Immune status and the immune response to hepatitis B virus vaccine in thalassemic patients after allogeneic bone marrow transplantation

Abstract

We evaluated the immune status with respect to HBV and the immune response to readministration of HBV vaccine in a series of 20 patients with homozygous β-thalassemia, aged 6–23 years (mean age: 13.0 ± 4.2) who had undergone allogeneic bone marrow transplantation (BMT). Thirteen of them (group A), had received three doses of plasma-derived HBV vaccine from 7 to 5 years before BMT and 4–5 weeks after the last dose of vaccine, they had had high serum levels of HBV antibodies (anti-HBs). The remaining seven patients (group B) had had clinical symptoms and laboratory evidence of HBV infection in childhood with markedly elevated serum of anti-HBs. Before revaccination, a significantly lower percentage of patients (P < 0.005) with seropositive levels of anti-hbs was observed in group a than in group b. after administration of the second dose of hbv vaccine the percentage of subjects with protective levels of anti-hbs rose to 100% in both groups of patients even if the geometric mean of titers of anti-hbs increased more significantly in group b patients than in group a. we conclude that the serum levels of anti-hbs afforded by hbv vaccine administered from 7 to 5 years previously are very low and probably non-protective in most β-thalassemic patients after allogeneic BMT, and that at least two doses of HBV vaccine should be readministered from 18 to 24 months after BMT to achieve adequate and long-term protection from HBV.