Long-term survivors following autologous haematopoetic stem cell transplantation have significant defects in their humoral immunity against vaccine preventable diseases,years on from transplant |
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Affiliation: | 1. Department of Infection, Immunity and Cardiovascular Diseases and the Florey Institute for Host-Pathogen Interactions, University of Sheffield, UK;2. South Yorkshire Regional Department of Infection & Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;3. Specialised Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;4. Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;5. Department of Haematology, St George’s University Hospitals NHS Foundation Trust, London, UK;6. Department of Virology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK |
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Abstract: | Current international guidelines recommend routinely vaccinating haematopoetic stem cell transplant (HSCT) recipients. Despite significant infection-related mortality following autologous HSCT, routine vaccination programmes (RVP) completion is poor. For recovered HSCT recipients, it is uncertain whether catch-up vaccination remains worthwhile years later.To determine potential susceptibility to vaccine preventable infections, we measured antibody titres in 56 patients, a median of 7 years (range 0–29) following autologous HSCT, who had not completed RVP. We found that almost all participants had inadequate titres against diphtheria (98.2%) and pneumococcal infection (100%), and a significant proportion had inadequate titres against measles (34.5%). Of those subsequently vaccinated according to available guidelines, many mounted adequate serological responses.These data suggest a pragmatic catch-up approach for autologous HSCT recipients who have not completed RVP is advisable, with universal vaccination against some pathogens (e.g. Streptococcus pneumoniae and diphtheria) and serologically-guided approaches for others (e.g. measles and varicella zoster virus). |
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Keywords: | HSCT Autologous Haematopoetic stem cell transplant Immunosuppressed Immunity Correlates of Protection Routine vaccination programme Infection Diphtheria Measles Pneumococcal Varicella VZV Tetanus Haemophilus Hib Mumps Rubella MMR Vaccination UK |
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