Longitudinal analysis of antibody response to immunization in paediatric survivors after allogeneic haematopoietic stem cell transplantation

Abstract

Summary The long-term antibody responses to re-immunization in recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) have not been well studied. We prospectively and longitudinally evaluated the antibody responses to 8 vaccine antigens (diphtheria, tetanus, pertussis, measles, mumps, rubella, hepatitis B, and poliovirus) and assessed the factors associated with negative titres in 210 allo-HSCT recipients at St. Jude Children’s Research Hospital. Antibody responses lasting for more than 5 years after immunization were observed in most patients for tetanus (95.7%), rubella (92.3%), poliovirus (97.9%), and, in diphtheria-tetanus-acellular pertussis (DTaP) recipients, diphtheria (100%). However, responses to pertussis (25.0%), measles (66.7%), mumps (61.5%), hepatitis B (72.9%), and diphtheria in tetanus-diphtheria (Td) recipients (48.6%) were less favourable, with either only transient antibody responses or persistently negative titres. Factors associated with vaccine failure were older age at immunization; lower CD3, CD4 or CD19 counts; higher IgM concentrations; positive recipient cytomegalovirus serology; negative titres before immunization; acute or chronic graft-versus-host disease; and radiation during preconditioning. These response patterns and clinical factors can be used to formulate re-immunization and monitoring strategies. Patients at risk for vaccine failure should have long-term follow-up; those with loss of antibody response or no seroconversion should receive booster immunizations.

Immunogenicity of a live-attenuated Japanese encephalitis vaccine in children and adolescents after hematopoietic stem cell transplantation

“…Inaba et al 15 demonstrated that 490% of the studied HSCT patients were able to maintain long-term protective Ab levels for tetanus, rubella, poliovirus and diphtheria. In contrast, the longterm response rates to pertussis, measles, mumps and hepatitis B were only 25, 66.7, 61.5 and 72.9%, respectively.…”

“…In contrast, the longterm response rates to pertussis, measles, mumps and hepatitis B were only 25, 66.7, 61.5 and 72.9%, respectively. 15 The seroconversion rates for the live-attenuated JE vaccine (SA 14-14-2) in healthy children were 95% for both the single-dose and 2-dose Abbreviations: HSCT = hematopoietic stem cell transplantation; JE = Japanese encephalitis.…”

“…The Ab titers against diphtheria, tetanus, pertussis, poliovirus, measles, mumps, rubella and hepatitis B were not above the preventive ranges in most HSCT patients. 14,15 Therefore, recommendations for vaccinations in HSCT recipients have been developed and are widely used in clinical settings. 16 However, the JE vaccine has not been included in the recommendations due to the lack of studies regarding the immunogenicity and appropriate timing of the vaccine in this special population.…”

Live (vaccines) from New York

“…15,16 Immunity to measles, mumps and rubella has been shown to wane continuously following HCT and leaves the majority of patients susceptible to infection within 5 years of their transplant. [4][5][6][7][8][9] Table 1 summarizes the peer-reviewed studies published to date on the use of the trivalent measles, mumps and rubella Live vaccines post HCT CJ Forlenza and TN Small vaccine following autologous and allogeneic HCT, [4][5][6][7][8][9][21][22][23][24] including the pro and cons of each study. To date, there have been no reports of severe adverse reactions following MMR.…”

“…Response to mumps was observed in 460% of patients and against rubella in 475%. [4][5][6][7][8][9][21][22][23][24] Two studies have demonstrated that MMR can be safely and effectively administered o2 years post HCT, particularly if the patient has no evidence of active chronic GVHD, is off immunosuppressive therapy and is at least 15 months post HCT. 13,14,22 There is limited data on MMR response in recipients of an unrelated, HLA-mismatched-related or cord blood transplant.…”