The Flu Shot for Leukemia and Lymphoma Patients - FAQs

Flu Shots in Blood Cancer Patients and Contacts

Pharmacist giving customer flu shot
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Should you get a flu shot if you have leukemia or lymphoma?  What about someone you are in contact with?  What happens if you are exposed to the flu?  These are very good questions to be asking, that could play a big role in keeping you healthy!

The Flu Can Be Risky

Influenza is a common illness during the fall and winter months. Each year in North America, hundreds of thousands of people are hospitalized or die as a result of complications from the flu.

If you or your child has a blood cancer, you may or may not be at higher risk of contracting influenza, but you are clearly at a higher risk of developing serious complications if you should catch the flu. The risk of getting influenza is higher in cancer patients, and protective antibody levels tend to be lower in patients with hematological malignancy, or blood cancer.

Many cases of influenza are preventable with annual vaccination. The CDC recommends flu shots for anybody who is high risk, and that includes not only people with cancer, but those who have contact with people with cancer, either in their families or in the healthcare professions.

The Type of Flu Shot is Critical

Flu vaccines come in different forms, and there is one form, in particular, that is not recommended this year, period: Flumist - the nasal flu vaccine, a live attenuated vaccine.

You should not get the Flumist nasal spray if you are going through cancer treatment. The nasal spray flu vaccine is a live vaccine, meaning that the virus is "attenuated" or partially inactivated.

 Since it is a live vaccine, people who are immunosuppressed such as those with cancer on chemotherapy could theoretically develop an infection from the vaccine. So, this vaccine is not recommended for patients with cancer because there is scarce data on safety.

Flumist nasal spray is also not recommended this year for the public, in general. This vaccine is also not recommended in the 2017-2018 season for the general public—whether you have a strong immune system or not—because of concerns about how well it will work.

The vaccine is still FDA-approved and on the market, however, so it may still be available, despite the recommendation that it not be used.

Cancer Patients are Considered a Special Population

For many patients with leukemia or lymphoma, flu vaccination is helpful and is therefore strongly recommended. Influenza vaccination should generally be offered to all cancer patients except those receiving intensive chemotherapy. Ultimately, it is best to confer with your doctor, however, if you are undergoing cancer treatment and are unsure about your candidacy for the flu vaccine. 

  • In general, inactivated vaccines seem to work better when given at least 2 weeks before the initiation of chemotherapy or other immunosuppressive therapy to maximize the immune response.
  • Experts say to avoid vaccination during chemotherapy or radiation therapy because antibody responses are not as good. However, vaccination with inactivated vaccines during this period is not harmful and appears to provide at least some protection in some patients.

If you are a candidate, and the time is right, other (non-live attenuated) forms of flu shots include: 

  • Regular flu shot: CDC recommends vaccination with an injectable flu vaccine for everyone 6 months and older before the end of October, if possible.
  • Intradermal flu shot - for use in adults aged 18 through 64 years of age
  • Flu-Zone High Dose - designed specifically for people 65 years and older

Depending on where you are in treatment, your oncologist may recommend either the regular flu shot or the Flu-Zone flu shot. Flu-Zone is designed for people who have less active immune systems and may be the vaccine of choice.  Since these are "killed" viruses, they do not carry the risk of causing the flu. That said, since vaccines work to create immunity to disease, they may not be effective when your immune system is suppressed due to treatment.

Can I Get a Flu Shot During Chemotherapy?

The chemotherapy that is used to treat your cancer may also weaken your immune system.

As a result, your immune system may not be able to mount as much of a protective response to the vaccine as healthy individuals when you are undergoing treatment. Your cancer, since it affects your immune system as well, may also decrease your response. However, patients with blood cancers can still receive protective benefits from the flu shots if they are given at the right time.

In order to get the best response, you should try to get the flu shot either 2 weeks before chemotherapy, 4 weeks after chemotherapy is completed, or after your white blood cell count recovers to 1,000 cells/mm. If you are in the middle of a chemotherapy regimen, you should get your flu shot at the furthest point away from a treatment time in your cycle.  It's important to talk to your oncologist before getting your flu shot since there may be a better or worse time to receive the vaccine depending on your specific protocol and response to treatment.

Rituxan (Rituximab) and the Flu Shot

Researchers have noted that certain drugs, such as rituximab and alemtuzumab, seem to make the body’s response to vaccine less effective. Talk to your doctor about what's right for you if you are receiving these or other monoclonal antibodies.

Stem Cell Transplants and the Flu Vaccine

While it is perfectly safe for you to get an inactivated form of the vaccine, research has shown that stem cell transplant recipients did not receive any benefit from the flu shot in the first 6 months following the transplant. So, even though vaccination is recommended in this group of patients, it is best to wait 3 to 4 months or more following your transplant before getting it.

What About My Family and Loved Ones?

The CDC recommends that anyone caring for or living with a high-risk individual, such as someone with leukemia or lymphoma, should also get the flu shot. The idea is that the more of us who are immunized, the less of us are getting sick and spreading the virus.  It's still uncertain whether someone who gets the flumist vaccine could "shed" the virus and expose someone who is immunosuppressed. Talk to your doctor about her recommendations for your family and loved ones.

What if I'm Exposed to the Flu or Develop Symptoms

If you are exposed to someone who has the flu, or if you develop any symptoms of the flu, call your doctor right away.  There are antiviral medications which can decrease the severity of the flu and possibly even prevent it, but they need to be started as soon as possible after exposure or when symptoms begin.

What Else Can I Do to Prevent the Flu?

In addition to receiving the flu vaccine, you can help prevent influenza with these steps:

  • Avoid people who are sick, and avoid others when you are sick.
  • Use a tissue or your shirt sleeve to cover your mouth when you cough or sneeze.
  • Use frequent, good handwashing.
  • Avoid touching your eyes, nose, and mouth. If you have picked up germs or viruses on your hands, these are places where it can enter your body and make you sick.
  • Stay healthy! Get lots of sleep, good food, and gentle exercise to keep your body in flu-fighting form.

What Side Effects May I Experience From the Flu Shot?

Possible flu shot side effects include:

  • Discomfort where the shot was given
  • Low-grade fever
  • Body aches

These side effects usually only last a couple of days. In rare situations, patients have had an allergic reaction to the injection.

Other Immunizations and Precautions with Cancer

There are other immunizations your doctor may recommend during cancer treatment, especially that to prevent pneumonia. At the same time there are immunizations which could be dangerous for you to receive, or dangerous to you even if given to people you are around.  Learn more about which shots to get and which to avoid during cancer treatment.

A Word from Verywell:

Despite that fact that patients with blood cancers such as leukemia and lymphoma may not get as strong of a response to the flu shot as healthy individuals, they still get a response. If you compare the risks to your health if you get the flu versus the unlikely adverse effects of the vaccine, the flu shot benefits will outweigh the negatives.

In short, the flu shot is safe, inexpensive, and may save your life. If you or your child has a suppressed immune system as a result of leukemia or lymphoma, or the treatment of a blood cancer, please speak to your hematologist or oncologist about your flu shot options.

View Article Sources
  • Ariza-Heredia EJ, Chemaly RF. Practical Review of Immunizations in Adult Patients With Cancer. Hum Vaccin Immunother. 2015;11(11):2606-2614.
  • Centers for Disease Control and Prevention. Key Facts About Seasonal Flu Vaccine. Updated September 11, 2017.
  • La Torre G, Mannocci A, Colamesta V, et al. Influenza. Influenza and Pneumococcal Vaccination in Hematological Malignancies: a Systematic Review of Efficacy, Effectiveness, and Safety. Mediterr J Hematol Infect Dis. 2016;8(1):e2016044.