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Prepublished online as a Blood First Edition Paper on September 19, 2002; DOI 10.1182/blood-2002-03-0832.
Submitted March 15, 2002
Accepted September 4, 2002
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
Massachusetts Biologic Laboratories, University of Massachusetts Medical School, Jamaica Plain, MA, USA; Department of Infectious Diseases, Children's Hospital, Boston, MA, USA
Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Medical Oncology, Brigham and Women's Hospital, Boston, MA, USA
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Hematology and Oncology, Children's Hospital, Boston, MA, USA
Massachusetts Biologic Laboratories, University of Massachusetts Medical School, Jamaica Plain, MA, USA
Department of Infectious Diseases, Children's Hospital, Boston, MA, USA
Wyeth Pharmaceuticals, St. Davids, PA, USA
* Corresponding author; email: deborah.molrine{at}state.ma.us.
Hematopoietic cell transplant (HCT) patients 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 transplant. Ninety-six patients scheduled to receive an allogeneic HCT 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<0.05) and for 4 of the 7 serotypes after two doses of vaccine (p<0.03). Sixty-seven percent of patients in the immunized donor group had presumed protective IgG concentrations  0.50 µg/ml to all seven serotypes following the first dose of vaccine compared to 36% in the unimmunized donor group (p=0.05). After the third dose of vaccine, both groups had greater than 60% of patients with concentrations 0.50 µg/ml to all vaccine serotypes. Donor immunization enhances early antibody responses of HCT patients to pneumococcal conjugate vaccine. A three dose schedule of PCV7 vaccine at 3, 6 and 12 months is immunogenic in HCT patients regardless of donor immunization.
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