Guidelines on Diagnosis and Treatment of Malignant Lymphomas

Vaccination Policy
Splenectomy may be carried out to de-bulk low grade
lymphomas such as marginal zone lymphomas or to treat itp
which is commoner in lymphoma patients. Functional
hyposplenism may be present in patients with lymphoma e.g.
enteropathy-type T-cell lymphoma associated with splenic atrophy
and immunodeficiency of varying degrees will exist among this
patient population. There fore patients with lymphomas benefit
from a formal vaccination and prophylactic antibiotics strategy
Pneumococcal and Haemophilus
influenzae Type B vaccine:
If splenectomy is required or if there is functional hyposplenism,
vaccination should be given ideally > 72 hours before surgery
but otherwise as soon as possible. All patients with HL
and hyposplenic states should have these vaccinations.
Pneumococcal vaccination should be repeated every 5 years.
Meningococcal Type C vaccine:
This vaccine should be given prior to splenectomy or in
hyposplenic states.
Influenza vaccination:
Annual vaccination is advised.
Prophylactic antibiotics:
Post-splenectomy patients are at risk of fulminant pneumococcal
sepsis and vaccination gives incomplete protection. They should
take prophylactic antibiotics in the form of penicillin V 333mg BD
or erythromycin 250mg BD if there is allergy to penicillin. Patients
should have prompt access to broad-spectrum antibiotics at all
times for use in the event of fever especially if they opt to avoid
the use of prophylactic antibiotics.
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