Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 19, Issue 1, Pages 109-116Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2012.08.015
Keywords
BMT; UCB transplantation; Vaccine; Influenza
Categories
Funding
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [K12HD068322] Funding Source: NIH RePORTER
- NATIONAL CANCER INSTITUTE [P01CA065493, R01CA072669] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [R01AI034495] Funding Source: NIH RePORTER
- NCI NIH HHS [R01 CA072669, P01 CA065493] Funding Source: Medline
- NIAID NIH HHS [R01 AI034495] Funding Source: Medline
- NICHD NIH HHS [K12 HD068322] Funding Source: Medline
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Influenza infection after allogeneic hematopoietic cell transplantation (allo-HCT) can result in severe complications. The effectiveness of the annual vaccine depends on age, immune competence, and the antigenic potential of the 3 strains included. We hypothesized that a second vaccine dose, the standard of care for vaccine-naive children, might improve post hematopoietic cell transplantation (HCT) immune responses. Patients > 60 days post-HCT were randomized to receive either 1 (n = 33) or 2 (n = 32) influenza vaccine doses separated by 1 month. The primary endpoint was whether 2 vaccinations induced superior immunity; however, we found no difference. Secondary endpoints were to identify variables associated with responses. Both hemagglutination inhibition (HI; P < .005) and ELISpot responses (P = .03) were greater for patients vaccinated >= 1 year posttransplantation. Umbilical cord blood (UCB) recipients showed less IFN-gamma responses (P < .001). Interestingly, there was a positive correlation between the total number of CD19(+) cells before vaccination and seroconversion (P = .01) and an inverse correlation for IFN-gamma responses (P = .05). Variables not associated with vaccine responses included prevaccine CD4(+) cell counts (total, naive, or memory), steroid usage at vaccination, age, or conditioning intensity. Time from transplantation to vaccination and absolute CD19(+) cell counts were the strongest predictors of vaccine responses. Methods to improve influenza vaccine responses after allo-HCT are needed. (C) 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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