Reimmunization after blood or marrow stem cell transplantation

Abstract

Summary:Protective immunity to diseases preventable by routine vaccination is lost over time following allogeneic and autologous blood and marrow transplantation. Adoptive transfer of immunity from donors to recipients after allogeneic transplantation is not sufficient to prevent this decline. Systematic reimmunization is necessary at appropriate time intervals following transplantation to re-establish immunity. Response to vaccination depends upon the type of transplant, the source of cells, the immune status of the patient, and the vaccine being used. While inactivated or subunit vaccines are safe in all transplant recipients, live vaccines are generally contraindicated. Reimmunization practices vary widely amongst transplant centers. This comprehensive review summarizes published data on post-transplant vaccination, and based upon these, suggests guidelines which may be used as a framework for development of reimmunization protocols. Keywords: allogeneic bone marrow transplantation; autologous bone marrow transplantation; hematopoietic stem cell transplantation; immunization; vaccination Passive immunization consists of the administration of antibody-containing immunoglobulin preparations to provide temporary protection. Active immunization refers to the administration of a vaccine or a toxoid and is analogous to vaccination. 1 Vaccines available for routine use in children include diphtheria-pertussis-tetanus (DPT), trivalent polio, measles-mumps-rubella (MMR), Haemophilus influenzae type b (Hib), hepatitis B and tuberculosis (BCG). Adult vaccines include diphtheria-tetanus (DT), hepatitis B, influenza virus and pneumococcus. The use of meningococcal, hepatitis A and varicella vaccines is increasing. A number of other vaccines are also available for special circumstances. 1 Most allogeneic and a large proportion of autologous bone marrow transplant recipients lose their immunity to poliovirus, tetanus, diphtheria and measles after transplantation. 2 risk of developing infections with organisms such as H. influenzae and Streptococcus pneumoniae for which vaccines are available. 9-11 Because of these reasons, it is essential to reimmunize peripheral blood stem cell (PBSCT) or bone marrow transplant (BMT) recipients at appropriate times following transplantation. 12-14 Current practiceSystematic post-transplant reimmunization is a relatively neglected area. 12,14 A survey of reimmunization protocols in Europe found wide variations in practice. 12 Tetanus toxoid vaccination was the most common practice, with 65% of the surveyed centers administering this to allograft recipients, and 37% to autograft recipients. On the other hand, pertussis vaccination was the least common practice, with only one center using this. 12 A survey of 45 North American transplant centers affiliated with the National Marrow Donor Program 14 showed that 97% of centers allografting patients under the age of 7 years and 88% of those allografting patients aged 7 years or older gave either the DPT or the DT vaccine, whereas 77% and 58%, res...

Antibody responses to vaccinations given within the first two years after transplant are similar between autologous peripheral blood stem cell and bone marrow transplant recipients

“…Before 2 years additional chemoprophylaxis may need to be considered and lifelong penicillin V is currently recommended for certain patient categories. 17,26 Eight of 24 autoPBSCT recipients had a complete response to tetanus toxoid, compared to only one of nine patients after autoBMT (P = NS). Our results are consistent with those observed by Chan and co-workers.…”

Reimmunization after bone marrow transplantation: current recommendations and perspectives

“…Chronic GVHD seems to interfere with the response to vaccination 4 months after BMT (9). Although diphtheria vaccination starting one year after transplantation has been mostly recommended, no definitive data are available concerning the best time to start vaccination.…”

“…The vaccines are therefore poorly immunogenic in transplant populations. Moreover, the polysaccharide vaccine does not cover 20% of the commonly pathogenic strains and immunized patients remain susceptible to them (9).…”

“…Several surveys regarding reimmunization after BMT have demonstrated that vaccination protocols vary greatly among BMT centers, with insufficient data to establish solid recommendations (6)(7)(8)(9).…”

Chronic graft-versus-host disease: is there an alternative to the conventional treatment?

“…84 Life-long prophylactic penicillin V (200 mg twice a day orally) is recommended for patients with cGVHD and splenectomized patients. 85,86 …”