tetano
Editor, Senior Moderator
Haematologica. 2011 Mar 21. [Epub ahead of print]
Graft-versus-host disease is the major determinant of humoral responses to the AS03-adjuvanted influenza A/09/H1N1 vaccine in allogeneic hematopoietic stem cell transplant recipients.
Mohty B, Bel M, Vukicevic M, Nagy M, Levrat E, Meier S, Grillet S, Combescure C, Kaiser L, Chalandon Y, Passweg J, Siegrist CA, Roosnek E.
Switzerland.
Abstract
Background. Vaccine responses to influenza vaccines are poorly characterized in immunocompromised patients. The goal of this study was to assess the efficacy of the AS03-adjuvanted influenza H1N1/A/09 vaccine in allogeneic hematopoietic stem cell transplant recipients. Design and methods. We enrolled 65 patients and 138 controls in an open prospective study. Controls received one dose and patients two doses of the AS03-adjuvanted influenza H1N1/A/09 vaccine at a 3-week interval. Geometric mean titres and seroprotection/seroconversion rates were determined by hemagglutination inhibition before and 4 weeks after the last immunization. Clinical and biological markers, including immunoglobulins, CD3+, CD4+, CD8+ and naive CD4+ T-cells counts were assessed in all patients. Results. Baseline seroprotection rates were low in patients (6.6%) and controls (14.8%). After 2 doses, patients (n=57, 92.3%) achieved similar seroprotection rates (84% vs 87%, p=0.65) and antibody titers (305 vs 340, p=0.88) as controls (n=131, 93.9%) after 1 dose. In univariate analysis, transplant-to-vaccination interval <12 months, active graft-vs-host disease, immunosuppressive drugs, hemoglobin <12g/l, lymphopenia <1G/l, IgG <4g/l, IgA <0.5g/l, IgM <0.5g/l and naive CD4+ T-cells <150/microL were significantly associated with weaker responses. Multivariate analysis identified transplant-to-vaccination interval and active graft-vs-host disease as the most powerful negative predictors of antibody responses (p=0.04 and p=0.002, respectively). Vaccination was well tolerated in both cohorts. Conclusions. In allogeneic hematopoietic stem cell transplant recipients, two doses of an adjuvanted influenza vaccine elicited comparable responses to a single dose in healthy individuals. However, vaccine responses remained poor in patients with ongoing graft-vs-host disease, supporting the need for additional strategies in this high-risk patient population (clinicaltrials.gov: ID: NCT01022905).
PMID: 21422117 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21422117
Graft-versus-host disease is the major determinant of humoral responses to the AS03-adjuvanted influenza A/09/H1N1 vaccine in allogeneic hematopoietic stem cell transplant recipients.
Mohty B, Bel M, Vukicevic M, Nagy M, Levrat E, Meier S, Grillet S, Combescure C, Kaiser L, Chalandon Y, Passweg J, Siegrist CA, Roosnek E.
Switzerland.
Abstract
Background. Vaccine responses to influenza vaccines are poorly characterized in immunocompromised patients. The goal of this study was to assess the efficacy of the AS03-adjuvanted influenza H1N1/A/09 vaccine in allogeneic hematopoietic stem cell transplant recipients. Design and methods. We enrolled 65 patients and 138 controls in an open prospective study. Controls received one dose and patients two doses of the AS03-adjuvanted influenza H1N1/A/09 vaccine at a 3-week interval. Geometric mean titres and seroprotection/seroconversion rates were determined by hemagglutination inhibition before and 4 weeks after the last immunization. Clinical and biological markers, including immunoglobulins, CD3+, CD4+, CD8+ and naive CD4+ T-cells counts were assessed in all patients. Results. Baseline seroprotection rates were low in patients (6.6%) and controls (14.8%). After 2 doses, patients (n=57, 92.3%) achieved similar seroprotection rates (84% vs 87%, p=0.65) and antibody titers (305 vs 340, p=0.88) as controls (n=131, 93.9%) after 1 dose. In univariate analysis, transplant-to-vaccination interval <12 months, active graft-vs-host disease, immunosuppressive drugs, hemoglobin <12g/l, lymphopenia <1G/l, IgG <4g/l, IgA <0.5g/l, IgM <0.5g/l and naive CD4+ T-cells <150/microL were significantly associated with weaker responses. Multivariate analysis identified transplant-to-vaccination interval and active graft-vs-host disease as the most powerful negative predictors of antibody responses (p=0.04 and p=0.002, respectively). Vaccination was well tolerated in both cohorts. Conclusions. In allogeneic hematopoietic stem cell transplant recipients, two doses of an adjuvanted influenza vaccine elicited comparable responses to a single dose in healthy individuals. However, vaccine responses remained poor in patients with ongoing graft-vs-host disease, supporting the need for additional strategies in this high-risk patient population (clinicaltrials.gov: ID: NCT01022905).
PMID: 21422117 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21422117