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  • Efficacy and Safety of Reva...
    Conrad, Anne; Perry, Marielle; Langlois, Marie-Elodie; Labussière-Wallet, Hélène; Barraco, Fiorenza; Ducastelle-Leprêtre, Sophie; Larcher, Marie-Virginie; Balsat, Marie; Boccard, Mathilde; Chidiac, Christian; Ferry, Tristan; Roure-Sobas, Chantal; Salles, Gilles; Valour, Florent; Ader, Florence

    Biology of blood and marrow transplantation, 09/2020, Letnik: 26, Številka: 9
    Journal Article

    •Adult allogeneic hematopoietic stem cell transplantation recipients should be reimmunized following a primary vaccination schedule.•The pediatric diphtheria, tetanus, acellular pertussis, hepatitis B virus, inactivated polio virus, and Haemophilus influenzae type b vaccine induces high (>90%) and sustained response rates.•Side effects of vaccination are rare and mild.•Hematologic and transplant-related characteristics affect antibody levels. Data on immunogenicity and safety of the recommended revaccination schedule against diphtheria, tetanus, poliomyelitis, pertussis, Haemophilus influenzae type b (Hib), and hepatitis B in adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients are limited. This prospective single-center cohort study (April 2014 to March 2018) included adult allo-HSCT recipients referred to a dedicated vaccinology consultation and vaccinated with the pediatric combined diphtheria, tetanus, acellular pertussis, hepatitis B virus, inactivated poliovirus, and Haemophilus influenzae type b (DTaP(±HB)-IPV-Hib) vaccine (3 doses 1 month apart, booster dose 1 year later). The proportion of responders to tetanus, diphtheria, Hib, and hepatitis B vaccine and geometric mean concentrations (GMCs) of antibodies were assessed before and up to 24 months after vaccination. A total of 106 patients were vaccinated at a median (interquartile range) time of 12.4 (10 to 18.4) months post-transplant. At 5.3 (4.8 to 6.6) and 23.1 (21.1 to 25.1) months after vaccine initiation, high and sustained rates of protective antibody titers were achieved for tetanus (97.8% 95% confidence interval (95% CI), 92.4% to 99.7%, n = 91/93 and 100% 95% CI, 92% to 100%, n = 44/44), diphtheria (94.6% 95% CI, 87.9% to 98.2%, n = 88/93 and 90.9% 95% CI, 78.3% to 97.5%, n = 40/44), Hib (96.6% 95% CI, 90.4% to 99.3%, n = 85/88 and 93% 95% CI, 80.9% to 98.5%, n = 40/43), and hepatitis B (83.5% 95% CI, 73.5% to 90.9%, n = 66/79 and 81.1% 95% CI, 64.8% to 92%, n = 30/37). Underlying disease, stem cell source, chronic graft-versus-host-disease, and extracorporeal photopheresis differentially influenced GMCs of tetanus, diphtheria, and hepatitis B antibodies after 3 doses but not in the long term (24 months). Six (5.7%) patients experienced mild side effects. The pediatric DTaP(±HB)-IPV-Hib vaccine was safe and effective in eliciting a sustained protective humoral response in adult allo-HSCT recipients. Hepatitis B revaccination might be optimized by using higher antigen doses.