Eligibility criteria for vaccinations after CD19-targeted CAR–T-cell therapy
| Criteria for vaccinations . |
|---|
| Indications* |
| Killed/inactivated vaccines† |
| • ≥6 mo post CD19-targeted CAR–T-cell therapy |
| • ≥2 mo since last immunoglobulin treatment; a trial off of supplemental immunoglobulins can be considered in patients without chronic or serious bacterial infections in the preceding 6 mo |
| Live and nonlive adjuvant vaccines |
| • ≥1 y post CD19-targeted CAR–T-cell therapy |
| Contraindications* |
| Killed/inactivated vaccines† |
| • Supplemental immunoglobulins within the past 2 mo |
| • Receiving immunosuppressive therapy that reduces T-cell or B-cell function or active symptoms of graft-versus-host disease that requires treatment |
| • Administration of an anti-CD20 or anti-CD19 agent within the past 6 mo |
| • Actively receiving chemotherapy‡ |
| Live and nonlive adjuvant vaccines |
| • Administration of an anti-CD20 or anti-CD19 agent within the past 6 mo |
| • ≤1 y post CD19-targeted CAR–T-cell therapy |
| • ≤2 y post autologous or allogeneic HCT |
| • ≤1 y off all systemic immunosuppressive therapy |
| • ≤8 mo after last dose of supplemental immunoglobulins |
| • Absolute CD4+ T-cell count ≤200 cells/mm3 |
| • Absolute CD19+ or CD20+ B-cell count ≤20 cells/mm3 |
| • Actively receiving chemotherapy‡ |
| Criteria for vaccinations . |
|---|
| Indications* |
| Killed/inactivated vaccines† |
| • ≥6 mo post CD19-targeted CAR–T-cell therapy |
| • ≥2 mo since last immunoglobulin treatment; a trial off of supplemental immunoglobulins can be considered in patients without chronic or serious bacterial infections in the preceding 6 mo |
| Live and nonlive adjuvant vaccines |
| • ≥1 y post CD19-targeted CAR–T-cell therapy |
| Contraindications* |
| Killed/inactivated vaccines† |
| • Supplemental immunoglobulins within the past 2 mo |
| • Receiving immunosuppressive therapy that reduces T-cell or B-cell function or active symptoms of graft-versus-host disease that requires treatment |
| • Administration of an anti-CD20 or anti-CD19 agent within the past 6 mo |
| • Actively receiving chemotherapy‡ |
| Live and nonlive adjuvant vaccines |
| • Administration of an anti-CD20 or anti-CD19 agent within the past 6 mo |
| • ≤1 y post CD19-targeted CAR–T-cell therapy |
| • ≤2 y post autologous or allogeneic HCT |
| • ≤1 y off all systemic immunosuppressive therapy |
| • ≤8 mo after last dose of supplemental immunoglobulins |
| • Absolute CD4+ T-cell count ≤200 cells/mm3 |
| • Absolute CD19+ or CD20+ B-cell count ≤20 cells/mm3 |
| • Actively receiving chemotherapy‡ |
Patients who previously received an HCT should also meet HCT-related criteria. These recommendations are irrespective of ongoing CD19+ B-cell aplasia.
For seasonal influenza vaccination, all patients should receive the annual vaccine irrespective of the above criteria.
Vaccination may be considered in patients who are receiving certain therapies that do not suppress T-cell and B-cell responses, such as checkpoint inhibitors, immunomodulatory agents (eg, lenalidomide), tyrosine kinase inhibitors, and select other agents.