Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives
Children with hemato-oncological diseases represent a heterogeneous population at heightened risk for vaccine-preventable diseases. Their immunosuppressed state reduces vaccine efficacy and raises safety concerns regarding live attenuated vaccines due to the risk of viral reactivation. The immunolog...
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MDPI AG
2025-04-01
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| Online Access: | https://www.mdpi.com/2076-393X/13/4/397 |
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| author | Baldassarre Martire Alessandra Beni Maria Felicia Mastrototaro Veronica Santilli Giorgio Ottaviano Davide Montin Caterina Rizzo Mayla Sgrulletti Michele Miraglia del Giudice Giorgio Costagliola Viviana Moschese |
| author_facet | Baldassarre Martire Alessandra Beni Maria Felicia Mastrototaro Veronica Santilli Giorgio Ottaviano Davide Montin Caterina Rizzo Mayla Sgrulletti Michele Miraglia del Giudice Giorgio Costagliola Viviana Moschese |
| author_sort | Baldassarre Martire |
| collection | DOAJ |
| description | Children with hemato-oncological diseases represent a heterogeneous population at heightened risk for vaccine-preventable diseases. Their immunosuppressed state reduces vaccine efficacy and raises safety concerns regarding live attenuated vaccines due to the risk of viral reactivation. The immunological and clinical implications of the single conditions are significantly different; therefore, specific vaccination strategies are needed. Despite the availability of vaccine guidelines for immunocompromised patients, clinical practice remains highly variable. It is generally recommended to avoid vaccinations during chemotherapy, with some exceptions for influenza, pneumococcal, and, in some countries, hepatitis B vaccines. The timing of immune recovery after chemotherapy depends on the specific treatment and most guidelines recommend administering vaccines 3–6 months after treatment cessation. Concerning HSCT, the timing of immune recovery is affected by several factors such as the HSCT platform, graft-versus-host disease (GvHD), and infections. Inactivated vaccines are typically administered 3–6 months post-HSCT, while live attenuated vaccines are delayed for at least two years. In children with asplenia or hyposplenism, recommendations focus on immunization against encapsulated bacteria, with tailored schedules based on the patient’s age and underlying condition. This paper explores the biological factors influencing vaccination efficacy and safety in pediatric hematology and oncology patients. It also provides an updated overview of the available evidence and current vaccination guidelines. Finally, this paper highlights the main clinical and research areas for further improvement to provide tailored vaccination schedules for this vulnerable population. |
| format | Article |
| id | doaj-art-1d2a7fb6e5734b058fed8d4697f72a81 |
| institution | OA Journals |
| issn | 2076-393X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj-art-1d2a7fb6e5734b058fed8d4697f72a812025-08-20T02:18:21ZengMDPI AGVaccines2076-393X2025-04-0113439710.3390/vaccines13040397Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and PerspectivesBaldassarre Martire0Alessandra Beni1Maria Felicia Mastrototaro2Veronica Santilli3Giorgio Ottaviano4Davide Montin5Caterina Rizzo6Mayla Sgrulletti7Michele Miraglia del Giudice8Giorgio Costagliola9Viviana Moschese10Unità Operativa Complessa (UOC) of Pediatrics and Neonatology, Maternal-Infant Department, “Monsignor A.R. Dimiccoli” Hospital, 70051 Barletta, ItalyDepartment of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, ItalyUnità Operativa Complessa (UOC) of Pediatrics and Neonatology, Maternal-Infant Department, “Monsignor A.R. Dimiccoli” Hospital, 70051 Barletta, ItalyResearch Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, ItalyDepartment of Pediatrics, Fondazione IRCCS San Gerardo Dei Tintori, 20900 Monza, ItalyDivision of Pediatric Immunology and Rheumatology, “Regina Margherita” Children Hospital, 10126 Turin, ItalyDepartment of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, ItalyPediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, ItalyDepartment of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalySection of Pediatric Hematology and Oncology, Azienda Ospedaliero Universitaria Pisana, 56100 Pisa, ItalyPediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Rome Tor Vergata, 00133 Rome, ItalyChildren with hemato-oncological diseases represent a heterogeneous population at heightened risk for vaccine-preventable diseases. Their immunosuppressed state reduces vaccine efficacy and raises safety concerns regarding live attenuated vaccines due to the risk of viral reactivation. The immunological and clinical implications of the single conditions are significantly different; therefore, specific vaccination strategies are needed. Despite the availability of vaccine guidelines for immunocompromised patients, clinical practice remains highly variable. It is generally recommended to avoid vaccinations during chemotherapy, with some exceptions for influenza, pneumococcal, and, in some countries, hepatitis B vaccines. The timing of immune recovery after chemotherapy depends on the specific treatment and most guidelines recommend administering vaccines 3–6 months after treatment cessation. Concerning HSCT, the timing of immune recovery is affected by several factors such as the HSCT platform, graft-versus-host disease (GvHD), and infections. Inactivated vaccines are typically administered 3–6 months post-HSCT, while live attenuated vaccines are delayed for at least two years. In children with asplenia or hyposplenism, recommendations focus on immunization against encapsulated bacteria, with tailored schedules based on the patient’s age and underlying condition. This paper explores the biological factors influencing vaccination efficacy and safety in pediatric hematology and oncology patients. It also provides an updated overview of the available evidence and current vaccination guidelines. Finally, this paper highlights the main clinical and research areas for further improvement to provide tailored vaccination schedules for this vulnerable population.https://www.mdpi.com/2076-393X/13/4/397aspleniachemotherapychimeric-antigen receptor T cells (CAR-T cells)hematopoietic stem cell transplantation (HSCT)immune reconstitution (IR)immunization |
| spellingShingle | Baldassarre Martire Alessandra Beni Maria Felicia Mastrototaro Veronica Santilli Giorgio Ottaviano Davide Montin Caterina Rizzo Mayla Sgrulletti Michele Miraglia del Giudice Giorgio Costagliola Viviana Moschese Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives Vaccines asplenia chemotherapy chimeric-antigen receptor T cells (CAR-T cells) hematopoietic stem cell transplantation (HSCT) immune reconstitution (IR) immunization |
| title | Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives |
| title_full | Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives |
| title_fullStr | Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives |
| title_full_unstemmed | Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives |
| title_short | Vaccinations in Pediatric Hematology and Oncology: Biologic Basis, Clinical Applications, and Perspectives |
| title_sort | vaccinations in pediatric hematology and oncology biologic basis clinical applications and perspectives |
| topic | asplenia chemotherapy chimeric-antigen receptor T cells (CAR-T cells) hematopoietic stem cell transplantation (HSCT) immune reconstitution (IR) immunization |
| url | https://www.mdpi.com/2076-393X/13/4/397 |
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