, and some become more important than they were before treatment.
During active treatment
Decisions about vaccination during treatment are led by your oncology team. The general principles:
- Live vaccines (MMR, varicella, yellow fever, BCG, oral typhoid) are usually avoided during chemotherapy and immune-suppressing therapy.
- Inactivated vaccines can be given but may not generate a strong immune response while you’re on treatment. Sometimes they’re given anyway because some protection is better than none.
- Annual influenza is strongly recommended even during treatment.
After chemotherapy ends
Wait at least 3 months after the last cycle of chemotherapy before live vaccines, longer if your oncologist advises (some immune-modulating therapies have prolonged effects). Inactivated vaccines and boosters can usually be given earlier, often as soon as 1 month post-treatment.
After stem-cell transplant
Allogeneic and autologous stem-cell transplants effectively reset your immune memory. You lose protection from childhood vaccinations and need to be fully re-vaccinated following a specialist-led schedule that usually starts 6–12 months post-transplant. This includes the childhood NIP schedule and additional doses depending on your situation. Your transplant team will provide the schedule.
Vaccinations that become more important
- Annual influenza.
- Pneumococcal.
- Shingles, the recombinant non-live formulation is preferred and may be NIP-funded.
- COVID-19 boosters per current ATAGI advice for immunocompromised cohorts.
- RSV where age and risk profile put you in the recommended group.
Coordinating with the team
Bring your treatment summary (or a letter from your oncologist) to the appointment. Your immuniser will work through the timing with you. For complex re-vaccination after transplant or relapse, your transplant or oncology service is usually the better place than a pharmacy, we’ll happily refer.
Read our companion post on vaccinating with autoimmune conditions for general live-vaccine timing principles.
Sources & further reading
General information only. This article is educational and is not a substitute for personal medical advice. Your immuniser will confirm eligibility and contraindications on the day.
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