Immune status and the immune response to hepatitis B virus vaccine in thalassemic patients after allogeneic bone marrow transplantation

Abstract

Summary:exclusion of those who had clinically significant symptoms and laboratory evidence of HBV infection. Therefore, all thalassemic patients, with the only exception being those We evaluated the immune status with respect to HBV and the immune response to readministration of HBV who had undergone allogeneic bone marrow transplantation (BMT), can be considered as protected against HBV infecvaccine in a series of 20 patients with homozygous ␤-thalassemia, aged 6-23 years (mean age: 13.0 ± 4.2) who tion. BM-transplanted patients must be considered as immunodeficient subjects and to be at increased risk of conhad undergone allogeneic bone marrow transplantation (BMT). Thirteen of them (group A), had received three tracting infectious diseases. 4,5 The immunosuppressive therapy that is used to prevent rejection and for the prophylaxis doses of plasma-derived HBV vaccine from 7 to 5 years before BMT and 4-5 weeks after the last dose of vacof graft-versus-host disease (GVHD) induces an almost complete loss of all immune functions. 4 Moreover, the cine, they had had high serum levels of HBV antibodies (anti-HBs). The remaining seven patients (group B) had immunity conferred by the donor's memory cells is transient and negligible 6 since the donor's memory cells engraft had clinical symptoms and laboratory evidence of HBV infection in childhood with markedly elevated serum of with difficulty, their numbers decline quickly according to their different degree of cellular maturity at the time of the anti-HBs. Before revaccination, a significantly lower percentage of patients (P Ͻ 0.005) with seropositive levtransplant 7 and a long time period is required for restoration of their complete function. 8 In addition, serum levels of els of anti-HBs was observed in group A than in group B. After administration of the second dose of HBV vacimmunoglobulins in these patients become normal within times ranging from 3-6 months to 1-2 years. 9 cine the percentage of subjects with protective levels of anti-HBs rose to 100% in both groups of patients evenThis study was performed to assess the immune status against HBV in BM-transplanted beta-thalassemic patients if the geometric mean of titers of anti-HBs increased more significantly in group B patients than in group A.who had previously been given HBV vaccine and in those who had had clinically significant symptoms and laboratory We conclude that the serum levels of anti-HBs afforded by HBV vaccine administered from 7 to 5 years preevidence of HBV infection, in order to evaluate if revaccination in these subjects is indicated and effective. In fact, viously are very low and probably non-protective in most ␤-thalassemic patients after allogeneic BMT, and these patients, although no longer treated by regular blood transfusion after successful BMT, are in the age range most that at least two doses of HBV vaccine should be readministered from 18 to 24 months after BMT to achieve susceptible to HBV infection 10 and live in a country where HBV is still quite prevalent. 1 adequate and l...

Response to Booster Hepatitis B Vaccines in Liver-Transplanted Children Primarily Vaccinated in Infancy

“…Unlike a low percentage of protective anti-HBs in thalassemic patients after bone marrow transplantation (18), nearly two thirds (20/31) of the children who completed a three-dose of primary HBV vaccination had a protective antiHBs after LT. This might be due to the preservation of bone marrow, which is the home of memory immunocytes.…”

Double-dose accelerated hepatitis B vaccine in patients with end-stage liver disease

“…13 Similarly, vaccination of persons with chronic renal disease or bone marrow transplant recipients with an impaired immune response has not been successful. [23][24][25] Vaccination strategies other than the standard approach, including double-strength and accelerated schedules, have been attempted in patients awaiting OLT and liver transplant recipients. A regular-strength (20-g) 3-dose acceler-ated schedule in OLT candidates had a 36% response rate after 8 weeks.…”

Immunizations in solid organ and hematopoeitic stem cell transplant patients: A comprehensive review

“…103 Other groups demonstrated seroconversion rates of 100% in smaller cohorts immunized after HSCT. 104,105 In all cases, antibody waning was frequent. [103][104][105] Therefore, anti-HBs should be checked at regular intervals and booster doses given if this falls below the protective level.…”