Measles, mumps, and rubella revaccination in children after completion of chemotherapy and hematopoietic stem cell transplantation: a single-center prospective efficacy and safety analysis

Wang, Min; Yuan, Qing; Deng, Pengfei; Yi, Fei; Zhang, Hua; Zhou, Fen; Chen, Wenjuan; Cao, Qing; Chen, Jing; Gao, Yijin

doi:10.1007/s12519-023-00721-x

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…During the first year after CAR-T cell therapy, only nearly 40–60% of patients achieve a protective response with vaccinations, including highly immunogenic vaccines such as SARS-CoV-2 [31–33,34 ▪▪ ]. In addition to the poor initial “take,” rapidly waning titers have been observed to vaccines that typically lead to a durable response, such as the MMR vaccine, in hematopoietic cell transplant recipients [35]. Pneumococcal vaccines also have low seroconversion rates and require multiple vaccinations [36].…”

Section: Trials In Immunocompromised Populations: Car-t Cell Recipientsmentioning

confidence: 99%

Targeting enhanced neutralizing antibody responses via increased germinal center activity: early-phase vaccine trials with novel clinical designs

Hahn,

Hill,

Kublin

2023

Current Opinion in HIV and AIDS

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Purpose of review Recent advances in the understanding of the difficult immunologic requirements for the induction of broadly neutralizing antibodies for HIV have spurred interest in optimizing vaccine approaches intended to stimulate a robust germinal center reaction. In preclinical models, techniques to optimize the germinal center response have included alterations in the timing, dose, and delivery method of immunogens and have resulted in substantially enhanced germinal center responses in lymph nodes and neutralizing antibodies in serum. One of the most promising approaches involves splitting the initial dose of vaccine into a series of gradual escalating doses administration (“fractional escalating doses”). In principle, these techniques may have broad implications for vaccines targeting a robust antibody response. Recent findings We review the upcoming vaccine trials that will test these concepts in clinical practice. The trials include both HIV and non-HIV immunogens, and will involve testing these concepts in both healthy adults and immunocompromised persons. Summary There are multiple trials that will test whether techniques to alter vaccine delivery such as fractional escalating doses enhances immunologic outcomes.

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Section: Trials In Immunocompromised Populations: Car-t Cell Recipientsmentioning

confidence: 99%

Targeting enhanced neutralizing antibody responses via increased germinal center activity: early-phase vaccine trials with novel clinical designs

Hahn,

Hill,

Kublin

2023

Current Opinion in HIV and AIDS

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“…13,[15][16][17][18][19] Fortunately, revaccination or resumption of indicated vaccinations following completion of cancer therapy can produce protective immunity in these children, even in patients with some ongoing immunosuppression. [19][20][21]…”

Section: S2 Of S12mentioning

confidence: 99%

“…Protective antibodies may drop regardless of a patient's vaccination status before chemotherapy or donor or recipient vaccination status before transplantation 13,15–19 . Fortunately, revaccination or resumption of indicated vaccinations following completion of cancer therapy can produce protective immunity in these children, even in patients with some ongoing immunosuppression 19–21 …”

Section: Introductionmentioning

confidence: 99%

Vaccinations in children with hematologic malignancies and those receiving hematopoietic stem cell transplants or cellular therapies

Neemann

Sato

2023

Transplant Infectious Dis

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Children who are immune compromised are uniquely threatened by a higher risk of infections, including vaccine‐preventable diseases (VPDs). Children who undergo chemotherapy or cellular therapies may not have preexisting immunity to VPDs at the time of their treatment including not yet receiving their primary vaccine series, and additionally they have higher risk of exposures (e.g., due to family structures, daycare and school setting) with decreased capacity to protect themselves using nonpharmaceutic measures (e.g., masking). In the past, efforts to revaccinate these children have often been delayed or incomplete. Treatment with chemotherapy, stem cell transplants, and/or cellular therapies impair the ability of the immune system to mount a robust vaccine response. Ideally, protection would be provided as soon as both safe and effective, which will vary by vaccine type (e.g., replicating versus nonreplicating; conjugated versus polysaccharide). While a single approach revaccination schedule following these therapies would be convenient for providers, it would not account for patient specific factors that influence the timing of immune reconstitution (IR). Evidence suggests that many of these children would mount a meaningful vaccine response as early as 3 months following completion of treatment. Here within, we provide updated guidance on how to approach vaccination both during and following completion of these therapies.

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Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children undergoing hematopoietic stem cell transplant

Tao,

Luo,

Zhang

et al. 2024

World J Pediatr

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Background Diarrhea is a common complication of hematopoietic stem cell transplantation (HSCT) and is associated with substantial morbidity, but its etiology is often unknown. Etiologies of diarrhea in this population include infectious causes, chemotherapy- or medication-induced mucosal injury and graft-versus-host disease (GVHD). Distinguishing these potential causes of diarrhea is challenging since diarrheal symptoms are often multifactorial, and the etiologies often overlap in transplant patients. The objectives of this study were to evaluate whether the FilmArray gastrointestinal (GI) panel would increase diagnostic yield and the degree to which pre-transplantation colonization predicts post-transplantation infection. Methods From November 2019 to February 2021, a total of 158 patients undergoing HSCT were prospectively included in the study. Stool specimens were obtained from all HSCT recipients prior to conditioning therapy, 28 ± 7 days after transplantation and at any new episode of diarrhea. All stool samples were tested by the FilmArray GI panel and other clinical microbiological assays. Results The primary cause of post-transplantation diarrhea was infection (57/84, 67.86%), followed by medication (38/84, 45.24%) and GVHD (21/84, 25.00%). Ninety-five of 158 patients were colonized with at least one gastrointestinal pathogen before conditioning therapy, and the incidence of infectious diarrhea was significantly higher in colonized patients (47/95, 49.47%) than in non-colonized patients (10/63, 15.87%) (P < 0.001). Fourteen of 19 (73.68%) patients who were initially colonized with norovirus pre-transplantation developed a post-transplantation norovirus infection. Twenty-four of 62 (38.71%) patients colonized with Clostridium difficile developed a diarrheal infection. In addition, FilmArray GI panel testing improved the diagnostic yield by almost twofold in our study (55/92, 59.78% vs. 30/92, 32.61%). Conclusions Our data show that more than half of pediatric patients who were admitted for HSCT were colonized with various gastrointestinal pathogens, and more than one-third of these pathogens were associated with post-transplantation diarrhea. In addition, the FilmArray GI panel can increase the detection rate of diarrheal pathogens in pediatric HSCT patients, but the panel needs to be optimized for pathogen species, and further studies assessing its clinical impact and cost-effectiveness in this specific patient population are also needed. Graphical abstract

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Measles, mumps, and rubella revaccination in children after completion of chemotherapy and hematopoietic stem cell transplantation: a single-center prospective efficacy and safety analysis

Cited by 4 publications

References 34 publications

Targeting enhanced neutralizing antibody responses via increased germinal center activity: early-phase vaccine trials with novel clinical designs

Targeting enhanced neutralizing antibody responses via increased germinal center activity: early-phase vaccine trials with novel clinical designs

Vaccinations in children with hematologic malignancies and those receiving hematopoietic stem cell transplants or cellular therapies

Diagnostic performance of a multiplexed gastrointestinal PCR panel for identifying diarrheal pathogens in children undergoing hematopoietic stem cell transplant

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