# Vaccinations around lymphoma treatment: the ones to have first, and the ones not to have at all

Source: https://onco.cc/terms/lymphoma-living-vaccinations/  
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## TL;DR

Inactivated vaccines work best when they are given at least two weeks before immunosuppressive treatment begins, and live vaccines are generally not given to someone whose immune system is suppressed. Treatment that removes B cells blunts the response to vaccines for a long time afterwards, so the order matters.

## Summary

**The two rules.** The Green Book, chapter 7, says that many live vaccines are contraindicated in people who are immunosuppressed, and that people with immunosuppression should nonetheless be given all inactivated vaccines in line with national recommendations, although they may not mount as good an antibody response. For those due to start immunosuppressive treatment, it says inactivated vaccines should ideally be administered at least two weeks before treatment begins; where that is not possible, vaccination may be done at any time and re-immunisation considered after treatment is finished and recovery has occurred.

**Why anti-CD20 treatment makes the timing matter more.** Rituximab and obinutuzumab deplete the B cells that respond to a vaccine, so a vaccine given during or soon after a course of them may produce little antibody. This is the reason the first fortnight after a lymphoma diagnosis often contains a vaccination appointment that feels out of place beside the scans.

**After a transplant.** The Green Book says that in people who receive bone marrow transplants, any protective antibodies from previous exposure or vaccination are likely to be lost, that it is unclear whether the recipient acquires the donor's immunity, and that all such people should be considered for a re-immunisation programme after treatment is finished, with specialist advice where needed. Lymphoma Action says the same of engineered T-cell therapy: you may lose immunity you previously had, and the team may recommend repeating the vaccinations.

**What to ask, and of whom.** Lymphoma Action's position throughout its material is to check with the medical team about which vaccinations you should and should not have, rather than to follow a general rule, and to take up the ones you are offered. Household contacts matter too: the Green Book notes that close contacts of immunosuppressed people may themselves need additional vaccines. The practical question at the first appointment is which vaccines are due, whether any of them can be given in the next fortnight, and which ones are off the list until further notice and for how long.

## Fields

- Kind: Term
- Last checked: 2026-10-01
- Also known as: Live vaccines and lymphoma; Vaccination before rituximab; Revaccination after transplant

## Sources

- Immunisation against infectious disease (the Green Book), chapter 7: immunisation of individuals with underlying medical conditions: https://assets.publishing.service.gov.uk/media/5e18a52940f0b65dc1918763/Greenbook_chapter_7_Immunsing_immunosupressed.pdf
- NHS: vaccinations: https://www.nhs.uk/vaccinations/
- Lymphoma Action: infections, risk and prevention: https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/infections-risk-and-prevention
- Lymphoma Action: CAR-T cell therapy: https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/car-t-cell-therapy

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- terms: [Hypogammaglobulinaemia and infection risk after B-cell therapies](https://onco.cc/terms/hypogammaglobulinaemia/), [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/), [Low antibodies and infection risk for years after anti-CD20 and bispecific antibodies](https://onco.cc/terms/lymphoma-living-infection-years-after/)

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