. 2023 Jul 29;25(Suppl 1):e14109. doi: 10.1111/tid.14109

TABLE 3.

Recommendations on revaccination timing post cellular therapy from expert international guidelines, expert center protocols, and expert opinion.

	Consensus guidelines (EBMT/JACIE/EHA, ASH‐ASTCT)	Expert center protocols	Expert opinions
Killed and inactivated vaccines: PCV13 (3 doses) PPSV23 (1 doses) DTaP (3 doses) HBV (3 doses) HAV (2 doses) SARS‐CoV‐2 (3+ doses) IIV (2 doses) VZV (aRZV) (2 doses) ACYW‐135 (2 doses) ^a Hib (3 doses) ^a	≥3 months after CAR‐T therapy AND Demonstrated immune reconstitution^* AND No ongoing immunosuppression (see text).	No IVIg in prior 2 months No anti‐CD19 or anti‐CD20 antibody therapy in prior 6 months Demonstrate vaccine response on one killed vaccine prior to revaccination with remaining schedule	Demonstrate detectable serum IgA (evidence of class switching) If no vaccine response demonstrated, re‐check immune reconstitution in 6 months and continue IVIg
Live vaccines MMR (2 doses) VZV (LAVV) (2 doses) Many travel vaccines (e.g., typhoid, yellow fever, and polio oral vaccine)	≥12 months after CAR‐T therapy AND Demonstrated immune reconstitution^* AND No ongoing immunosuppression AND No IVIg in prior 8 months	No IVIg in prior 5 months No anti‐CD19 or anti‐CD20 antibody therapy in prior 6 months No HCT ≤2 years prior No systemic immunosuppression in prior 12 months Demonstrated response to killed/inactive vaccine	Demonstrate detectable serum IgA (evidence of class switching)

Consensus guidelines (EBMT/JACIE/EHA, ASH‐ASTCT)

Expert center protocols

Expert opinions

Killed and inactivated vaccines:

PCV13 (3 doses)

PPSV23 (1 doses)

DTaP (3 doses)

HBV (3 doses)

HAV (2 doses)

SARS‐CoV‐2 (3+ doses)

IIV (2 doses)

VZV (aRZV) (2 doses)

ACYW‐135 (2 doses) ^a

Hib (3 doses) ^a

≥3 months after CAR‐T therapy

AND

Demonstrated immune reconstitution^*

AND

No ongoing immunosuppression (see text).

No IVIg in prior 2 months

No anti‐CD19 or anti‐CD20 antibody therapy in prior 6 months

Demonstrate vaccine response on one killed vaccine prior to revaccination with remaining schedule

Demonstrate detectable serum IgA (evidence of class switching)

If no vaccine response demonstrated, re‐check immune reconstitution in 6 months and continue IVIg

Live vaccines

MMR (2 doses)

VZV (LAVV) (2 doses)

Many travel vaccines (e.g., typhoid, yellow fever, and polio oral vaccine)

≥12 months after CAR‐T therapy

AND

Demonstrated immune reconstitution^*

AND

No ongoing immunosuppression

AND

No IVIg in prior 8 months

No IVIg in prior 5 months

No anti‐CD19 or anti‐CD20 antibody therapy in prior 6 months

No HCT ≤2 years prior

No systemic immunosuppression in prior 12 months

Demonstrated response to killed/inactive vaccine

Demonstrate detectable serum IgA (evidence of class switching)

Abbreviations: ACYW‐135, meningococcal quadrivalent conjugate vaccine; aRZV, adjuvanted recombinant zoster virus vaccine; CAR‐T, chimeric antigen receptor T cell; CD19, cluster of differentiation 19; CD20, cluster of differentiation 20; DTaP, higher dose diphtheria, tetanus, and acellular pertussis vaccine; HAV vaccine, hepatitis A virus; HBV vaccine, hepatitis B virus; HCT, hematopoietic cell transplant; Hib, Haemophilus influenzae type B conjugate vaccine; IgA, immunoglobulin A; IIV, inactivated influenza vaccine; IVIg, intravenous immunoglobulin; LAVV, live‐attenuated varicella vaccine; MMR, measles, mumps, and rubella live virus vaccine; PCV, pneumococcal conjugate vaccine; PPSV23, pneumococcal 23‐valent polysaccharide vaccine; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; VZV, varicella zoster virus.

^{^a}

Revaccination against meningococcal and hemophilus to be considered in patients with CAR‐T patients and additional risk factors, such as splenectomy.