A randomized, double-blind trial of pneumococcal vaccination in adult allogeneic stem cell transplant donors and recipients.
BACKGROUND
Adult allogeneic hematopoietic stem cell transplant (HSCT) recipients are at high risk of invasive pneumococcal disease but have suboptimal responses to the recommended pneumococcal polysaccharide vaccine (PPV23). Pneumococcal conjugate vaccine (PCV7) may improve immunogenicity in this population, and a donor vaccination strategy may benefit patients undergoing HSCT.


METHODS
Sixty-four pairs of donors and recipients scheduled to undergo HSCT were randomized to receive either PPV23 or PCV7. Vaccinations were administered to donors before transplantation and to recipients at 6 months after transplantation. Serotype-specific antipneumococcal titers were measured in donors at the time of harvest and in recipients before transplantation and 6 and 12 months after transplantation.


RESULTS
Overall, immunogenicity was poor with both strategies. However, at 6 months, response to at least 1 serotype was seen in 0 (0%) of 19 and 8 (38.6%) of 21 evaluable recipients whose donors had received PPV23 and PCV7, respectively (P=.003). At 12 months, response was seen in 10 (55.6%) of 18 and 20 (90.9%) of 22 HSCT recipients who had received PPV23 and PCV7, respectively (P=.02). Multivariate logistic regression revealed that, at 12 months after transplantation, the type of vaccine given was the only significant factor affecting response, with an odds ratio of 8.85 (95% confidence interval, 1.62-47.6; P=.012) favoring PCV7.


CONCLUSIONS
A donor and recipient paired vaccination strategy with PCV7 demonstrated safety and greater immunogenicity than did a similar strategy with PPV23.
Kumar
Deepali
D
Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada. deepali.kumar@ualberta.ca
Chen
Maggie Hong
MH
Welsh
Brenda
B
Siegal
Deborah
D
Cobos
Isabel
I
Messner
Hans A
HA
Lipton
Jeff
J
Humar
Atul
A
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D019520:Living Donors; D008297:Male; D022401:Meningococcal Vaccines / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000009:adverse effects; D014184:Transplantation, Homologous; D018074:Vaccines, Conjugate / Q000009:adverse effects
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate