Antibody responses to vaccinations given within the first two years after transplant are similar between autologous peripheral blood stem cell and bone marrow transplant recipients Impact of influenza-like illness and effectiveness of influenza vaccination in oncohematological children who have completed cancer therapy Antibody responses to pneumococcal and haemophilus vaccinations in patients with B-cell chronic lymphocytic leukaemia. Vaccination of patients with haematological malignancies with one or two doses of influenza vaccine: a randomised study IMMUNOGENICITY AND SAFETY OF INACTIVATED INFLUENZA VIRUS VACCINE IN YOUNG CHILDREN IN 2003–2004 Revaccination with measles, tetanus, poliovirus, Haemophilus influenzae type B, meningococcus C, and pneumococcus vaccines in children after hematopoietic stem cell transplantation. Response to pneumococcal (PNCRM7) and haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT). Protective antibody responses to pneumococcal conjugate vaccine after autologous hematopoietic stem cell transplantation. Dose-related safety and immunogenicity of baculovirus-expressed trivalent influenza vaccine: a double-blind, controlled trial in adult patients with non-Hodgkin B cell lymphoma. Antibody responses of splenectomized patients with non-Hodgkin's lymphoma to immunization with polyvalent pneumococcal vaccines. A comparison of early and late vaccination with Haemophilus influenzae type b conjugate and pneumococcal polysaccharide vaccines after allogeneic BMT. Influenza A/H1N1 in Pediatric Oncology Patients A prospective study on antibody response to repeated vaccinations with pneumococcal capsular polysaccharide in splenectomized individuals with special reference to Hodgkin's lymphoma. Immunogenicity of trivalent influenza vaccine in children with acute lymphoblastic leukemia during maintenance therapy. Antibody responses to pneumococcal and hemophilus vaccinations in splenectomized patients with hematological malignancies or trauma A prospective study on the efficacy of two-dose influenza vaccinations in cancer patients receiving chemotherapy.
As a consequence of the significantly larger inoculum of lymphoid cells present in peripheral blood stem cell ( PBSC ) harvests compared to bone marrow ( BM ) , it is possible that autoPBSCT recipients may have an earlier and * or enhanced response to vaccines . Until data to confirm this become available , the European Blood and Marrow Transplantation Association ( EBMT ) recommend that all transplant recipients be immunized in the same way regardless of stem cell source . We performed a prospect i ve study comparing serological responses to influenza , pneumococcal polysaccharide and tetanus toxoid vaccines between autoPBSCT with autoBMT recipients .  Antibody responses in sibling HLA-matched allogeneic BMT ( alloBMT ) survivors were also evaluated . All vaccines were administered within the first 2 years after stem cell transplantation . Fifty patients were enrolled . The time of vaccination after transplant was similar between autoPBSCT ( mean 11 months for each vaccine ) and autoBMT recipients ( mean 12 months except 13 months for tetanus toxoid ) ( P = NS ) . Serological responses were poor and no significant difference in response to any of the vaccines used was seen between the three transplant cohorts . We provide no evidence that current EBMT guidelines be modified . Large prospect i ve vaccine studies are needed to address the issue more fully . Bone Marrow Transplantation ( 2001 ) 28 , 775–781 Abstract In order to evaluate the impact of influenza-like illness and the effectiveness of influenza vaccination  in children with oncohematological disease who have completed cancer therapy , 182 children with a diagnosis of oncohematological disease were divided into two subgroups on the basis of the length of time off therapy ( < 6 months or 6–24 months ) and r and omised 1:1 to receive influenza vaccination or not . The controls were 91 otherwise healthy children unvaccinated against influenza .  The results show that the clinical and socioeconomic impact of influenza-like illnesses and the effectiveness of influenza vaccination  in oncohematological children who have completed cancer therapy are related to the length of the off therapy period , and seem to be significantly greater in those who have been off therapy for less than 6 months in comparison with healthy controls . This suggests that the administration of influenza vaccination should be strongly recommended only among oncohematological children who have been off therapy for less than 6 months Although vaccination against Streptococcus pneumoniae ( S. pneumoniae ) and Haemophilus influenzae type b ( Hib ) is recommended for immunocompromised patients , such as patients with B-cell chronic lymphocytic leukaemia ( B-CLL ) , its protective effect is question able . We studied antibody responses to pneumococcal polysaccharide vaccine ( Pneumovax-23 ) and to conjugated H. influenzae type b-vaccine ( Act-Hib ) in 25 patients with B-CLL . After vaccination , the number of patients with antibody levels in the protective range against pneumococcal serotypes and H. influenzae b increased from 9 ( 38 % ) to 12 ( 50 % ) of 24 patients and from 8 ( 35 % ) to 11 ( 48 % ) of 23 patients , respectively . The patients with adequate antibody response to Pneumovax-23 and Act-Hib had significantly less advanced stages of B-CLL , higher gammaglobulin levels , total IgG-levels and IgG-subclasses 2 and 4 levels , and lower levels of soluble CD23 . Consequently , vaccination with these vaccines should be given as soon as the diagnosis of B-CLL is made , early in the course of the disease with determination of post-vaccination antibody levels An open , r and omised study was performed to determine whether two doses of influenza vaccine were more effective than one to elicit an immune response in 70 patients with haematological malignancies . The responses were not improved by two doses compared with one ( influenza A virus serotypes H1/N1 18 % vs. 22 % and H3/N2 26 % vs. 14 % ; influenza B 25 % vs. 22 % ) . The results were similar in patients with ongoing and discontinued therapy . Patients treated with monoclonal antibodies for lymphoma had very poor responses . We conclude that two doses of influenza vaccine do not improve the antibody response in patients with haematological malignancies This study assessed the safety and immunogenicity of a pediatric formulation of the 2003–2004 inactivated , trivalent , split virion influenza vaccine , administered in a 2-dose schedule in healthy children ages 6–36 months , of whom 94 % had protective titers ( ≥1/40 ) to at least 1 antigen . The 2003–2004 split virion influenza vaccine was safe and immunogenic in young children BACKGROUND There is a decrease in antibody levels after hematopoietic stem cell transplant ( HSCT ) , and such patients may be at increased risk of acquiring vaccine-preventable infection . A simple and vali date d revaccination schedule is required . The aim of this study was to evaluate the immunogenicity of a revaccination schedule for pediatric HSCT recipients . METHODS Thirty-eight children ( age , 1 - 18 years ) who had undergone autologous or allogeneic HSCT for malignant diseases were recruited . All children received vaccinations in accordance with a predefined schedule . Antibody concentrations were measured before and 2 - 4 weeks after vaccination against tetanus ; Haemophilus influenzae type b ( Hib ) ; meningococcus C ; measles ; poliovirus serotypes 1 , 2 , and 3 ; and 9 pneumococcus serotypes . RESULTS Before vaccination , protective antibody levels were found for tetanus in 95 % of patients ( geometric mean concentration [ GMC ] , 0.07 IU/mL ; 95 % CI , 0.05 - 0.1 IU/mL ) , for Hib in 63 % ( GMC , 0.34 microg/mL ; 95 % CI , 0.21 - 0.57 microg/mL ) , for measles in 60 % ( GMC , 102 mIU/mL ; 95 % CI , 41 - 253 mIU/mL ) , for meningococcus C in 11 % ( geometric mean titer [ GMT ] , 1:4 ; 95 % CI , 1:2 - 1:8.4 ) , for all 3 poliovirus serotypes in 29 % , and for all 9 pneumococcal serotypes in 0 % . Vaccination result ed in a significant increase ( P < or = .05 ) in antibody levels to each vaccine antigen studied , with 100 % of patients achieving protection against tetanus ( GMC , 2.2 IU/mL ; 95 % CI , 1.8 - 2.7 IU/mL ) , 100 % achieving protection against Hib ( GMC , 8.4 microg/mL ; 95 % CI , 7.6 - 9.3 microg/mL ) , 100 % achieving protection against measles ( GMC , 2435 mIU/mL ; 95 % CI , 1724 - 3439 mIU/mL ) , 100 % achieving protection against meningococcus C ( GMT , 1:5706 ; 95 % CI , 1:3510 - 1:9272 ) , 92 % achieving protection against the 3 poliovirus serotypes , and > or = 80 % achieving protection against each of the heptavalent pneumococcal conjugate vaccine-associated serotypes . No factors relevant to age , underlying disease , or treatment type were found to significantly influence responses . CONCLUSION Revaccination of pediatric HSCT recipients in accordance with this revaccination schedule provides a high level of protection against these vaccine-preventable diseases Young children and allogeneic hematopoietic cell transplantation ( HCT ) recipients respond poorly to polysaccharide antigens , rendering them susceptible to severe infections because of encapsulated bacteria . This study evaluated the responses of 127 HCT patients , median age 23.0 years , vaccinated with PNCRM7 and Haemophilus influenzae ( HIB ) conjugate , 2 conjugate vaccines highly immunogenic in healthy children .  Median time to vaccination was 1.1 years after HCT . Sixty-two percent of patients responded to PNCRM7 ( 45 of 51 children , 34 of 76 adults , P < .001 ) . Overall response to HIB was 86 % , including 77 % of PNCRM7 nonresponders . Although PNCRM7 response was adversely affected by older age ( P < .001 ) , individuals > or = 50 years old responded significantly better if vaccinated following acquisition of specific minimal milestones of immune competence , CD4 > 200/microL , IgG > 500 mg/dL , PHA within 60 % lower limit of normal ( 11 of 19 versus 0 of 8 , P < .006 ) . A similar trend was observed in patients with limited chronic graft-versus-host disease ( cGVHD ) .  In all patients , higher levels of circulating CD4(+)CD45RA cells correlated with improved PNCRM7 response . These data demonstrate that PNCRM7 is immunogenic in allogeneic HCT patients , including older adults , but suggest that vaccination at fixed intervals after HCT , irrespective of immune competence , may limit its effectiveness . Prospect i ve , multicenter trials assessing the best strategy to administer this vaccine and its impact on pneumococcal infections following transplantation are warranted Patients undergoing autologous hematopoietic stem cell transplantation ( autoHCT ) are at increased risk for infection with Streptococcus pneumoniae and have impaired antibody responses to pneumococcal polysaccharide vaccines . We performed this study to examine the ability of autoHCT patients to respond to a heptavalent pneumococcal conjugate vaccine ( PCV7 ) given after transplantation and to determine whether there was a potential benefit of immunizing these patients before stem cell collection . Sixty-one patients scheduled for autoHCT were r and omized to receive either PCV7 or no vaccine before stem cell collection . After stem cell reinfusion , all study patients were immunized with PCV7 at 3 , 6 , and 12 months . Pneumococcal immunoglobulin G antibody concentrations were measured at the time of each immunization and 1 month after the 12-month dose . Serotype-specific pneumococcal antibody concentrations were significantly higher in patients immunized with PCV7 before stem cell collection compared with patients not immunized before their stem cells were collected for 6 of 7 serotypes at 3 months , 6 of 7 serotypes at 6 months , 4 of 7 serotypes at 12 months , and 3 of 7 serotypes at 13 months . After the 3-dose series of PCV7 after autoHCT , > 60 % of study patients had protective concentrations of antibody to all 7 vaccine serotypes regardless of immunization before stem cell collection . Pneumococcal conjugate vaccine is immunogenic in autoHCT patients and may be an effective strategy to prevent invasive disease after transplantation In 27 patients r and omized to receive commercial trivalent influenza vaccine ( TIV ) containing 15 microg of the hemagglutinin ( HA ) of influenza A ( H3N2 and H1N1 ) and B virus or a recombinant vaccine ( rHAO ) containing 15 , 45 , or 135 microg of each HA , reactogenicity was minor . Among patients with similar prevaccination titers , 40 % given 45 microg and 60 % given 135 microg of rHAO developed an increase in influenza A/H3 neutralizing antibody levels ; there were no increases in 4 given TIV . For each vaccine , the highest frequencies of increases in neutralizing antibody levels and the highest mean titers occurred in those given the 135- microg vaccine The serum antibody responses of splenectomized patients with non-Hodgkin 's lymphoma ( NHL ) who had been immunized with a polyvalent pneumococcal vaccine ( Pneumovax 23 )  were evaluated by an enzyme-linked immunosorbent assay with the 23-valent pneumococcal vaccine as the antigen . A response to immunization , defined as a twofold-or-higher rise of the prevaccination titer of antibodies against Streptococcus pneumoniae polysaccharide , was elicited in 5 of 11 patients with NHL . No significant difference in the level of antibodies against S. pneumoniae polysaccharide between lymphoma patients and patients who had undergone splenectomy for other reasons was detected ( P = 0.83 and 0.87 before and after vaccination , respectively ) . NHL patients who did not respond to the first immunization received a booster dose of the polysaccharide vaccine . This injection did not increase the pneumococcal-antibody titer significantly ( P = 0.7 ) . We conclude that vaccination with pneumococcal polysaccharides in splenectomized patients with NHL elicits an adequate antibody response in 45.4 % of the cases and should therefore be administered . Revaccination of the nonresponders does not further increase the pneumococcal-antibody levels Forty-five adult allogeneic BMT recipients were r and omized to receive Haemophilus influenzae type b (Hib)-diphtheria toxoid conjugate vaccine ( PRP-D ) at 6 and pneumococcal polysaccharide vaccine ( Pnc PS ) at 8 months ( early group ; n = 23 ) or at 18 and 20 months ( late group ; n = 22 ) after BMT , respectively . Serum antibody concentrations against Hib and Pnc PS types with varying immunogenicity ( serotypes 3 , 6B , and 19F ) were measured by ELISA . The responses at 1 month after vaccination with PRP-D and Pnc PS were poor and similar in the two vaccination groups , except that two-fold responses in the concentration of antibodies to the most immunogenic Pnc serotype 3 occurred more frequently in the late group . In the late group recipients , the antibody responses elicited by Pnc serotypes 3 and 19F correlated with the concentrations of the corresponding antibodies in the donor . This study on allogeneic BMT recipients shows that vaccination at 6 - 8 months after BMT with one dose of PRP-D and Pnc PS vaccine is as immunogenic as vaccination at 18 - 20 months after BMT , and suggests that donor immunity to Pnc PS affects recipient responses to Pnc PS vaccination . Consequently , as among allogeneic BMT recipients the greatest risk for infections by encapsulated bacteria occurs during the first 1 - 2 years after BMT , Hib and Pnc vaccines should not be given later than 6 - 8 months post-BMT Background : Our aim was to determine the clinical and epidemiological features of p and emic influenza A/H1N1 in immunocompromised children with solid tumors and hematological malignancies . Patients and Methods : A prospect i ve study was conducted during the H1N1 p and emic between August 2009 and February 2010 in a pediatric hematology-oncology unit . Demographic and clinical data were obtained from all children with suspected H1N1 infection ( high fever with or without respiratory symptoms ) . Laboratory diagnosis of influenza A/H1N1 was performed by means of polymerase chain reaction analysis of nasopharyngeal wash specimens . Results : We identified 57 episodes of suspected influenza A/H1N1 infection in 40 children . In all episodes , children were treated with oseltamivir and antibiotics until influenza A/H1N1 results were received . Of all episodes , 13 ( 22.8 % ) tested positive for influenza A/H1N1 . Two of the H1N1-positive children ( 15.4 % ) had been previously immunized against influenza A/H1N1 . No differences between H1N1-positive and H1N1-negative children were noted in terms of demographic features , clinical presentation , laboratory findings , and underlying disease . Three polymerase chain reaction-positive ( 23.0 % ) children and 1 H1N1-negative ( 2.3 % ) child were admitted to the pediatric intensive care unit and were mechanically ventilated ( P=0.03 ) . One ( 7.7 % ) H1N1-positive patient died versus none of the H1N1-negative patients ( P=0.2 ) . The condition of all other children in both the groups improved rapidly during hospitalization . Conclusions : Febrile hospitalized pediatric oncology patients , with and without p and emic influenza A/H1N1 , had a similar demographic and clinical presentation with a relatively good outcome . This was probably because of early antiviral treatment and possibly because of the relatively low virulence of the virus . Immunization should be encouraged in these patients BACKGROUND Splenectomy is accompanied by a life-long risk of overwhelming postsplenectomy infection ( OPSI ) , mainly caused by polysaccharide ( PS ) encapsulated bacteria such as Streptococcus pneumoniae . Despite extensive prophylactic efforts the mortality and morbidity rates remain high . The present study was based on a strategy with a predefined vaccination algorithm including repeated 23-valent pneumococcal vaccinations and monitoring of pneumococcal antibody levels . The antibody levels of splenectomized Hodgkin 's lymphoma ( HL ) patients were compared with those patients splenectomized due to immune-mediated cytopenias [ autoimmune haemolytic anaemia ( AIHA ) and immune thrombocytopenic purpura ( ITP ) ] and also individuals who were splenectomized because of trauma ( TRAUMA ) . METHODS A total of 311 splenectomized individuals were included in this prospect i ve study ( 208 HL ; 15 AIHA ; 60 ITP ; 28 TRAUMA ) . Depending on their individual anti-PS antibody levels measured by enzyme-linked immunosorbent assay technique the patients were revaccinated with 23-valent pneumococcal PS vaccine up to four times in accordance with the predefined algorithm . For each vaccination occasion , serum was collected at vaccination , after 1 month + /- 2 weeks ( peak ) , and after 1 year + /- 6 months ( follow-up ) . Patient files , a national population -based data base , and microbiological data bases were checked for 124 HL patients to identify OPSI . RESULTS A significant response was recorded on primary vaccination as well as on two revaccination occasions for HL , AIHA/ITP , as well as TRAUMA patients . None of the variables age , gender , or time elapsed between splenectomy and first pneumococcal vaccination was found to be associated with mean PS antibody levels at prevaccination , peak or follow-up . No severe adverse events were reported . Amongst 124 clinical ly monitored HL patients , 10 OPSI were recorded in seven patients during the study period . One of these patients , a middle-aged female , died as a result of fulminant pneumococcal bacteraemia , which was her third OPSI during a 7-year period . CONCLUSIONS A significant response to pneumococcal PS vaccination was found in all three groups ( HL , AIHA/ITP and TRAUMA ) of splenectomized patients . Importantly , both primary and repeated vaccinations were safe . Until further knowledge is gained regarding the protective concentration of serotype-specific antibody concentrations we believe that the value of vaccination and frequent revaccination ( every 1 - 5 years ) in combination with education of patients and health care professionals and clinical monitoring is beneficial for these patients at risk for OPSI PURPOSE The aim of this study was to assess the immune response of children with acute lymphoblastic leukemia ( ALL ) to influenza vaccine and to compare it with healthy controls . PROCEDURE Thirty-two children aged 1 - 18 years with ALL on maintenance therapy and 30 healthy sibling controls were enrolled in the study . All children were vaccinated with trivalent inactivated influenza vaccine .  Hemagglutinin-inhibition ( HI ) antibody titers were determined in sera of both patient and control groups just before and 4 weeks after vaccination . The ability of each group to mount a protective ( > or = 40 ) and /or fourfold titer was measured . RESULTS The protective response for virus subunits among patients and healthy controls were 43.4 % versus 88 % for H1N1 ( P = 0.04 ) , 63.3 % versus 80 % for H3N2 antigens ( P = 0.06 ) , and 26 % versus 73 % for B antigen ( P = 0.001 ) . Responses for H1N1 and B subunits were significantly lower in patients than controls . In the patient group , the significant response to each virus was demonstrated in the analysis of pre- and post-vaccination geometric mean titer ( GMT ) ( P = 0.001 ) . The percentage of patients and controls with fourfold increase in HI titers were 56.2 % versus 80 % for H1N1 ( P = 0.04 ) , 40.6 % versus 53.3 % for H3N2 ( P = 0.31 ) , and 59.4 % versus 83.3 % for B ( P = 0.038 ) . Immune responses for H1N1 and B subunits were significantly lower in patients than controls . CONCLUSIONS Influenza vaccine is tolerated well in ALL patients with acceptable but limited immune response compared to healthy controls . These findings support the recommendation for annual influenza vaccination in children with ALL ZusammenfassungZiel der vorliegenden Studie war es zu untersuchen , ob eine zu Grunde liegende maligne hämatologische Erkrankung bei splenektomierten Patienten Einfluss auf die Immunantwort nach Impfung mit einem Bakterienpolysaccharid-Antigene ( Streptococcus pneumoniae , Haemophilus influenzae ) hat . Zwischen 1993 und 2003 wurden 44 splenektomierte Erwachsene in diese prospektive Studie eingeschlossen . 23 Patienten litten an einer malignen hämatologischen Erkrankung und waren zusätzlich splenektomiert ( HM ) ; 21 Patienten waren aufgrund eines Traumas splenektomiert ( T ) und dienten als Kontrollgruppe . Jeder Patient erhielt eine einmalige intramuskuläre Impfung mit 0,5 ml eines 23-valenten Pneumokokken Polysaccharid-Impfstoffes , sowie am and eren Arm 0,5 ml eines an Tetanus Toxid konjugierten Haemophilus influenzae Typ b Kapselpolysaccharid Impfstoffes . Betreffend die Impfantwort auf den 23-valenten Pneumokokken Impfstoff f and sich ein signifikant geringerer IgG und IgM Titeranstieg in der HM Gruppe verglichen mit der T-Gruppe ( medianer IgG Anstieg : 1.27 [ 25 to 75 % interquartile range : 0.7 ; 2.39 ] vs. 3.9 [ 2.1 ; 15.3 ] p < 0.001 ; medianer IgM Anstieg : 1.33 [ 1.0 ; 2.67 ] vs. 5.25 [ 2.33 ; 7.78 ] , p < 0.001 ) . In der HM Gruppe zeigten 8/23 und 6/23 Patienten einen zumindest zweifachen Titeranstieg von IgG und IgM , während die entsprechenden Werte für die T-Gruppe 16/21 und 16/20 betrugen . Der Antikörperanstieg in der HM Gruppe nach Hib-Impfung war zwar etwas ausgeprägter als nach der Pneumokokken-Polysaccharid Impfung , aber signifikant geringer als in der T-Gruppe . Zusammenfassend kann diskutiert werden , dass bei splenektomierten Patienten mit hämatologischer Grunderkrankung der Impferfolg nach Pneumokokken- aber auch nach Haemophilus influenzae-Impfung durch Bestimmung der Antikörper evaluiert werden sollte . Summary In this study we addressed the question of whether an underlying hematological malignancy may affect the immune response to vaccination against bacterial polysaccharide antigens ( e.g. Haemophilus influenzae type b , Streptococcus pneumoniae ) in splenectomized patients . Between 1993 and 2003 , 44 splenectomized adults from the outpatient clinic for infectious diseases were prospect ively included in the study : 23 patients suffered from hematological malignancies ( HM ) and had undergone splenectomy ; 21 were splenectomized following trauma ( T ) and served as the control group . Each patient received an intradeltoid injection with 0.5 ml of a single lot of a 23-valent pneumococcal polysaccharide vaccine , and 0.5 ml of a polyribosyl ribitol phosphate capsular polysaccharide vaccine of H. influenzae type b ( Hib ) into the opposite arm . Blood sample s for determination of pneumococcal and Hib antibodies were taken prior to vaccination and again 6–8 weeks later . In assessing responses to the 23-valent pneumococcal polysaccharide vaccine , we found significant differences in antibody titer increase between the HM and T groups ( median IgG increase 1.27 [ 0.7 ; 2.39 ] vs. 3.9 [ 2.1 ; 15.3 ] , P < 0.001 ; and median IgM increase 1.33 [ 1.0;2.67 ] vs. 5.25 [ 2.3 ; 7.78 ] , P < 0.001 ) . In the HM group , only 8/23 and 6/23 showed a titer increase of twice or more the base value for IgG and IgM respectively , whereas in the trauma group an adequate response was shown by 16/21 and 16/20 respectively . Patients with splenectomy and hematological malignancies  responded poorly to the 23-valent polysaccharide vaccine .  Response to the conjugated Hib vaccine was slightly better , but still significantly lower than in individuals with posttraumatic splenectomy . Data suggest that vaccination response to the polysaccharide vaccines should be evaluated at least in the high-risk group OBJECTIVE Cancer patients receiving chemotherapy  are at risk of acquiring influenza infections . Two-dose vaccination is a proposed strategy for increasing vaccination efficacy ; however , this has yet to be confirmed in this population . The purpose of this study was to clarify the efficacy and safety of this strategy . METHODS We conducted a multicentre prospect i ve study on a two-dose vaccination regimen in cancer patients receiving chemotherapy . Second vaccinations were performed in patients who did not respond to all three viral strains after the first vaccination . Serum haemagglutination inhibition titres were measured to determine the patients ' immunological response , 2 weeks prior to the first vaccination , 3 - 5 weeks after each vaccination , and at the end of the influenza season . RESULTS We enrolled 109 patients , including 70 with solid tumours , 36 with haematological malignancies , and 3 with both cancer types . Among the total patients , the proportion of patients with protective titres against the three viral strains increased significantly from 3 to 27 % ( P < 0.01 ) following vaccination . Among the 79 patients who received a second vaccination , the proportion of those with protective titres against the individual strains increased by 10 % ( H1N1 ) , 8 % ( H3N2 ) , and 3 % ( B ) compared with after the first vaccination . Serious adverse events were not observed . CONCLUSIONS We recommend influenza vaccinations for cancer patients , including those receiving chemotherapy . Also , the additional benefit of the second vaccination may be limited
BACKGROUND The risk of getting influenza and pneumococcal disease is higher in cancer patients , and serum antibody levels tend to be lower in patients with hematological malignancy .
OBJECTIVE To assess flu and pneumococcal vaccinations  efficacy , effectiveness , and safety in onco-hematological patients .