Submitted April 10, 2006
Accepted May 24, 2006
Immunogenicity of recombinant hepatitis B vaccine (rHBV) in recipients of unrelated or related allogeneic hematopoietic cell transplantation (HCT)
Dana Jaffe, Esperanza B Papadopoulos, James W Young, Richard J O'Reilly, Susan Prockop, Nancy A Kernan, Ann Jakuboski, Farid Boulad, Miguel-Angel Perales, Hugo Castro-Malaspina, and Trudy N Small*
Memorial Sloan-Kettering Cancer Center, New York City, NY
* Corresponding author; email: smallt{at}mskcc.org.
Current European and US guidelines for rHBV after HCT vary. The EBMT recommends rHBV starting 6-12 months after HCT (1). Immunization is optional in the CDC guidelines (2). Nevertheless, rHBV is required for re-entry to school and certain workplaces. To determine the immunogenicity of rHBV following HCT, the pre and post vaccine titers of 292 allogeneic transplant recipients who were immunized with rHBV were analyzed. Immunization was initiated in patients off immunosuppression who achieved specific minimal milestones of immune competence. Overall, 64% of patients seroconverted. In multivariate analyses, response was adversely affected by age >18 years (p<0.01) and history of prior chronic GVHD (p<0.0001) but not by donor type, use of T cell depletion, adoptive immunotherapy, or rituximab. By comparison, 89% of rHBV non-responders mounted a 
3 fold rise in polio titers following three doses of inactivated poliovirus. These data demonstrate that the rate of seroconversion following rHBV is lower in allogeneic HCT recipients compared with age matched normal controls. The data emphasize the need to document pre and post vaccine titers to ensure response and suggest that immunization guidelines based on time interval from HCT, irrespective of immune competence, may not ensure adequate protection against certain vaccine preventable diseases.
