Synapse - Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT)

Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT) Journal Article

Authors:	Pao, M.; Papadopoulos, E. B.; Chou, J.; Heller, G.; Castro-Malaspina, H.; Jakubowski, A. A.; Kernan, N. A.; Perales, M. A.; Prokop, S.; Scaradavou, A.; Van Den Brink, M. R.; Young, J. W.; O'Reilly, R. J.; Small, T. N.
Article Title:	Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT)
Abstract:	Young children and allogeneic hematopoietic cell transplantation (HCT) recipients respond poorly to polysaccharide antigens, rendering them susceptible to severe infections because of encapsulated bacteria. This study evaluated the responses of 127 HCT patients, median age 23.0 years, vaccinated with PNCRM7 and Haemophilus influenzae (HIB) conjugate, 2 conjugate vaccines highly immunogenic in healthy children. Median time to vaccination was 1.1 years after HCT. Sixty-two percent of patients responded to PNCRM7 (45 of 51 children, 34 of 76 adults, P < .001). Overall response to HIB was 86%, including 77% of PNCRM7 nonresponders. Although PNCRM7 response was adversely affected by older age (P < .001), individuals ≥50 years old responded significantly better if vaccinated following acquisition of specific minimal milestones of immune competence, CD4 >200/μL, IgG >500 mg/dL, PHA within 60% lower limit of normal (11 of 19 versus 0 of 8, P < .006). A similar trend was observed in patients with limited chronic graft-versus-host disease (cGVHD). In all patients, higher levels of circulating CD4+CD45RA cells correlated with improved PNCRM7 response. These data demonstrate that PNCRM7 is immunogenic in allogeneic HCT patients, including older adults, but suggest that vaccination at fixed intervals after HCT, irrespective of immune competence, may limit its effectiveness. Prospective, multicenter trials assessing the best strategy to administer this vaccine and its impact on pneumococcal infections following transplantation are warranted. © 2008 American Society for Blood and Marrow Transplantation.
Keywords:	adolescent; adult; child; controlled study; child, preschool; middle aged; recovery of function; retrospective studies; transplantation, homologous; human cell; major clinical study; drug efficacy; unspecified side effect; methotrexate; rituximab; prospective studies; pneumococcus vaccine; hematopoietic stem cell transplantation; hodgkin disease; age; chronic disease; acute graft versus host disease; acute leukemia; chronic graft versus host disease; hematologic malignancy; myelodysplastic syndrome; nonhodgkin lymphoma; whole body radiation; hematologic neoplasms; statistical significance; immunoglobulin g; infant; immunogenicity; cd4+ t lymphocyte; vaccination; drug response; donor lymphocyte infusion; allogeneic hematopoietic stem cell transplantation; lymphoproliferative disease; cd4 lymphocyte count; cd4 antigen; tacrolimus; graft vs host disease; cyclosporin; graft recipient; multicenter studies as topic; alemtuzumab; immunocompetence; streptococcus infection; cd45ra antigen; aplastic anemia; chronic leukemia; correlation function; haemophilus influenzae; pneumococcus; haemophilus influenzae type b vaccine; phytohemagglutinin; pncrm 7; haemophilus vaccines; meningococcal vaccines; pneumococcal infections; pneumococcal vaccines
Journal Title:	Biology of Blood and Marrow Transplantation
Volume:	14
Issue:	9
ISSN:	1083-8791
Publisher:	Elsevier Inc.
Date Published:	2008-09-01
Start Page:	1022
End Page:	1030
Language:	English
DOI:	10.1016/j.bbmt.2008.06.012
PUBMED:	18721765
PROVIDER:	scopus
PMCID:	PMC3242699
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-49449103359&partnerID=40&md5=218958588848cf0b62e0eb9ef653efbc
Notes:	--- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus"