Safety and Seropositivity after Live Attenuated Vaccine in Adult Patients Receiving Hematopoietic Stem Cell Transplantation.

Authors:
Takatoshi Aoki
Takatoshi Aoki
University of Occupational and Environmental Health School of Medicine
Tomohiko Kamimura
Tomohiko Kamimura
Harasanshin Hospital
Shuro Yoshida
Shuro Yoshida
Miyazaki Prefectural Miyazaki Hospital
Japan
Yasuo Mori
Yasuo Mori
Kyoto University
Japan
Masanori Kadowaki
Masanori Kadowaki
Tokyo University of Agriculture
Japan
Kentaro Kohno
Kentaro Kohno
Oita University Faculty of Medicine
Japan
Daisuke Ishihara
Daisuke Ishihara
1​ Graduate School of Life and Environmental Sciences
Shingo Urata
Shingo Urata
Kyushu University Graduate School of Medical Sciences
Japan

Biol Blood Marrow Transplant 2019 Apr 6. Epub 2019 Apr 6.

Department of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan. Electronic address:

Vaccination against vaccine-preventable diseases (VPDs) is highly recommended for hematopoietic stem cell transplantation (HSCT) recipients by several guidelines; however, the safety and seropositivity after live attenuated vaccines remain unclear in adult HSCT recipients. We analyzed titers of antibodies against measles, rubella, mumps, and varicella zoster virus (VZV) from Japanese adult patients who underwent allogeneic HSCT (allo-HSCT) (n = 74), autologous HSCT (auto-HSCT) (n = 39), or chemotherapy (n = 93). The seropositive rates for measles, rubella, mumps, and VZV in allo-HSCT recipients were 20.2%, 36.4%, 5.4%, and 55.4%, respectively. These rates were equivalent to those in auto-HSCT recipients but were significantly lower than those in patients receiving chemotherapy. Antibody titers tended to gradually decrease with time. Twenty-nine allo-HSCT recipients and 8 auto-HSCT recipients received live attenuated vaccines against VPDs for which they tested seronegative. The titers of antibodies against measles, rubella, and mumps significantly increased after 2 shots of vaccine, and the seropositive rate increased up to 19%, 30%, and 27%, respectively. Three patients (8.1%) experienced mild adverse events, which resolved promptly, indicating safe administration of the live attenuated vaccines. In multivariate analysis, history of chronic graft-versus-host disease was significantly associated with high seropositivity for measles as well as high seroconversion rate for measles after vaccination. Live attenuated vaccines against VPDs were safely administered in seronegative adult HSCT recipients. A further observational study is crucial to evaluate the efficacy of vaccination in seronegative HSCT patients.

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http://dx.doi.org/10.1016/j.bbmt.2019.04.006DOI Listing
April 2019
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