From the Guidelines
Chemotherapy can negate the protection from the MMR vaccine, and revaccination is recommended for patients with acute leukemia (AL) more than 24 months after completion of therapy, based on serostatus (BIIt) 1. The impact of chemotherapy on MMR vaccine protection is a significant concern, particularly for patients with hematologic malignancies or solid tumors. According to the guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) 1, patients with AL are at high risk of losing immunity to measles, mumps, and rubella due to chemotherapy-induced immunosuppression. Key considerations for MMR vaccination in patients undergoing chemotherapy include:
- The timing of vaccination: MMR vaccination should be performed more than 24 months after completion of therapy 1.
- Serostatus: Revaccination should be considered based on the patient's serostatus 1.
- Immunosuppression: Live vaccines, including MMR, are contraindicated in patients with severe immunosuppression, and alternative approaches, such as passive immunization, may be necessary 1. Healthcare providers should assess the individual patient's risk factors, including the type and intensity of chemotherapy, to determine the best approach for maintaining or restoring MMR immunity. In general, patients with AL should receive a booster dose of MMR vaccine after completion of treatment, as the risk of measles infection is high in immunocompromised patients, and antibody titers are likely to decline after chemotherapy 1.
From the Research
Effect of Chemotherapy on MMR Vaccine Protection
- Chemotherapy can negatively impact the protection provided by the Measles, Mumps, and Rubella (MMR) vaccine 2, 3, 4, 5.
- Studies have shown that a significant number of children lose preexisting humoral immunity against MMR after completion of chemotherapy 2.
- The loss of immunity against MMR viruses has been observed in patients undergoing chemotherapy, with seropositivity rates declining after treatment 3, 4, 5.
- Factors such as age and the type of chemotherapy may influence the loss of immunity, with younger patients and those receiving certain types of chemotherapy being more likely to experience a decline in antibody levels 2, 3.
Restoration of Immunity
- Re-vaccination after chemotherapy can restore protective immunity against MMR viruses in some patients 4, 6.
- A single booster dose of the MMR vaccine has been shown to elicit protective titers in the majority of patients, with a second dose being effective in non-responders 3, 6.
- The optimal number of doses and the role of post-vaccination titers in adult hematopoietic cell transplant recipients are still being studied, but available data suggest that MMR vaccination can be effective in restoring immunity in this population 6.
Implications for Patient Care
- Patients who have undergone chemotherapy may be at increased risk of infection with MMR viruses due to the loss of immunity 2, 3, 4, 5.
- Healthcare providers should consider evaluating the immune status of patients after chemotherapy and providing revaccination as needed to restore protective immunity against MMR viruses 4, 5.