{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T02:02:10Z","timestamp":1790560930390,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T00:00:00Z","timestamp":1753488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Multiple myeloma (MM) is a hematological malignancy characterized by profound immunosuppression resulting from both disease\u2010related mechanisms and treatment\u2010induced immune dysfunction. This compromised immune status markedly increases susceptibility to infections, a leading cause of morbidity and mortality in MM patients. While vaccination represents a cornerstone of infection prevention, standard immunization strategies often yield suboptimal responses in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This review synthesizes current evidence on the immunological barriers and clinical effectiveness of vaccination in MM. We evaluate vaccines targeting influenza, <jats:styled-content style=\"fixed-case\"><jats:italic>Streptococcus pneumoniae<\/jats:italic><\/jats:styled-content>, SARS\u2010CoV\u20102, and other relevant pathogens, and explore determinants influencing vaccine efficacy, including optimal timing, formulation, and patient\u2010specific immune parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive literature review was conducted, encompassing clinical trials, retrospective cohort studies, expert consensus guidelines, and population\u2010based data. Extracted outcomes included serological responses, infection\u2010related events, and vaccine safety in MM patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with MM exhibit impaired vaccine responses due to hypogammaglobulinemia, T\u2010 and B\u2010cell dysfunction, and therapy\u2010induced lymphodepletion. Despite modest immunogenicity, influenza and pneumococcal vaccines reduce respiratory infections and hospitalizations. Sequential administration of PCV13 followed by PPSV23, as well as post\u2010autologous stem cell transplantation (ASCT) three\u2010dose regimens, is associated with reduced pneumonia incidence. COVID\u201019 vaccines elicit variable responses, particularly in patients on anti\u2010CD38 or BCMA\u2010targeted therapies, highlighting the need for booster doses and, in selected cases, prophylactic monoclonal antibodies. Vaccines against herpes zoster, hepatitis B, and <jats:styled-content style=\"fixed-case\"><jats:italic>Haemophilus influenzae<\/jats:italic><\/jats:styled-content> type B are also recommended, particularly around ASCT. Immunophenotypic markers such as CD19+ B\u2010cell and CD4+ T\u2010cell counts are predictive of vaccine responsiveness, supporting immune profiling as a tool for individualized vaccination planning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaccination remains a critical component of infection prevention in MM. Although immunogenicity may be attenuated, clinical benefits\u2014namely, reduced infection burden and healthcare utilization\u2014support broad vaccine implementation. A personalized approach, considering the treatment phase, disease control, and immune status, is essential to optimize vaccine effectiveness. Ongoing research into high\u2010dose, adjuvanted, and next\u2010generation vaccines is critical to enhance protection in this vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.70013","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T07:28:59Z","timestamp":1753514939000},"page":"334-343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Vaccination in Multiple Myeloma: Challenges and Strategies"],"prefix":"10.1111","volume":"115","author":[{"given":"Enrica Antonia","family":"Martino","sequence":"first","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Vigna","sequence":"additional","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology  Cosenza 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