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Infections

A pilot randomized trial of adjuvanted influenza vaccine in adult allogeneic hematopoietic stem cell transplant recipients

Bone Marrow Transplantation volume 52, pages 1016–1021 (2017)Cite this article

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Abstract

The annual influenza vaccine is recommended for hematopoietic stem cell transplant (HSCT) patients although studies have shown suboptimal immunogenicity. Influenza vaccine containing an oil-in-water emulsion adjuvant (MF59) may lead to greater immunogenicity in HSCT recipients. We randomized adult allogeneic HSCT patients to receive the 2015–2016 influenza vaccine with or without MF59 adjuvant. Preimmunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assay. We randomized 73 patients and 67 (35 adjuvanted; 32 non-adjuvanted) had paired samples available at follow-up. Median age was 54 years (range 22–74) and time from transplant was 380 days (range 85–8107). Concurrent graft-versus-host disease was seen in 42/73 (57.5%). Geometric mean titers increased significantly after vaccination in both groups. Seroconversion to at least one of three influenza antigens was present in 62.9% vs 53.1% in adjuvanted vs non-adjuvanted vaccine (P=0.42). Factors associated with lower seroconversion rates were use of calcineurin inhibitors (P<0.001) and shorter duration from transplantation (P=0.001). Seroconversion rates were greater in patients who got previous year influenza vaccination (82.6% vs 45.5%, P=0.03). Adjuvanted vaccine demonstrated similar immunogenicity to non-adjuvanted vaccine in the HSCT population and may be an option for some patients.

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Acknowledgements

Author contributions

YN, AH and DK participated in research design, the writing of the paper, the performance of the research and data analysis. JL and DDHK participated in writing of the paper and data analysis. PA and KH participated in the performance of the research.

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Authors and Affiliations

  1. Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, ON, Canada

    Y Natori, A Humar, P Ashton & D Kumar

  2. Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada

    J Lipton & D D Kim

  3. Public Health England, London, UK

    K Hoschler

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  1. Y Natori
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  2. A Humar
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  3. J Lipton
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  6. K Hoschler
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  7. D Kumar
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Correspondence to D Kumar.

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Competing interests

DK has received research funding from Roche and GSK, honoraria from GSK and Sanofi. The remaining authors have no conflicts of interest.

Additional information

Presented in part at IDWeek, New Orleans, 23–27 October 2016.

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Natori, Y., Humar, A., Lipton, J. et al. A pilot randomized trial of adjuvanted influenza vaccine in adult allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 52, 1016–1021 (2017). https://doi.org/10.1038/bmt.2017.24

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