title: Polysaccharide conjugate vaccine responses in bone marrow transplant patients.
abstract: Bone marrow transplant patients have impaired responses to pure polysaccharide (PS) vaccines and are at an increased risk for disease caused by PS encapsulated pathogens such as Haemophilus influenzae type B (HIB) and Streptococcus pneumoniae. We immunized 35 BMT patients (21 allogeneic and 14 autologous) ages 2-45 years with pure PS pneumococcal (Pnu-imune 23) HIB-conjugate (HibTITER), and tetanus toxoid vaccines. Patients were assigned to receive vaccines at either 12 and 24 months after transplantation or at 24 months only. Only 19% of all enrolled patients developed protective antibody concentrations (> or = 0.300 microgram antibody nitrogen/ml) to the 6 pneumococcal serotypes measured after the 24-month immunization. Poor response to pneumococcal vaccine was not different for the 2 study groups and was similar to previous studies. In contrast, HIB-conjugate vaccine elicited protective concentrations of antibody (> or = 1.0 microgram/ml) in 56% of patients after 1 dose and in 80% after 2 doses. The group that received 2 doses of HIB-conjugate vaccine had a significantly higher geometric mean antibody concentration of 14.5 micrograms/ml as compared with 1.43 micrograms/ml for those receiving only 1 dose (P = 0.012). Responses to tetanus toxoid vaccine were similar to HIB-conjugate vaccine, with a booster response documented after the second dose. In summary, 2 doses of HIB-conjugate vaccine given at 12 and 24 months after transplantation produced protective antibody concentrations in 80% of patients. While the response to pure PS pneumococcal vaccine was poor, the results with HIB-conjugate vaccine suggest that future pneumococcal conjugate vaccines may also benefit BMT patients.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115.
authors.forename: E C
authors.initials: EC
authors.lastname: Guinan
authors.forename: D C
authors.initials: DC
authors.lastname: Molrine
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
authors.forename: M C
authors.initials: MC
authors.lastname: Lee
authors.forename: H J
authors.initials: HJ
authors.lastname: Weinstein
authors.forename: S E
authors.initials: SE
authors.lastname: Sallan
authors.forename: S K
authors.initials: SK
authors.lastname: Parsons
authors.forename: C
authors.initials: C
authors.lastname: Wheeler
authors.forename: W
authors.initials: W
authors.lastname: Gross
authors.forename: C
authors.initials: C
authors.lastname: McGarigle
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000097:blood; D000917:Antibody Formation; D001426:Bacterial Proteins / Q000276:immunology*; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D018073:Haemophilus Vaccines / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008875:Middle Aged; D013745:Tetanus Toxoid / Q000276:immunology; D013997:Time Factors; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000276:immunology
chemical_list: D001426:Bacterial Proteins; D018073:Haemophilus Vaccines; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D013745:Tetanus Toxoid; D014614:Vaccines, Synthetic; C061963:HibTITER protein, Haemophilus influenzae