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ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS.

Abstract

BACKGROUND

International guidelines recommend vaccinating allogeneic hematopoietic cell transplant (HCT) recipients at 3 months after transplant, giving three doses of pneumococcal conjugate vaccine (PCV) followed by either a dose of pneumococcal polysaccharide vaccine or a fourth PCV dose in the case of graft-versus-host disease (GvHD). However, the long-term immunity after this regimen is unknown, and there is no recommendation from 24 months after transplant regarding boosts. Our objective was to assess the antipneumococcal antibody titers and seroprotection rates of allogeneic HCT recipients years after different schedules of vaccination.

METHODS

We assessed 100 adult HCT recipients a median of 9.3 years (range: 1.7-40) after transplant. All patients had received at least one dose of PCV and were assessed for antipneumococcal immunoglobulin G (IgG) antibody titers against the seven serotypes shared by PCV7, PCV13, and PSV23. Sixty-six percent of the patients had been vaccinated according to the current guidelines.

RESULTS

Considering an IgG titer > 0.35 µg/mL as protective for each serotype, the seroprotection rate was 50% for 7/7 serotypes and 70% for 5/7 serotypes, with no differences between the different vaccination schedules. The lack of seroprotection was associated with a transplant performed not in complete remission or from a cord-blood unit, a relapse after transplant, or chronic GvHD at assessment.

CONCLUSION

Because only half of the vaccinated patients had long-term protection, pending prospective studies defining the best boost program after the initial one, we recommend the assessment of specific IgG titers starting from 24 months to decide for further doses.

Authors+Show Affiliations

Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France. University Paris-Est-Créteil, Créteil, France.APHP Cochin Hospital and University Paris-Descartes, Plateforme d'Immunomonitoring Vaccinal, Laboratoire d'Immunologie, Paris, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France.APHP, Cochin Hospital and University Paris-Descartes, Laboratoire d'Immunologie, U1016, Institut Cochin, Paris, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France. University Paris-Est-Créteil, Créteil, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France. University Paris-Est-Créteil, Créteil, France.Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France. University Paris-Est-Créteil, Créteil, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31794975

Citation

Robin, Christine, et al. "ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION in ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2019.
Robin C, Bahuaud M, Redjoul R, et al. ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS. Clin Infect Dis. 2019.
Robin, C., Bahuaud, M., Redjoul, R., Jeljeli, M., Leclerc, M., Cabanne, L., ... Cordonnier, C. (2019). ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, doi:10.1093/cid/ciz1168.
Robin C, et al. ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION in ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS. Clin Infect Dis. 2019 Dec 4; PubMed PMID: 31794975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ANTIPNEUMOCOCCAL SEROPROTECTION YEARS AFTER VACCINATION IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS. AU - Robin,Christine, AU - Bahuaud,Mathilde, AU - Redjoul,Rabah, AU - Jeljeli,Mohamed, AU - Leclerc,Mathieu, AU - Cabanne,Ludovic, AU - Beckerich,Florence, AU - Pautas,Cécile, AU - Maury,Sébastien, AU - Cordonnier,Catherine, Y1 - 2019/12/04/ PY - 2019/09/12/received PY - 2019/12/4/entrez PY - 2019/12/4/pubmed PY - 2019/12/4/medline KW - Allogeneic HCT KW - Long-term immunity KW - Pneumococcal vaccination JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. N2 - BACKGROUND: International guidelines recommend vaccinating allogeneic hematopoietic cell transplant (HCT) recipients at 3 months after transplant, giving three doses of pneumococcal conjugate vaccine (PCV) followed by either a dose of pneumococcal polysaccharide vaccine or a fourth PCV dose in the case of graft-versus-host disease (GvHD). However, the long-term immunity after this regimen is unknown, and there is no recommendation from 24 months after transplant regarding boosts. Our objective was to assess the antipneumococcal antibody titers and seroprotection rates of allogeneic HCT recipients years after different schedules of vaccination. METHODS: We assessed 100 adult HCT recipients a median of 9.3 years (range: 1.7-40) after transplant. All patients had received at least one dose of PCV and were assessed for antipneumococcal immunoglobulin G (IgG) antibody titers against the seven serotypes shared by PCV7, PCV13, and PSV23. Sixty-six percent of the patients had been vaccinated according to the current guidelines. RESULTS: Considering an IgG titer > 0.35 µg/mL as protective for each serotype, the seroprotection rate was 50% for 7/7 serotypes and 70% for 5/7 serotypes, with no differences between the different vaccination schedules. The lack of seroprotection was associated with a transplant performed not in complete remission or from a cord-blood unit, a relapse after transplant, or chronic GvHD at assessment. CONCLUSION: Because only half of the vaccinated patients had long-term protection, pending prospective studies defining the best boost program after the initial one, we recommend the assessment of specific IgG titers starting from 24 months to decide for further doses. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31794975/ANTIPNEUMOCOCCAL_SEROPROTECTION_YEARS_AFTER_VACCINATION_IN_ALLOGENEIC_HEMATOPOIETIC_CELL_TRANSPLANT_RECIPIENTS L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz1168 DB - PRIME DP - Unbound Medicine ER -