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Prepublished online as a Blood First Edition Paper on September 19, 2002; DOI 10.1182/blood-2002-03-0832.
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Blood, 1 February 2003, Vol. 101, No. 3, pp. 831-836
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Donor immunization with pneumococcal conjugate vaccine and early
protective antibody responses following allogeneic hematopoietic cell
transplantation
Deborah C. Molrine,
Joseph H. Antin,
Eva C. Guinan,
Robert J. Soiffer,
Kristin MacDonald,
Richard Malley,
Frank Malinoski,
Susan Trocciola,
Marjorie Wilson, and
Donna M. Ambrosino
From the Massachusetts Biologic Laboratories,
University of Massachusetts Medical School, Jamaica Plain, MA;
Departments of Adult Oncology and Pediatric Oncology, Dana-Farber
Cancer Institute, Division of Hematology and Oncology and Infectious
Diseases, Children's Hospital, Division of Medical Oncology, Brigham
and Women's Hospital, Boston MA; and Wyeth Pharmaceuticals, St Davids,
PA.
Patients undergoing hematopoietic cell transplantation (HCT) are at
increased risk for infections with Streptococcus pneumoniae and have long-lasting, impaired antibody responses to pneumococcal polysaccharide vaccines. We examined whether donor immunization with a
heptavalent pneumococcal conjugate vaccine (PCV7) would elicit
protective antibody responses to additional doses of vaccine administered early after transplantation. Ninety-six patients scheduled
to receive an allogeneic hematopoietic cell transplant were randomized
with their donors to receive either a dose of PCV7 vaccine or no
vaccine before transplantation. All patients received PCV7 at 3 months,
6 months, and 12 months following transplantation, and
serotype-specific antibody concentrations were determined after each
dose. Following HCT, geometric mean antibody concentrations of patients in the immunized donor group were significantly higher for
5 of the 7 vaccine serotypes after one dose (P < .05)
and for 4 of the 7 serotypes after 2 doses of vaccine
(P < .03). Sixty-seven percent of patients in the
immunized donor group had presumed protective IgG concentrations more
than or equal to 0.50 µg/mL to all 7 serotypes following the first
dose of vaccine compared to 36% in the unimmunized donor group
(P = .05). After the third dose of vaccine, both groups
had more than 60% of patients with concentrations at least 0.50 µg/mL to all vaccine serotypes. Donor immunization enhances early
antibody responses of patients undergoing HCT to pneumococcal conjugate
vaccine. A 3-dose schedule of PCV7 vaccine at 3, 6, and 12 months is
immunogenic in these patients regardless of donor immunization.
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