Vaccination post-allogeneic hematopoietic stem cell transplantation: what is feasible?

Conrad, Anne; Alcazer, Vincent; Valour, Florent; Ader, Florence

doi:10.1080/14760584.2018.1449649

Cited by 15 publications

(16 citation statements)

References 73 publications

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“…Annual vaccination against influenza for HSCT recipients and their close contacts, creating a "protective cocoon," is an important strategy to mitigate the risk that this virus poses, including bacterial and fungal coinfection, hospitalization, and mortality [39]. Influenza vaccination is recommended by local and international guidelines 2 weeks prior to starting a conditioning regimen to prevent early influenza infections post-HSCT and 6 months post-HSCT [40][41][42][43]. Administration of influenza vaccine prior to 6 months post-HSCT is associated with significantly impaired vaccine efficacy [39,44,45], and the addition of a second dose has little effect [46].…”

Section: Discussionmentioning

confidence: 99%

Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

Marinelli

Wee

Rowe

et al. 2020

Biology of Blood and Marrow Transplantation

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Common respiratory viral infections (CRVIs) frequently complicate hematopoietic stem cell transplantation (HSCT). We conducted a retrospective, single-center, observational cohort study to determine the incidence of CRVI in patients who received an allogeneic (allo) or autologous (auto) HSCT at the Royal Adelaide Hospital between 2009 and 2017. The median follow-up was 8.9 and 4.5 years for auto-and allo-HSCT recipients, respectively. There were 149 CRVI episodes in 74 patients, with rhinovirus being the most commonly isolated virus (n = 81, 47%). The majority of CRVIs (113/149, 75.8%) occurred more than 100 days post-HSCT and 67% were diagnosed in the outpatient setting. There was evidence of lower respiratory tract infection (LRTI) in 45.6% (68/149) of CRVIs. On multivariate logistic regression analysis, coviral infections and cytomegalovirus viremia were independent risk factors for progression of CRVI to LRTI. Ten (6.7%) CRVI episodes resulted in admission to intensive care for ventilatory support and 8 (5.4%) patients died within 30 days of CRVI diagnosis. In our study, 10.4% of HSCT recipients experienced a CRVI post-transplant, primarily causing late morbidity and potentially mortality. Prevention with strict infection control practices, vaccination, and patient education is essential.

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Section: Discussionmentioning

confidence: 99%

Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

Marinelli

Wee

Rowe

et al. 2020

Biology of Blood and Marrow Transplantation

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“…In current guidelines, revaccination starts 3-6 months after HSCT, but looking at thresholds of the CD4+ T cells and ability for class switch recombination might be a useful biomarker to guide the timing of vaccination compared to fixed time point after HSCT. Live attenuated vaccines could be considered two years after HSCT, in patients without cGVHD or immunosuppression (102).…”

Section: Infections and Vaccinationmentioning

confidence: 99%

B Cell Reconstitution and Influencing Factors After Hematopoietic Stem Cell Transplantation in Children

et al. 2019

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B cell reconstitution after hematopoietic stem cell transplantation (HSCT) is variable and influenced by different patient, donor, and treatment related factors. In this review we describe B cell reconstitution after pediatric allogeneic HST, including the kinetics of reconstitution of the different B cell subsets and the development of the B cell repertoire, and discuss the influencing factors. Observational studies show important roles for stem cell source, conditioning regimen, and graft vs. host disease in B cell reconstitution. In addition, B cell recovery can play an important role in post-transplant infections and vaccine responses to encapsulated bacteria, such as pneumococcus. A substantial number of patients experience impaired B cell function and/or dependency on Ig substitution after allogeneic HSCT. The underlying mechanisms are largely unresolved. The integrated aspects of B cell recovery after HSCT, especially BCR repertoire reconstitution, are awaiting further investigation using modern techniques in order to gain more insight into B cell reconstitution and to develop strategies to improve humoral immunity after allogeneic HSCT.

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“…Vaccination before proper immune reconstitution may impair vaccine responses. However, as the risk of infection increases with time, postponing revaccination unnecessarily is undesirable [ 8 , 9 ]. Furthermore, recommendations for allogeneic HSCT (alloHSCT) and autologous HSCT (autoHSCT) recipients are uniform, whereas immunologic memory and immune reconstitution differ [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Vaccine Responses in Adult Hematopoietic Stem Cell Transplant Recipients: A Comprehensive Review

Janssen

Bruns

Kuball

et al. 2021

Cancers

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Consensus on timing of post-hematopoietic stem cell transplantation (HSCT) vaccination is currently lacking and is therefore assessed in this review. PubMed was searched systematically for articles concerning vaccination post-HSCT and included a basis in predefined criteria. To enable comparison, data were extracted and tables were constructed per vaccine, displaying vaccine response as either seroprotection or seroconversion for allogeneic HSCT (alloHSCT) and autologous HSCT (autoHSCT) separately. A total of 33 studies were included with 1914 patients in total: 1654 alloHSCT recipients and 260 autoHSCT recipients. In alloHSCT recipients, influenza vaccine at 7–48 months post-transplant resulted in responses of 10–97%. After 12 months post-transplant, responses were >45%. Pneumococcal vaccination 3–25 months post-transplant resulted in responses of 43–99%, with the response increasing with time. Diphtheria, tetanus, pertussis, poliomyelitis and Haemophilus influenzae type b at 6–17 months post-transplant: 26–100%. Meningococcal vaccination at 12 months post-transplant: 65%. Hepatitis B vaccine at 6–23 months post-transplant: 40–94%. Measles, mumps and rubella at 41–69 months post-transplant: 19–72%. In general, autoHSCT recipients obtained slightly higher responses compared with alloHSCT recipients. Conclusively, responses to childhood immunization vaccines post-HSCT are poor in comparison with healthy individuals. Therefore, evaluation of response might be indicated. Timing of revaccination is essential for optimal response. An individualized approach might be necessary for optimizing vaccine responses.

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Vaccination post-allogeneic hematopoietic stem cell transplantation: what is feasible?

Cited by 15 publications

References 73 publications

Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation

B Cell Reconstitution and Influencing Factors After Hematopoietic Stem Cell Transplantation in Children

Vaccine Responses in Adult Hematopoietic Stem Cell Transplant Recipients: A Comprehensive Review

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