Abstract
Children with CML need TKI treatment for many years, and the lack of knowledge about immune dysfunction with TKI has hindered routine immunizations. This review attempts to provide an overview of the effects of TKIs licensed for children (e.g., imatinib, dasatinib, and nilotinib) on immune function, as well as its implications on immunizations. We discuss surveillance strategies (e.g., immunoglobulin blood serum levels and hepatitis B reactivation) and immunizations. All inactivated vaccines (e.g., influenza, pneumococcal, and streptococcal) can be given during the treatment of CML in the chronic phase, although their efficacy may be lower. As shown in single cases of children and adults with CML, live vaccines (e.g., varicella, measles, mumps, rubella, and yellow fever) may be administered under defined circumstances with great precautions. We also highlight important aspects of COVID-19 in this patient population (e.g., the outcome of COVID-19 infection in adults with CML and in children with varying hemato-oncological diseases) and discuss the highly dynamic field of presently available different vaccination options. In conclusion, TKI treatment for CML causes humoral and cellular immune dysfunction, which is mild in most patients, and thus infectious complications are rare. Routine immunizations are important for health maintenance of children, but vaccinations for children with CML on TKI therapy should be carefully considered.
Highlights
Chronic myeloid leukemia (CML) is a clonal myeloproliferative malignancy characterized by the presence of a BCR-ABL1 fusion gene as a consequence of the t(9;22)(q34.1;q11.2)reciprocal chromosomal translocation
We provide an overview of the effects of tyrosine kinase inhibitor (TKI) on immune function that have emerged to date, as well as its implications for immunizations
During the COVID-19 pandemic, data reported from Italy and China pointed to a lower prevalence in patients under TKI treatment
Summary
Chronic myeloid leukemia (CML) is a clonal myeloproliferative malignancy characterized by the presence of a BCR-ABL1 fusion gene as a consequence of the t(9;22)(q34.1;q11.2). TKIs function by blocking the activity of BCR-ABL1. The introduction of TKIs has dramatically increased the survival of patients with CML. TKIs inhibit BCR-ABL1 and many other targets, and they cause various side effects via off-target effects, including impaired immune function [5]. Children with CML need TKI treatment for many years, and the lack of knowledge about immune dysfunction with TKIs has hindered routine immunizations. We provide an overview of the effects of TKIs on immune function that have emerged to date, as well as its implications for immunizations. We highlight important aspects of COVID-19 in this patient population and discuss the different vaccination options
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