Immunity after (re)vaccination of paediatric patients following haematopoietic stem cell transplantation

Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Acta Paediatrica (Impact Factor: 1.67). 04/2012; 101(8):e373-7. DOI: 10.1111/j.1651-2227.2012.02710.x
Source: PubMed


Loss of specific immunity follows allogeneic haematopoietic stem cell transplantation (HSCT) in the majority of cases. Responses to (re)vaccinations can be used as indicators of a functional immunological recovery.
Twenty-three paediatric recipients of HSCT were enrolled in a single centre setting and responses to scheduled immunizations analysed.
Immunity to vaccine-preventable diseases was impaired post HSCT, but (re)vaccinations induced protective responses in 59-100%, depending on the vaccine, regardless of prior graft-versus-host disease (GVHD) history.
Despite the marked impact of moderate to severe chronic prior GVHD on both the qualitative and quantitative T-cell recovery post allogenic HSCT, most paediatric recipients of allogeneic stem cell grafts appear to attain protective antibody levels after immunization.

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    ABSTRACT: Vaccines that prevent the development of numerous infectious diseases should be designed to bring a maximum advantage accompanied by a minimal risk. Since the immunological memory is mediated by antigen-specific T- and B-lymphocytes, the precondition for a vaccine to be successful is the presence of a competent immune system. In immunodeficient patients, this precondition is lacking at a variable extent depending on the specific molecular defect. Primary immunodeficiencies (PID) can either affect the specific (combined T-/B-cell immunity, humoral B-cell-immunity, cellular T-cell-immunity) or the nonspecific (phagocyte system, innate immunity) immune system. The experiences from HIV and stem cell transplantation can help to decide how vaccines may be beneficial or harmful in patients with PID. The following publication reviews current vaccination strategies in immunodeficient patients with special consideration to inactivated and live vaccines as well as risks and benefit. The question whether or not a patient is under replacement with immunoglobulins needs to be considered. After stem cell transplantion in immundeficient patients like SCID vaccine strategies need to consider the degree of immune reconstitution.
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