Presenting Authors: Christopher Clayton, PharmD, BCOP, and Sol Atienza, BS, PharmD, Advocate Health, Milwaukee, WI
Co-Authors: Justin Graff, PharmD, BCOP, University of Wisconsin Health, Madison, WI; Brittany Mejaki, PharmD, BCOP, and Michael Williams, PharmD, BCOP, Advocate Health, Milwaukee, WI
BACKGROUND: Post-transplant vaccination plays a key role in restoring immunocompetence after hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor T cell therapy (CAR-T), a population at increased risk for preventable infections because of the loss of humoral immunity and long-term immunosuppression. In 2020, our vaccine protocol and procedures were updated to delegate post-transplant vaccination management to the HSCT pharmacists. This included electronic immunization plan generation, scheduling coordination with clinic staff, and quarterly compliance tracking. Vaccination compliance was added as an internal quality measure, with an overall aim of >90% inactive vaccine receipt.
OBJECTIVES: The primary objective was to evaluate the incidence of vaccine administration in baseline and pharmacist-managed groups at each due time. The secondary objectives were to measure if administrations were on time (within 1 month of due date) as well as the utilization of optional vaccines (meningococcal, hepatitis B, varicella-zoster) among the baseline population.
METHODS: This retrospective, single-center review obtained data via the electronic medical record and state immunization registry for all patients who received an autologous or allogeneic HSCT, or CAR-T within our institution between December 1, 2017, and September 1, 2021, which allowed for all patients to be at least 24 months post-transplant. Those patients who received more than 1 HSCT or cellular therapy during the study time were excluded. COVID-19 and influenza vaccines were not included. The patients were divided into 2 groups: baseline and pharmacist managed. If death occurred during the revaccination period, the patient was deemed ineligible for remaining vaccines due. Live vaccines were evaluated separately because of the potential variations in clinical eligibility.
RESULTS: Overall, 125 patients were included for evaluation: 50 baseline and 75 pharmacist managed. The baseline cohort consisted of 100% autologous HSCT and the intervention group consisted of 67% autologous, 28% allogeneic, and 5% CAR-T. Inactive vaccine compliance was increased on average from a baseline 88.3% to 95.4%; 80% of the time points were above goal. Nearly 25% more patients in the intervention group were on time. Live vaccine administration was higher in the baseline population than in the pharmacist-managed population (71% vs 44%, respectively). Optional vaccines were received 64% of the time.
CONCLUSION: HSCT pharmacist intervention improved inactive vaccine compliance and timeliness under a revised schedule that contained historically optional vaccines as standard. Discrepancy in live vaccine administration may result from the study cutoff soon after the 24-month eligibility date for some patients, as well as a clinically heterogenous patient population. Based on these findings, we will continue the pharmacist-managed revaccination service at our site.
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- Centers for Disease Control and Prevention. Altered immunocompetence: recipients of hematopoietic cell transplants. Accessed December 19, 2023. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html