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Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Immune System

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Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) are indicated at the recommended age for all children with asplenia. Following the administration of the appropriate number of doses of PCV13, PPSV23 should be administered starting at age 24 months. A second dose should be administered 5 years later. For children aged 2 to 5 years with a complete PCV7 series who have not received PCV13, a supplemental dose of PCV13 should be administered. For asplenic individuals aged 6 to 18 years who have not received a dose of PCV13, a supplemental dose of PCV13 should be considered.[7] (Refer to the Pneumococcal Infections section of the Red Book for more information.) Hib immunization should be initiated at age 2 months, which is recommended for otherwise healthy young children and for all previously unimmunized children with asplenia.[7] (Refer to the Scheduling Immunizations section of the Red Book for more information.)

Daily antimicrobial prophylaxis against pneumococcal infections is recommended for many children with asplenia, regardless of their immunization status. Although the efficacy of antimicrobial prophylaxis has been proven only in patients with sickle cell anemia, other children with asplenia at particularly high risk, such as children with malignant neoplasms or thalassemia, should also receive daily chemoprophylaxis. In general, antimicrobial prophylaxis (in addition to immunization) should be considered for all children with asplenia younger than 5 years and for at least 1 year after splenectomy.

The age at which chemoprophylaxis is discontinued is often an empiric decision. On the basis of a multicenter study, prophylactic penicillin can be discontinued at age 5 years in children with sickle cell disease who are receiving regular medical attention and who have not had a severe pneumococcal infection or surgical splenectomy. The appropriate duration of prophylaxis is unknown for children with asplenia attributable to other causes. Some experts continue prophylaxis throughout childhood and into adulthood for particularly high-risk patients with asplenia.

Table 12. Spleen Late Effects

Predisposing TherapyImmunologic EffectsHealth Screening/Interventions
GVHD = graft-versus-host disease; HSCT = hematopoietic stem cell transplantation; IgA = immunoglobulin A; T = temperature.
Radiation impacting spleen; splenectomy; HSCT with currently active GVHDAsplenia/hyposplenia; overwhelming post-splenectomy sepsisBlood cultures during febrile episodes (T >38.5°C); empiric antibiotics
HSCT with any history of chronic GVHDImmunologic complications (secretory IgA deficiency, hypogammaglobulinemia, decreased B cells, T cell dysfunction, chronic infections [e.g., conjunctivitis, sinusitis, and bronchitis associated with chronic GVHD])History: chronic conjunctivitis, chronic sinusitis, chronic bronchitis, recurrent or unusual infections, sepsis
Exam: attention to eyes, nose/sinuses, and lungs
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