Pneumococcal Vaccination in Hematological Malignancies (HM)-Indian Hematology Expert Consensus 2025
Pneumococcal vaccination is strongly recommended for patients with specific hematological malignancies, a recently released Indian hematology expert consensus has stated.
The consensus, published in Frontiers in Oncology (May 2025), addresses critically low vaccination rates in India, with only 0.68% in elderly cancer patients ≥60 years and 1.8% in cancer patients aged ≥45 years having received pneumococcal vaccination. To develop this consensus, a six-member Indian hematology panel with ≥10 years' experience from all four zones of India led a modified Delphi process involving PubMed/MEDLINE review (1970–2024), Round-1 e-survey, Round-2 virtual meeting, and final approval.
Key Consensus Recommendations
| No | Recommendations | Consensus Level |
| 1 | PCV first, followed by PPSV23 8 weeks later, is the optimum pneumococcal vaccination sequence in patients with hematological malignancies (after immune status assessment).
| High Consensus, GOR ++ “highly beneficial, recommended without restriction, should be performed” |
| 2 | Immediate vaccination with PCV13 is strongly recommended for Chronic Lymphocytic Leukemia, Multiple Myeloma, and Hematopoietic Stem Cell Transplantation patients.
| High Consensus |
| 3 | Pneumococcal vaccination is strongly recommended for splenectomy, acute lymphoblastic leukemia, and newly diagnosed lymphoma patients.
| High Consensus |
| 4 | Systematic revaccination is advised for acute lymphoblastic leukemia children; PCV13 is recommended post-chemotherapy in acute lymphoblastic leukemia.
| Moderate Consensus |
| 5 | Conditional vaccination during maintenance therapy for multiple myeloma and lymphoma is supported.
| Moderate Consensus |
| 6 | Infections in hematological malignancy patients are highly fatal and prolonged.
| 100% Expert Agreement |
| 7 | Vaccination reduces pneumonia risk and lowers infection-related deaths.
| Evidence-based finding highlighted by the consensus |
One of the authors of the consensus, Dr. Tulika Seth, Professor of Haematology, AIIMS, New Delhi, shared her insights on the consensus. "The key takeaway is that vulnerable patients with blood disorders can now be protected from a serious infection that can lead to pneumonia or other infections."
On pneumococcal disease prevention in sickle cell disease patients, Dr. Seth further highlighted, "The persons living with sickle cell disease are also at high risk for pneumococcal infections. International guidelines have recommended vaccination, and the government has adopted this strategy to protect our population with sickle cell disease. More options of pneumococcal vaccine and specifically those which cover endemic strains will add to the benefits of vaccination and disease prevention."
Commenting on the newly launched single dose pneumococcal vaccine PCV20 and its value in hematological malignancies, she noted, "The guidelines took a lot of time and effort to prepare. The hard work was done prior to the release of this new version of pneumococcal vaccine. It is a good move and we now have more options. I look forward to real world data on its effectiveness."
PCV 20 – Single Dose Pneumococcal Vaccination Now Available in India
PCV20 is now available in India, providing a broad and long-lasting immune response through a single dose. The updated CDC-ACIP and Indian Consensus Guidelines for Adult Immunisation recommend consideration of PCV20 as a single dose for all adults aged ≥50 years and for adults aged 19–49 years with immunocompromising conditions, including cancer, HIV, and AIRDs and chronic conditions (diabetes, chronic heart, lung, liver, or kidney disease).
Abbreviations: PCV – Pneumococcal Conjugate Vaccine, PPSV23 – 23-Valent Pneumococcal Polysaccharide Vaccine, PCV13 – 13-Valent Pneumococcal Conjugate Vaccine, PCV15 – 15-Valent Pneumococcal Conjugate Vaccine, PCV20 – 20-Valent Pneumococcal Conjugate Vaccine, HMs – Hematological Malignancies, CLL – Chronic Lymphocytic Leukemia, MM – Multiple Myeloma, HSCT – Hematopoietic Stem Cell Transplantation, ALL – Acute Lymphoblastic Leukemia, AML – Acute Myeloid Leukemia, CML – Chronic Myeloid Leukemia, NHL – Non-Hodgkin Lymphoma, IPD – Invasive Pneumococcal Disease, AIRDs – Autoimmune Rheumatic Diseases, ChT – Chemotherapy, ICU – Intensive Care Unit, GOR – Grade of Recommendation, Delphi – Modified Delphi Consensus Process (structured expert consensus methodology), CDC – Centers for Disease Control and Prevention, ACIP – Advisory Committee on Immunization Practices
References
1. Seth, Tulika et al. “Preventing pneumococcal infections in patients with hematological malignancies: a review of evidence and recommendations based on modified Delphi consensus.” Frontiers in Oncology vol. 15 1546641. 1 May. 2025, doi:10.3389/fonc.2025.1546641
2. Centers for Disease Control and Prevention (CDC). Pneumococcal Vaccine Timing for Adults. NCIRDwt; October 2024. Available at: www.cdc.gov/pneumococcal
3. Indian Consensus Guideline on Adult Immunization. Available at: https://apiindia.org/reader/Indian%20Consensus%20Guideline%20on%20Adult%20Immunization. Accessed on: 03 September 2025.
