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Predictive factors for vaccine failure to guide vaccination in allogeneic hematopoietic stem cell transplant recipients

Bone Marrow Transplantation volume 56, pages 2922–2928 (2021)Cite this article

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A Correction to this article was published on 31 March 2022

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Abstract

Vaccination after hematopoietic stem cell transplantation (HSCT) is essential to protect high-risk patients against potentially lethal infections. Though multiple studies have evaluated vaccine specific responses, no comprehensive analysis of a complete vaccination schedule post-HSCT has been performed and little is known about predictors for vaccine failure. In this context, allogeneic HSCT (alloHSCT) patients were included and vaccinated starting one year post-transplantation. Antibody responses were measured by Multiplex Immuno Assay for pneumococcal (PCV13), meningococcal C, diphtheria, pertussis, tetanus and Haemophilus influenza type b one month after the last vaccination and correlated to clinical and immunological parameters. Vaccine failure was defined as antibody response above vaccine-specific cut-off values for less than four out of six vaccines. Ninety-six patients were included of which 27.1% was found to have vaccine failure. Only 40.6% of all patients responded adequately to all six vaccines. In multivariate analysis, viral reactivation post-HSCT (OR 6.53; P = 0.03), B-cells <135 per mm3 (OR 7.24; P = 0.00) and NK-cells <170 per mm3 (OR 11.06; P = 0.00) were identified as predictors for vaccine failure for vaccination at one year post-alloHSCT. Measurement of antibody responses and an individualized approach for revaccination guided by clinical status and immune reconstitution of B-cells and NK-cells may improve vaccine responses.

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Fig. 1: Percentages of the study population with adequate antibody responses compared to the general healthy population.

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Acknowledgements

We thank Marjan Kuijer and Jeffrey van Vliet for performing the Multiplex Immuno Assay analyses at the Center for Infectious Disease Control, RIVM, Bilthoven, the Netherlands.

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Author notes

  1. These authors contributed equally: Debbie van Baarle, Jürgen Kuball.

Authors and Affiliations

  1. Department of Infectious Diseases, UMC Utrecht, Utrecht, the Netherlands

    Michelle J. M. Janssen & Anke H. W. Bruns

  2. Department of Microbiology, UMC Utrecht, Utrecht, the Netherlands

    Frans M. Verduyn Lunel

  3. Department of Hematology, UMC Utrecht, Utrecht, the Netherlands

    Reinier A. P. Raijmakers, Roel J. de Weijer & Jürgen Kuball

  4. Center for Infectious Disease Control, RIVM, Bilthoven, the Netherlands

    Nening M. Nanlohy, Gaby P. Smits & Debbie van Baarle

  5. Center for Translational Immunology, UMC Utrecht, Utrecht, the Netherlands

    Debbie van Baarle

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Contributions

MJ and AB designed the study and wrote the manuscript. RJW collected clinical data, FVL collected samples for immunological data. NN and GS performed the Multiplex Immuno Assays on collected samples and DVB supervised these assays. MJ analyzed and interpreted the clinical and immunological data. AB, RR, DVB and JK gave critical input. All authors critically revised the manuscript, approved the final version to be published and agreed to accountability of the work.

Corresponding author

Correspondence to Michelle J. M. Janssen.

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The original version of this article was revised: In table 2 the outlining has beem done incorrectly, as now the ‘univariate analysis’ has been put above ‘P-value’, and ‘multivariate analysis’ has been put above both the univariate and multivariate results. Furthermore, another error had occurred in table 2, namely instead of <135/170 (cell counts), in this table it says ‘>’, which is incorrect, it should be read ‘<’

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Janssen, M.J.M., Bruns, A.H.W., Verduyn Lunel, F.M. et al. Predictive factors for vaccine failure to guide vaccination in allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 56, 2922–2928 (2021). https://doi.org/10.1038/s41409-021-01437-0

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