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Comparison of post-transplant vaccination among allogeneic and autologous hematopoietic stem cell transplant patients: a single center quality analysis

Bone Marrow Transplantation volume 56, pages 1717–1719 (2021)Cite this article

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Late infections occur in the majority of allogeneic HCT (allo-HCT) patients, with higher rates in unrelated donor patients and patients with advanced graft-versus-host disease (GVHD) [1]. The Center for International Blood and Marrow Transplant Research (CIBMTR) has reported infection as the cause of death in 11–13% of allo-HCT patients beyond 100 days post transplant. Similarly, infection is reported as the cause of death in 7% of autologous HCT (auto-HCT) patients [2]. Given that antibody titers to vaccine-preventable diseases decline to undetectable levels in the first several years following HCT, the 2009 international guidelines by the American Society of Blood and Marrow Transplantation (ASBMT) and other international societies established schedules for initiating revaccination among both auto-HCT and allo-HCT patients at 6–12 months post transplant [3, 4]. The implementation of these established guidelines; however, is known to be variable [5, 6]. Concerns regarding concomitant immunosuppression from GVHD or therapies such as rituximab or corticosteroids have been shown to delay revaccination efforts at multiple HCT centers [6,7,8]. In order to evaluate our center’s adherence to the 2009 ASBMT guideline-recommended schedule, we performed a retrospective quality improvement study aimed at identifying the differences in the initiation of post-transplant vaccination between allo- and auto-HCT patients. We further hypothesized that HCT patients with GVHD would have lower rates of post-transplant vaccination and longer times to initiation of the vaccination series.

We performed a retrospective analysis of allo-HCT patients at Mount Sinai Hospital from 2015 to 2017 and auto-HCT patients from 2017. Analysis was done in February 2019. Patients were included if they were alive 12 months post transplant and had not had an additional HCT after the transplant of analysis. The diagnosis of acute GVHD was verified by review of the Mount Sinai Acute GVHD International Consortium database [9]. The diagnosis of chronic GVHD within 1-year post transplant was determined by chart review. Charts were reviewed for the administration of post-transplant vaccines including: pneumococcal conjugate; tetanus, diphtheria, and pertussis (Tdap or DTaP); Haemophilus influenzae type B (HiB); inactivated polio; recombinant hepatitis B vaccine; hepatitis A; and meningococcal conjugate. Initiation of post-transplant vaccination was defined as starting at least three separate vaccination series. The percentage of patients initiated on post-transplant vaccination was compared using the two-sided Fisher’s exact test. The median time to initiation was compared using the two-tailed Mann–Whitney U test.

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Fig. 1: Percentage of all eligible HCT patients from 2017 initiated on post-transplant vaccinations by vaccine type.

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Authors and Affiliations

  1. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Benjamin Puliafito

  2. Department of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Yan Zhao, Solmaz Afshar, Zachary Galitzeck & Amir Steinberg

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  1. Benjamin Puliafito
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Correspondence to Benjamin Puliafito.

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Puliafito, B., Zhao, Y., Afshar, S. et al. Comparison of post-transplant vaccination among allogeneic and autologous hematopoietic stem cell transplant patients: a single center quality analysis. Bone Marrow Transplant 56, 1717–1719 (2021). https://doi.org/10.1038/s41409-021-01240-x

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