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Immunogenicity of the inactivated influenza vaccine in children who have undergone autologous stem cell transplant

Bone Marrow Transplantation volume 55, pages 1829–1831 (2020)Cite this article

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Autologous stem cell transplant (SCT) is an upfront therapeutic modality for children with malignancies such as high-risk neuroblastoma and atypical teratoid rhabdoid tumour and a salvage option for children with lymphoma and a variety of solid tumours. The administration of high-dose myeloablative chemotherapy during conditioning increases vulnerability to infection. Influenza infection can result in significant complications, in particular progression to pneumonia, in patients who have undergone autologous SCT [1, 2]. Influenza vaccination is recommended to prevent infection in children following autologous SCT [3], however, there is limited evidence regarding its benefit in this population [4]. Due to the paucity of data, we performed a prospective multicentre study to evaluate the immunogenicity of the seasonal inactivated influenza vaccine in children who have undergone autologous SCT compared with healthy matched controls.

Recruitment was undertaken during the Southern Hemisphere influenza seasons of 2013–2016 (March to September) from three tertiary paediatric haematology, oncology and bone marrow transplant units in Australia (Princess Margaret Hospital for Children, Perth; Queensland Children’s Hospital, Brisbane; Women’s and Children’s Hospital, Adelaide). Children between the ages of 6 months and 18 years who were ≥6 months and ≤2 years post autologous SCT were eligible. Healthy siblings were recruited as age-matched controls. Exclusion criteria included anaphylaxis to previous doses of any influenza vaccine, a history of egg anaphylaxis, receipt of intravenous immunoglobulin within the last 3 months, a history of Guillain–Barre syndrome or current medical condition that would be compromised by inclusion in the study. Informed consent was obtained from the parents of each child prior to recruitment.

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References

  1. Nichols WG, Guthrie KA, Corey L, Boeckh M. Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis. 2004;39:1300–6.

    Article  Google Scholar 

  2. Whimbey E, Elting LS, Couch RB, Lo W, Williams L, Champlin RE, et al. Influenza A virus infections among hospitalized adult bone marrow transplant recipients. Bone Marrow Transplant. 1994;13:437–40.

    CAS  PubMed  Google Scholar 

  3. Cordonnier C, Einarsdottir S, Cesaro S, Di Blasi R, Mikulska M, Rieger C, et al. Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19:e200–12.

    Article  Google Scholar 

  4. Dulek DE, de St Maurice A, Halasa NB. Vaccines in pediatric transplant recipients-Past, present, and future. Pediatr Transplant. 2018;22:e13282.

    Article  Google Scholar 

  5. Ryan AL, Wadia UD, Jacoby P, Cheung LC, Kerr F, Fraser C, et al. Immunogenicity of the inactivated influenza vaccine in children who have undergone allogeneic haematopoietic stem cell transplant. Bone Marrow Transplant. 2019. https://doi.org/10.1038/s41409-019-0728-5. [Epub ahead of print]

  6. Australian Technical Advisory Group on Immunisation. The Australian Immunisation Handbook, 10th Ed. Canberra: Australian Government Department of Health, 2013.

  7. WHO Global Influenza Surveillance Network. Manual for the laboratory diagnosis and virological surveillance of influenza, 2011. Available from URL: https://www.who.int/influenza/gisrs_laboratory/manual_diagnosis_surveillance_influenza/en/. Accessed 15 Oct 2019.

  8. Committee for Proprietary Medicinal Products (CPMP). Note for guidance on harmonisation of requirements for influenza vaccines. CPMP/BWP/214/96. European Agency for the Evaluation of Medicinal Products (EMEA). March 1997.

  9. Gandhi MK, Egner W, Sizer L, Inman I, Zambon M, Craig JI, et al. Antibody responses to vaccinations given within the first two years after transplant are similar between autologous peripheral blood stem cell and bone marrow transplant recipients. Bone Marrow Transplant. 2001;28:775–81.

    Article  CAS  Google Scholar 

  10. Pauksen K, Linde A, Hammarstrom V, Sjolin J, Carneskog J, Jonsson G, et al. Granulocyte-macrophage colony-stimulating factor as immunomodulating factor together with influenza vaccination in stem cell transplant patients. Clin Infect Dis. 2000;30:342–8.

    Article  CAS  Google Scholar 

  11. Engelhard D, Zakay-Rones Z, Shapira MY, Resnick I, Averbuch D, Grisariu S, et al. The humoral immune response of hematopoietic stem cell transplantation recipients to AS03-adjuvanted A/California/7/2009 (H1N1)v-like virus vaccine during the 2009 pandemic. Vaccine. 2011;29:1777–82.

    Article  CAS  Google Scholar 

  12. Engelhard D, Nagler A, Hardan I, Morag A, Aker M, Baciu H, et al. Antibody response to a two-dose regimen of influenza vaccine in allogeneic T cell-depleted and autologous BMT recipients. Bone Marrow Transplant. 1993;11:1–5.

    CAS  PubMed  Google Scholar 

Download references

Funding

RSK (NHMRC APP1142627) and CCB (NHMRC APP1111596) are supported by Fellowships from the National Health and Medical Research Council of Australia. This study was funded by a Perth Children’s Hospital Foundation Project Grant and a Pfizer Cancer Competitive Research Grant. The WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, is supported by the Australian Government Department of Health. This study was approved by the Child and Adolescent Health Service Ethics Committee (Ethics Approval Number 1988/EP), with ethical approval granted at all sites under the National Mutual Acceptance agreement. The study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12614000240640).

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Authors and Affiliations

  1. Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children’s Hospital, Perth, Western Australia, Australia

    Anne L. Ryan, Fiona Kerr, Nicholas G. Gottardo & Rishi S. Kotecha

  2. Department of Infectious Diseases, Perth Children’s Hospital, Perth, Western Australia, Australia

    Ushma D. Wadia, Christopher C. Blyth & Peter C. Richmond

  3. Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia

    Peter Jacoby, Laurence C. Cheung, Nicholas G. Gottardo & Rishi S. Kotecha

  4. School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia

    Laurence C. Cheung & Rishi S. Kotecha

  5. Blood and Bone Marrow Transplant Program, Queensland Children’s Hospital, Brisbane, Queensland, Australia

    Chris Fraser

  6. Department of Clinical Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia

    Heather Tapp

  7. WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Louise A. Carolan, Karen L. Laurie & Ian G. Barr

  8. Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia

    Christopher C. Blyth, Nicholas G. Gottardo, Peter C. Richmond & Rishi S. Kotecha

  9. Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia

    Christopher C. Blyth & Peter C. Richmond

  10. PathWest Laboratory Medicine WA, Perth, Western Australia, Australia

    Christopher C. Blyth

Authors
  1. Anne L. Ryan
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  2. Ushma D. Wadia
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  3. Peter Jacoby
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  4. Laurence C. Cheung
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  5. Fiona Kerr
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  6. Chris Fraser
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  7. Heather Tapp
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  8. Louise A. Carolan
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  9. Karen L. Laurie
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  10. Ian G. Barr
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  11. Christopher C. Blyth
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  12. Nicholas G. Gottardo
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  13. Peter C. Richmond
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  14. Rishi S. Kotecha
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Contributions

UDW, PCR and RSK conceived and designed the study. ALR, FK, CF, HT and RSK recruited patients onto the study. LAC, KLL and IGB performed serological analysis. PJ performed statistical analysis. ALR, PJ and RSK analysed and interpreted the results. ALR and RSK wrote the paper. All authors edited and approved the final version of the paper for submission.

Corresponding author

Correspondence to Rishi S. Kotecha.

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Ryan, A.L., Wadia, U.D., Jacoby, P. et al. Immunogenicity of the inactivated influenza vaccine in children who have undergone autologous stem cell transplant. Bone Marrow Transplant 55, 1829–1831 (2020). https://doi.org/10.1038/s41409-019-0770-3

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