Establishing a Post-Hematopoietic Stem Cell Transplant Immunization Clinic: A Single Institution Experience

Background: Antibody titers from vaccinations administered prior to hematopoietic stem cell transplant (HSCT) for vaccine-preventable diseases (e.g., tetanus, polio) decline 2-5 years after both allogeneic and autologous HSCT. The lack of protective titers to vaccine preventable diseases poses a threat to the immunosuppressed patient population. At Memorial Sloan-Kettering Cancer Center, data indicate that among those eligible to receive vaccination post HSCT, many were not timely immunized or did not receive full recommended series. An immunization clinic for this population was established to increase access, provide timely vaccination administration, and decrease risk to vaccine preventable disease for this population.

Population: Patients with leukemia, lymphoma or plasma cell disorders at minimum of 9 months post allogeneic or autologous HSCT, referred by a primary practitioner.

Project Description: To establish a centralized clinic led by an advanced practice nurse dedicated to the immunization of the HSCT population. The approach consisted of a multi-phase implementation: implementation of standardized treatment guidelines, creation of patient and staff education materials, and the creation and implementation of computer-based data collection systems.

Conclusion: Preliminary results of this project demonstrate that the establishment of a centralized immunization clinic increases access to care, improves patient education, and promotes use of standardized guidelines at this institution. This clinic served over 179 HSCT patients, cataloguing 363 unique visits, within its first 12 months of inception. This presentation will include data related to the feasibility of establishing a vaccination clinic as an effective intervention for purposes of increasing access and standardizing evidence-based patient care. Data presented will include the barriers to clinic implementation, rate of vaccination since clinic inception, and the development of a documentation system for data capture related to post HSCT immunization practices. Increasing access and providing comprehensive immunization treatment plans for this patient population may reduce risk to vaccine preventable diseases.