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Association between graft source and response to live-attenuated vaccination in pediatric hematopoietic stem cell transplantation recipients: a single-center retrospective study

Bone Marrow Transplantation volume 55, pages 1872–1874 (2020)Cite this article

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Infection control is one of the most important issues after hematopoietic stem cell transplantation (HSCT). The risk of vaccine-preventable diseases (VPDs) still exists for HSCT recipients; indeed, several cases of fatal VPD have been reported in this population [1, 2]. Immunity acquired before HSCT, including acquired immunity from previous vaccination, has been well described as diminishing after HSCT [3,4,5,6]. Most patients who have had a natural history of infection reportedly remain seropositive, while children who have been immunized commonly lose their immunity after bone marrow transplantation (BMT) [4, 5]. HSCT recipients, especially pediatric patients, must therefore be considered for revaccination after HSCT. Several guidelines for vaccination following HSCT have been proposed [3, 7,8,9]. However, reports on the efficacy and safety of vaccination (particularly live-attenuated vaccination) after HSCT remain limited. Moreover, no studies have compared immunity or vaccine response among BMT, umbilical cord blood transplantation (CBT), and autologous peripheral blood stem cell transplantation (PBSCT).

Here, we studied 86 consecutive pediatric HSCT recipients who underwent revaccination between July 2008 and October 2018 at Nagoya University Hospital and reviewed the efficacy and safety of vaccinations. In addition, we compared antibody responses with live-attenuated vaccination according to clinical backgrounds, including graft sources. Detailed methods of this study are available in the Supplementary Methods. In brief, HSCT recipients underwent initial vaccination at >6 months after HSCT without relapse of the underlying disease and had neither active chronic graft-versus-host disease (GVHD) nor ongoing immunosuppression. Inactivated vaccines generally were administered prior to live-attenuated vaccines. Live-attenuated vaccines were normally administered >24 months after HSCT to seronegative recipients. Patients usually underwent immunological assay 4–6 weeks apart from the vaccination during a periodic visit. Additional second vaccination was performed if the titer of the antibody was below the respective threshold for each antigen (seronegative). The second dose was usually scheduled at least 8–12 weeks after the first dose if the patient remained seronegative. Information regarding the safety of each vaccine was collected at regular visits during follow-up.

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Fig. 1: Comparisons of seropositivity after HSCT and seroconversion rate for the four live-attenuated vaccines among the three different sources of HSCT.

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Authors and Affiliations

  1. Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Takako Suzuki, Jun-ichi Kawada, Eri Nishikawa, Yuka Torii, Kazuhiro Horiba, Suguru Takeuchi, Toshihiko Okumura, Hideki Muramatsu, Yoshiyuki Takahashi & Yoshinori Ito

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  1. Takako Suzuki
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  2. Jun-ichi Kawada
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Correspondence to Yoshinori Ito.

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Suzuki, T., Kawada, Ji., Nishikawa, E. et al. Association between graft source and response to live-attenuated vaccination in pediatric hematopoietic stem cell transplantation recipients: a single-center retrospective study. Bone Marrow Transplant 55, 1872–1874 (2020). https://doi.org/10.1038/s41409-020-0867-8

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