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      Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network

      review-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 2 , 12 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 7 , 23 , 24 , 25 , 7 , 26 , 2 , 27
      Leukemia
      Nature Publishing Group UK
      Health care, Disease prevention

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          Abstract

          Vaccination is one of the most successful medical interventions that has saved the life of millions of people. Vaccination is particularly important in patients with multiple myeloma, who have an increased risk of infections due to the disease-inherent immune suppression, and because of the immune suppressive effects of therapy. Hence, all appropriate measures should be exploited, to elicit an effective immune response to common pathogens like influenza, pneumococci, varicella zoster virus, and to those bacteria and viruses (haemophilus influenzae, meningococci, and hepatitis) that frequently may pose a significant risk to patients with multiple myeloma. Patients after autologous, and specifically after allogeneic transplantation have severely reduced antibody titers, and therefore require a broader spectrum of vaccinations. Response to vaccination in myeloma often is less vigorous than in the general population, mandating either measurement of the postvaccination antibody titers and/or repeating the vaccination. Here, we compile the existing data on vaccination in multiple myeloma and provide recommendations for clinical practice.

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          EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.

          Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase. All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors. The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint. The typical indication for treatment requires HBV DNA >2,000IU/ml, elevated ALT and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide, represents the treatment of choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All treated and untreated patients should be monitored for treatment response and adherence, and the risk of progression and development of complications. HCC remains the major concern for treated chronic hepatitis B patients. Several subgroups of patients with HBV infection require specific focus. Future treatment strategies to achieve 'cure' of disease and new biomarkers are discussed.
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            Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.

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              Estimates of global seasonal influenza-associated respiratory mortality: a modelling study

              Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015.
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                Author and article information

                Contributors
                heinz.ludwig@extern.gesundheitsverbund.at
                Journal
                Leukemia
                Leukemia
                Leukemia
                Nature Publishing Group UK (London )
                0887-6924
                1476-5551
                19 August 2020
                19 August 2020
                2021
                : 35
                : 1
                : 31-44
                Affiliations
                [1 ]Wilhelminen Cancer Research Institute, c/o 1st Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Vienna, Austria
                [2 ]GRID grid.432329.d, ISNI 0000 0004 1789 4477, Myeloma Unit, Division of Hematology, , Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, ; Torino, Italy
                [3 ]GRID grid.411162.1, ISNI 0000 0000 9336 4276, Service hematologie et thérapie cellulaire, PRC. cic 1402 Inserm, , CHU poitiers, ; Poitiers, France
                [4 ]GRID grid.411730.0, ISNI 0000 0001 2191 685X, CIMA, IDISNA, CIBERONC, , Clínica Universidad de Navarra, ; Pamplona, Spain
                [5 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Seràgnoli Institute of Hematology, , Bologna University School of Medicine, ; Bologna, Italy
                [6 ]GRID grid.18886.3f, ISNI 0000 0001 1271 4623, The Institute of Cancer Research, ; London, UK
                [7 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Hematology, Amsterdam UMC, , VU University, ; Amsterdam, The Netherlands
                [8 ]GRID grid.410463.4, ISNI 0000 0004 0471 8845, Hôpital Claude Huriez, , Lille University Hospital, ; Lille, France
                [9 ]GRID grid.413349.8, ISNI 0000 0001 2294 4705, Department of Medical Oncology and Hematology, , Cantonal Hospital St Gallen, ; St Gallen, Switzerland
                [10 ]GRID grid.412684.d, ISNI 0000 0001 2155 4545, Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, , University of Ostrava, ; Ostrava, Czech Republic
                [11 ]GRID grid.5216.0, ISNI 0000 0001 2155 0800, Hematology & Medical Oncology, Department of Clinical Therapeutics, , National and Kapodistrian University of Athens, ; Athens, Greece
                [12 ]GRID grid.508721.9, Unité de Génomique du Myélome, , University of Toulouse, ; Toulouse, France
                [13 ]1st Department of Medicine, Center for Hematology, Oncology, and Palliatic Care, Clinic Ottakring, Vienna, Austria
                [14 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Department of Clinical Hematology and Cellular Therapy, Hospital Saint-Antoine, , Sorbonne University, ; Paris, France
                [15 ]GRID grid.411258.b, IBSAL, Cancer Research Center, , University Hospital of Salamanca, ; Salamanca, Spain
                [16 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Department of Internal Medicine II, , University Hospital Würzburg, ; Würzburg, Germany
                [17 ]GRID grid.410569.f, ISNI 0000 0004 0626 3338, Department of Hematology, , UZ Leuven, ; Leuven, Belgium
                [18 ]GRID grid.411374.4, ISNI 0000 0000 8607 6858, Department of Clinical Hematology, , CHU of Liège, ; Liège, Belgium
                [19 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, II. Medizinische Klinik und Poliklinik, , Universitätsklinikum Hamburg—Eppendorf, ; Hamburg, Germany
                [20 ]GRID grid.420004.2, ISNI 0000 0004 0444 2244, NCCC, , Newcastle upon Tyne Hospitals Trust, ; Newcastle upon Tyne, UK
                [21 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine-Team Proliferation and Differentiation of Stem Cells, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service d’Hématologie, , Sorbonne Université, ; Paris, France
                [22 ]GRID grid.5963.9, Interdisciplinary Tumor Center, Faculty of Freiburg, , University of Freiburg, ; Freiburg, Germany
                [23 ]GRID grid.411162.1, ISNI 0000 0000 9336 4276, Poitiers University Hospital, ; Poitiers, France
                [24 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Internal Medicine V and National Center for Tumor Diseases (NCT), , University Hospital Heidelberg, ; Heidelberg, Germany
                [25 ]GRID grid.7256.6, ISNI 0000000109409118, Department of Hematology, , Ankara University, ; Ankara, Turkey
                [26 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Hematology, Odense University Hospital, , University of Southern Denmark, ; Odense, Denmark
                [27 ]GRID grid.6906.9, ISNI 0000000092621349, Erasmus MC Cancer Institute, , Erasmus University of Rotterdam, ; Rotterdam, The Netherlands
                Author information
                http://orcid.org/0000-0002-3302-8726
                http://orcid.org/0000-0001-8130-5209
                http://orcid.org/0000-0002-7190-0028
                http://orcid.org/0000-0001-6955-6267
                http://orcid.org/0000-0001-5133-1422
                http://orcid.org/0000-0003-2390-1218
                http://orcid.org/0000-0002-7680-0819
                http://orcid.org/0000-0003-1797-8657
                Article
                1016
                10.1038/s41375-020-01016-0
                7787974
                32814840
                ebc3437d-0673-4feb-82a4-940faa6ab118
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 8 April 2020
                : 24 July 2020
                : 5 August 2020
                Categories
                Review Article
                Custom metadata
                © The Author(s), under exclusive licence to Springer Nature Limited 2021

                Oncology & Radiotherapy
                health care,disease prevention
                Oncology & Radiotherapy
                health care, disease prevention

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