When treating pancreatic body/tail lesions that result in significant dose spread to the spleen, what is your threshold to offer pneumococcal, hemophilus influenza, and meningococcal vaccines? 

A really great question, and one that we don’t necessarily have a lot of data for guidance. There are some guidelines out there, though, that I think can be helpful to consider. The first is the recent guideline from ASCO on the vaccination of adults with cancer (Kamboj et al., PMID 38498792). In line with CDC guidance, adult patients with cancer are recommended to get the pneumococcal vaccine independent of splenic dose considerations. For Hib and meningococcal vaccination, it should be considered for patients with other specific risk factors including functional asplenia. Regarding a threshold radiation dose, a report from the Childhood Cancer Survivor Study found an association between radiation dose to the spleen and late infection-rela...

No threshold