Immune Reconstitution and Need for Booster Vaccinations Among Non-Transplant Childhood Cancer Survivors: A Single-Center Experience.
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BACKGROUND: Waning immunity from childhood vaccines can be more profound in pediatric patients following chemo/immunotherapy. Moreover, childhood cancer survivors (CCS) are at significantly increased risk for life-threatening infections. We implemented an institutional standard of practice (SOP) to assess immune reconstitution and provide recommendations for re-vaccination for non-transplant CCS. METHODS: A lymphocyte mitogen proliferation panel was obtained at around 6 months off therapy to assess non-specific lymphocyte proliferation to phytohemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM). Serologic concentrations of immunoglobulin G (IgG) antibodies were measured for hepatitis B (hepB) virus, tetanus toxoid, and Streptococcus pneumoniae. Booster vaccines were recommended for seronegative patients. Catch-up vaccines were recommended for CCS not previously up to date. RESULTS: All evaluated patients were considered immune reconstituted at 6 months off therapy. Most patients (about 80%) were seronegative for hepB virus and S. pneumoniae, but nearly 100% retained immunity against tetanus. Most patients had positive seroconversion with a single booster vaccination with hepB (86%) and PPSV23 (76%). There were missed opportunities with each step of the institutional SOP due to provider omission with varying degrees depending on the provider. CONCLUSIONS: This study suggests that most CCS are ready for re-immunization with inactivated vaccines by 6 months of therapy and underscores the need for boosters to optimize protection against vaccine-preventable infections. Future studies are needed to inform consensus guidelines adapted to patient age, underlying cancer diagnosis, and treatment intensity.