Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

Abstract

Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.

Soluble immune checkpoint molecules: Serum markers for cancer diagnosis and prognosis

“…In vitro studies with human T cells showed that sCTLA‐4 is a potent inhibitor of T‐cell activity, including antigen‐specific proliferation and secretion of pro‐inflammatory cytokines like IFN‐γ and IL‐17 . Tregs were also found to be able to secrete sCTLA‐4, which further contributed to the suppressive effects of the regulatory T cells by inducing secretion of immunosuppressive cytokines TGF‐β and IL‐10 . Therefore, sCTLA‐4 participates in the immune regulation in a cell‐extrinsic manner, which can affect the development and prognosis of several diseases including autoimmunity and cancer.…”

“…31 Tregs were also found to be able to secrete sCTLA-4, which further contributed to the suppressive effects of the regulatory T cells by inducing secretion of immunosuppressive cytokines TGF-β and IL-10. 31,32 Therefore, sCTLA-4 participates in the immune regulation in a cell-extrinsic manner, which can affect the development and prognosis of several diseases including autoimmunity and cancer.…”

Vaccine-Derived Immunity in Children With Cancer-Analysis of Anti-Tetanus and Anti-Diphtheria Antibodies Changes after Completion of Antineoplastic Therapy

“…The Italian guidelines recommend that patients who stopped the course of the vaccination schedule during chemotherapy resume the program starting from the suspended dose. It is not considered mandatory to measure antibody titers to decide on revaccination or to check response after vaccination . The British guidelines recommend giving a single dose of diphtheria‐tetanus—acellular pertussis (DTaP), inactivated poliovirus, Haemophilus influenzae b conjugate, and measles‐mumps‐rubella vaccines at 6 months after completion of standard chemotherapy.…”

Are we missing an opportunity for cancer prevention? Human papillomavirus vaccination for survivors of pediatric and young adult cancers

“…Most pediatric cancer patients do recover normal immune function within 6 months of treatment completion . Furthermore, current recommendations support nonliving vaccine administration on schedule, even during chemotherapy, as long as the patient is not severely neutropenic . Ongoing research will determine the need for boosters in patients who receive vaccinations while they are immunocompromised.…”