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Volume 14
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10.3390/vaccines14010046
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Article

Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel

by
Monia Marchetti
1,*,
Giovanni Barosi
2,
Francesco Passamonti
3,4,
Marco Falcone
5,
Emanuele Nicastri
6,
Simona Sica
7,8,
Pellegrino Musto
9,10,
Francesca Romana Mauro
11 and
Corrado Girmenia
12
1
Hematology and Transplant Unit, Azienda Ospedaliera Universitaria di Alessandria, University of Eastern Pedemont, 15121 Alessandria, Italy
2
Center for the Study of Myelofibrosis, Scientific Direction, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, 27100 Pavia, Italy
3
Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
4
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
5
Department of Clinical and Experimental Medicine, Azienda Osperdaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
6
National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy
7
Department of Laboratory and Hematological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
8
Hematology Section, Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, 20123 Rome, Italy
9
Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy
10
Department of Precision and Regenerative Medicine and Ionian Area, “Aldo Moro” University School of Medicine, 70121 Bari, Italy
11
Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
12
Dipartimento di Attività Cliniche Onco-Ematologiche, Dermatologiche e della Diagnostica Anatomo-Patologica, Azienda Ospedaliera Universitaria Policlinico Umberto I, 00161 Rome, Italy
 
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*
Author to whom correspondence should be addressed.
Vaccines 2026, 14(1), 46; https://doi.org/10.3390/vaccines14010046 (registering DOI)
Submission received: 12 November 2025 / Revised: 18 December 2025 / Accepted: 26 December 2025 / Published: 30 December 2025
(This article belongs to the Special Issue Vaccination for Patients with Hematologic Diseases)
Review Reports Versions Notes

Abstract

Background: Pre-exposure passive immune prophylaxis (PrEP) might contribute to improve hematologic malignancy (HM) outcomes; however, there are currently no specific guidelines to inform patient selection. Methods: A literature review and a Delphi consensus process were used to identify COVID-19 risk factors, critical COVID-19 outcomes, and efficacy of PrEP against SARS-CoV-2 in HMs. An analytic hierarchy process was used to assign a priority score to candidate outcomes and to determine the PrEP indications. For these decisions, the experts assumed adequate compliance with anti-COVID-19 vaccination and acknowledged the effectiveness of PrEP in reducing SARS-CoV-2-related mortality and hospital admissions. Results: Based on the literature review, the expert panel identified 80 risk categories among patients with HM and prioritized eight clinical outcomes related to SARS-CoV-2 PrEP. The highest mean priority scores were observed for HM-related mortality (7.0), intensive care unit admission (6.7), and delays in anti-HM treatment (6.6). Based on such a framework, the experts deemed that if there was a variant-specific PrEP promptly available, it would be considered mandatory for all candidates receiving allogeneic hematopoietic cell transplantation, CAR-T therapy, or bispecific antibodies, regardless of local viral epidemiology. During epidemiological waves, variant-specific PrEP would also be recommended for patients with HMs at high risk of unfavorable COVID-19 clinical outcomes. Conclusions: This study identified PrEP indications for patients with HM receiving appropriate active immunization against COVID-19.
Keywords: COVID-19; immune prophylaxis; vaccine; hematologic malignancies COVID-19; immune prophylaxis; vaccine; hematologic malignancies

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MDPI and ACS Style

Marchetti, M.; Barosi, G.; Passamonti, F.; Falcone, M.; Nicastri, E.; Sica, S.; Musto, P.; Mauro, F.R.; Girmenia, C. Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel. Vaccines 2026, 14, 46. https://doi.org/10.3390/vaccines14010046

AMA Style

Marchetti M, Barosi G, Passamonti F, Falcone M, Nicastri E, Sica S, Musto P, Mauro FR, Girmenia C. Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel. Vaccines. 2026; 14(1):46. https://doi.org/10.3390/vaccines14010046

Chicago/Turabian Style

Marchetti, Monia, Giovanni Barosi, Francesco Passamonti, Marco Falcone, Emanuele Nicastri, Simona Sica, Pellegrino Musto, Francesca Romana Mauro, and Corrado Girmenia. 2026. "Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel" Vaccines 14, no. 1: 46. https://doi.org/10.3390/vaccines14010046

APA Style

Marchetti, M., Barosi, G., Passamonti, F., Falcone, M., Nicastri, E., Sica, S., Musto, P., Mauro, F. R., & Girmenia, C. (2026). Key Indications for Passive Immune Prophylaxis Against SARS-CoV-2 Infection in Malignant Hematological Disorders: An Analytic Hierarchy Process by an Ad Hoc Italian Expert Panel. Vaccines, 14(1), 46. https://doi.org/10.3390/vaccines14010046

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