Pneumococcal immunity and response to immunization with pneumococcal vaccine in bone marrow transplant patients: the influence of graft versus host reaction

Abstract

The aim of this study was to evaluate levels and subclass distribution of pneumococcal antibodies in 40 bone marrow transplant (BMT) and 42 autologous bone marrow transplant (ABMT) recipients during the first year after transplant, and response to vaccination with a polyvalent pneumococcal vaccine. Before transplantation, 35/40 recipients of allogeneic grafts, all 42 autologous BMT recipients and 38/39 donors had adult levels of anti-pneumococcal antibodies of the IgG2 subclass. During the first year after transplantation, antibody levels decreased in 29 BMT patients while 11 retained their pretransplant antibody levels. No change was noted among ABMT patients. In the 8 BMT patients who had chronic graft versus host disease (GVHD), none showed normal levels of anti-pneumococcal antibodies 1 year after BMT as compared to 11/32 without chronic GVHD. Three different response patterns were seen after vaccination of 29 BMT patients who lost immunity with a polyvalent pneumococcal vaccine. Ten patients responded with an increase in IgG2 antibodies, 8 responded with an increase in IgG1 and 11 patients did not respond at all. In the 8 patients with chronic GVHD, none responded with an increase in IgG2 antibodies and 6/8 did not respond at all. The results of this study suggest that chronic GVHD is the main factor contributing to loss of immunity to pneumococci and lack of responsiveness to vaccination with pneumococcal polysaccharides after BMT. Furthermore, the difference in capability, between BMT and ABMT recipients, of retaining anti-pneumococcal activity may explain the clinical experience of severe pneumococcal infections in these patients.

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

“…2,6,7 However, more highly immunogenic protein Ags (for example, tetanus toxoid) and polysaccharide-protein conjugates (for example, Haemophilus influenzae type B vaccine) can elicit Ab responses earlier in post-HSCT patients and increase immune responses for immunosuppressed patients. 8 This paper attempts to explore the evidence behind preHSCT vaccination in donors and recipients of HSCT as well as address the ethical, medical and logistical complexities involved in this type of vaccination schedule.…”

Relationship between IgG titers and opsonocytophagocytic activity of anti-pneumococcal antibodies after immunization with the 7-valent conjugate vaccine in allogeneic stem cell transplant

“…The immune response to the PPV23 is suboptimal during the first year after transplant, and even later in the case of chronic GVHD or immunosuppressive drugs. 2 The PCV7 is more immunogenic than the polysaccharide vaccine, both in infants 3 and in HSCT recipients 4 and has been evaluated in adults 5 and pediatric transplant recipients. 6 Because pneumococcal infection may occur before 6 months, 1 the EBMT has run a prospective trial (IDWP01) to compare the immune response after an early vs a latestarting at 3 or at 9 months after transplant-immunization with three doses of PCV7.…”

Polysaccharide antibody responses are impaired post bone marrow transplantation for severe combined immunodeficiency, but not other primary immunodeficiencies

“…14 Chronic GVHD in particular seems to lead to a depressed response to pneumococcal polysaccharide antigen post BMT. 15,16 In this series, differences were not because of the age of the bone marrow donor. No differences in cell lineage specific chimerism were found, although B-cell microchimerism was not measured.…”