Care Gaps in Revaccination of Non-Hematopoietic Stem Cell Transplant Childhood Cancer Survivors

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Pediatric Blood & Cancer

Abstract

Background: National childhood vaccination rates are declining. For children entering kindergarten in 2016-2017 compared to 2024-2025, national vaccination rates fell from 95.2% to 92.1% for DTaP, 95.2% to 92.5% for Polio, 95% to 92.5% for MMR and 94.2% to 92.1% for 2 dose varicella. Additionally, data overall suggest childhood cancer survivors are inadequately protected against vaccine preventable disease. One study specifically found only 26.7% of those who received two doses of the MMR vaccine before diagnosis had positive measles and mumps titers following treatment. There is no national standard for revaccination for non-hematopoietic stem cell transplant (non-HSCT) childhood cancer survivors.

Objectives: Ascertain the current practice regarding revaccination protocol for non-HSCT childhood cancer survivors at Helen Devos Children’s Hospital (HDVCH) to identify gaps in care and potential benefit of practice standardization.

Design/Method: Ten question, single answer choice survey completed by the ten HDVCH pediatric hematology/oncology physicians. Each question included a text box for further clarification and detailed responses.

Results: 1/10 HDVCH providers routinely revaccinate nonHSCT patients, 3/10 elect to sometimes, depending on diagnosis, treatment or titers, and for 6/10 it is not their standard practice. The one provider who routinely revaccinates does so after assessing titers, most often giving Pneumovax, while only one additional provider routinely checks titers and 1/10 sometimes check titers depending on therapy received or delayed lymphocyte recovery. 7/10 do not routinely assess childhood vaccines titers. 4/10 providers routinely assess for immune reconstitution, primarily via absolute lymphocyte count or immunoglobulins. For management of routine childhood vaccines post therapy 4/10 rely on PCP, 4/10 co-manage with the PCP and 2/10 managed themselves. 7/10 providers felt specific attention and specialized protocol would be necessary for revaccinating post-immunotherapy (ex. Blinatumomab and Rituximab). 10/10 providers agree that a standardized post chemotherapy vaccine protocol would potentially benefit their practice.

Conclusion: There is no consensus or standard for revaccinating non-HSCT childhood cancer survivors at HDVCH, a population particularly at risk given inadequate protection against vaccine preventable disease and the national growing threat to heard immunity. Additionally, the rise in immunotherapy (ex. Blinatumomab) and immune modulators as primary therapy requires further research on the impact of these treatments to vaccine titers and post therapy vaccine efficacy and timing. Identifying these inconsistencies highlights a significant gap in care and provides the basis on which to develop a practice wide standardization for revaccination to ensure lifelong health in this vulnerable population.

Volume

73

Issue

Suppl 2

First Page

s211

Comments

American Society of Pediatric Hematology/Oncology(ASPHO) Conference, April 29-May 2, 2026, Minneapolis, MN

Helen DeVos Children’s Hospital

Last Page

s212

DOI

10.1002/1545-5017.70343

ISSN

1545-5009

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