Reimmunization after bone marrow transplantation: current recommendations and perspectives

Abstract

Autologous and allogeneic bone marrow transplantation (BMT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children <7 years old), Haemophilus influenzae type b conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time to vaccinate, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers, suggesting that the lack of sufficient data has not permitted the formulation of reliable recommendations. The use of other vaccines and the perspectives for different vaccination protocols are analyzed in this review.

Difficulties in the revaccination program of hematopoietic stem cell transplantation recipients

“…It is known that GVHD and its treatment may decrease vaccine responses to T-cell and antibodies 2 , 3 , 10 , 17 , 18 and that is the main excuse used by the HSCT team to postpone vaccination. A more recent communication from the International Consensus Conference on Clinical Practice in chronic GVHD proposed the postponement of vaccinations for up to 3 months in adult patients, if they are receiving three or more immunosuppressive agents for the treatment of GVHD 19 .…”

Revaccination of bone marrow transplant recipients: a review of current practices in Australia

“…The differences in opinion and practice of haematologists concerning the vaccination schedule possibly stems from a lack of information supporting revaccination in BMT recipients. There is lack of high‐level randomly controlled trials, which means that vaccination schedules are often based on limited evidence 7,9 . This is particularly true when different types of BMT are examined.…”

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.…”