Pertussis response to Tdap (8 mcg/dose of the Pertussis Toxoid (PT) in recipients of allogeneic hematopoietic stem cell transplants (Allo HSCT) Meeting Abstract
| Authors: | Papadopoulos, E.; Iovino, C. S.; Knowles, M.; Barker, J.; Scaradavou, A.; Kernan, N. A.; Small, T. N. |
| Abstract Title: | Pertussis response to Tdap (8 mcg/dose of the Pertussis Toxoid (PT) in recipients of allogeneic hematopoietic stem cell transplants (Allo HSCT) |
| Meeting Title: | 52nd Annual Meeting of the American Society of Hematology (ASH) |
| Abstract: | In 2005, fa an effort to reduce the increasing incidence of pertussis in adolescents and adults two Vaccines containing tetanus, reduced diphtheria and acellular pertussis toxoids (Tdap) were approved for this population. Although both vaccines contain similar amounts of tetanus and diphtheria toxoid, they vary in their pertussis toxoid(PT) content (2.5 vs 8 mcg/dose). In 2006, the Advisory Committee on Immunization Practices recommended that all adolescents and adults receive a single dose of Tdap. In 2008, we reported at this meeting an evaluation of the Tdap containing 2.5 mcg/dose approved for individuals 11-64 years of age. Although response to tetanus was 71% when this vaccine was given as a booster, only 7 of 41 patients responded to PT, 6 of whom were children. This poor response was likely due in part to the low dose of PT and the limited numbers of pertussis specific memory T and B cells potentially transferred from the stem cell donor. At the end of 2008, the upper age limit for Tdap containing 8 mcg PT/dose was extended from 18 3,ears of age to 64 years. We now report response to this vaccine in 64 alloHSCT recipients (20 children, 44 adults). Patients were transplanted for the treatment of acute (n=31) or chronic (n=6) leukemia, lymphoma (n=16), MDS (n=5), multiple myeloma (n=3), or other (n=3). Forty-four pts were > 18 yrs of age at time of transplant and 20 were < 18 yrs of age. Stem cell donors were an HLA matched sibling (n=31), HLA mismatched related (n=4), or unrelated adult (n=18) or unrelated cord blood (n=11) donor. Forty-four percent of patients received a T-cell-depleted. allograft. Patients were a median age of 34 years at transplant and 36 years at vaccination. Over 90% of patients had pre vaccine PT of less than 2 IU/ml. Patients received one (n=47), two (n=15), or three (n=2) immunizations. Of pts receiving more than one vaccine, the median time to a second Tdap Was 153 days (range 28-390). There were no severe local or systemic reactions in any recipient of Tdap including those who received > 1 vaccine. Response was defined as seroconversion > 5 IU/mL or > 2 fold rise in PT titer for seropositive patients. Of the 63 patients evaluable after a single Tdap, 9 of 20 children and 9 of 43 adults responded (p=0.04) Response was associated with younger age, receipt of an unmodified transplant, and non-myeloablative or reduced intensity conditioning. None of the 11 UCBT recipients responded to a single Tdap. Currently, 9 of 12 patients evaluable for response following a second or third Tdap responded, including 2 of 3 UCBT recipients. In the last decade, pertussis in adolescents and adults has steadily increased with ail estimated incidence of 800,000 to 3.3 million cases/year. Our studies suggest that use of Tdap containing 8 mcg/dose is preferable in alloHCT recipients and that administration of > 1 Tdap is safe and often necessary to elicit pertussis immunity an this vulnerable patient population. |
| Keywords: | hla matched sibling |
| Journal Title: | Blood |
| Volume: | 116 |
| Issue: | 21 |
| Meeting Dates: | 2010 Dec 4-7 |
| Meeting Location: | Orlando, FL |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2010-11-19 |
| Start Page: | 549 |
| Language: | English |
| ACCESSION: | BIOSIS:PREV201100423828 |
| PROVIDER: | biosis |
| PUBMED: | 22276300 |
| DOI: | 10.1182/blood.V116.21.1282.1282 |
| Notes: | --- - Meeting Abstract: 1282 - 52nd Annual Meeting of the American-Society-of-Hematology (ASH) - Orlando, FL, USA - December 04 -07, 2010 - Amer Soc Hematol - "Source: Biosis" |
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512Kernan -
234Small -
243Scaradavou -
415Papadopoulos -
335Barker -
5Iovino -
5Knowles
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