Donor immunization with pneumococcal conjugate vaccine and early protective antibody responses following allogeneic hematopoietic cell transplantation

Abstract

Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk for infections with Streptococcus pneumoniae and have long-lasting, impaired antibody responses to pneumococcal polysaccharide vaccines. We examined whether donor immunization with a heptavalent pneumococcal conjugate vaccine (PCV7) would elicit protective antibody responses to additional doses of vaccine administered early after transplantation. Ninety-six patients scheduled to receive an allogeneic hematopoietic cell transplant were randomized with their donors to receive either a dose of PCV7 vaccine or no vaccine before transplantation. All patients received PCV7 at 3 months, 6 months, and 12 months following transplantation, and serotype-specific antibody concentrations were determined after each dose. Following HCT, geometric mean antibody concentrations of patients in the immunized donor group were significantly higher for 5 of the 7 vaccine serotypes after one dose (P < .05) and for 4 of the 7 serotypes after 2 doses of vaccine (P < .03). Sixty-seven percent of patients in the immunized donor group had presumed protective IgG concentrations more than or equal to 0.50 g/mL to all 7 serotypes following the first dose of vaccine compared to 36% in the unimmu-

Pretransplant vaccinations in allogeneic stem cell transplantation donors and recipients: an often-missed opportunity for immunoprotection?

“…At 3, 6, 12 and 13 months, there were significantly higher serotype-specific Ab concentrations in the pretransplant vaccinated group. 15 Furthermore, Molrine et al 9 evaluated the PCV7 administration in 43 recipients of matched-related donor HSCT and determined that Ab concentrations to six serotypes in PCV7 were significantly higher in recipients after one and two doses of the vaccine post transplant if the donor had been immunized before transplant. 9 This result suggests that immunity was transferred to the HSCT recipients and enhanced their responses to additional vaccine doses administered to the HSCT recipients post transplantation.…”

“…15 Furthermore, Molrine et al 9 evaluated the PCV7 administration in 43 recipients of matched-related donor HSCT and determined that Ab concentrations to six serotypes in PCV7 were significantly higher in recipients after one and two doses of the vaccine post transplant if the donor had been immunized before transplant. 9 This result suggests that immunity was transferred to the HSCT recipients and enhanced their responses to additional vaccine doses administered to the HSCT recipients post transplantation. However, no study has compared this strategy with an early post-HSCT vaccination strategy as studied by Cordonnier et al 3 Diphtheria-tetanus-pertussis There are two types of diphtheria and tetanus vaccines, DT and Td.…”

“…[9][10][11][12] The median onset of invasive diseases occur 1 year post HSCT, although infections occur also early after HSCT. [10][11][12][13] Vaccination before transplant in both donors and recipients has shown to influence Ab responses post transplant.…”

“…[10][11][12][13] Vaccination before transplant in both donors and recipients has shown to influence Ab responses post transplant. 9,14,15 In the United States, there are currently two pneumococcal vaccinations available that include the PCV13 (pneumococcal conjugate vaccine) and the PPV23 (pneumococcal polysaccharide vaccine). The Food and Drug Administration approved the PCV13 vaccine in 2011 for prevention of pneumonia and invasive disease caused by PCV13 serotypes among adults ⩾ 50 years of age.…”

Reimmunization after bone marrow transplantation: current recommendations and perspectives

“…The recipients received three doses of the vaccine at 3, 6 and 12 months after BMT. Protective immunity was achieved earlier in patients whose donors had been vaccinated, but after the three doses of the vaccine, protective immunity was similar in the two groups (22).…”