Analysis of factors affecting immune recovery and initial response to tetanus after DTaP vaccination in pediatric allogeneic HSCT patients

作者：Boles Erin E; Chiuzan Codruta; Ragucci Dominic; Hudspeth Michelle P^*

来源：Pediatric Transplantation, 2014, 18(8): 882-888.

DOI：10.1111/petr.12361

• immunization
• allogeneic stem cell transplantation
• immune responses

Transfer of donor immunity after allo-HSCT is limited, requiring re-vaccination after HSCT. The CDC 2009 guidelines introduced earlier vaccination post-HSCT with a uniform vaccination strategy. This study objective was to describe predictors of immune recovery and initial response to tetanus after DTaP vaccination post-HSCT. We conducted a retrospective chart review of pediatric allo-HSCT patients transplanted between July 1, 2007-June 30, 2012 who survived %26gt;1yr without relapse (N=27). Response to tetanus onemonth after the initial dose of DTaP was defined as a 4 fold increase in tetanus titers 1month after vaccination. Wilcoxon rank-sum exact test and Kruskall-Wallis tests were used to analyze CD4, CD8, and CD19 counts. Exact conditional logistic regression was utilized to analyze initial tetanus vaccination response. A statistically significant increase in median CD4, CD8, and CD19 counts occurred from six to 12months post-HSCT (p0.0001, 0.005, 0.004). Only 36% of patients had initial tetanus vaccination response at first attempt post-HSCT. None of the variables tested were statistically significant in predicting initial tetanus response to vaccination. There was no association between predictors of immune recovery or transplant variables and initial tetanus response. A uniform vaccination strategy is unlikely to provide protective antibodies for many post-HSCT patients and should be evaluated in larger studies.

• 出版日期2014-12