Storek J, Dawson M A, Lim L C-L, Burman B E, Stevens-Ayers T, Viganego F, Herremans M M P T, Flowers M E D, Witherspoon R P, Maloney D G, Boeckh M
Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA 98109-1024, USA.
Bone Marrow Transplant. 2004 Feb;33(3):337-46. doi: 10.1038/sj.bmt.1704336.
Allogeneic hematopoietic cell transplantation is followed by humoral immunodeficiency. We evaluated whether antibody levels can be improved by recipient vaccination on day -1 and 50 and whether the levels can be further improved by donor vaccination on day -20. A total of 85 patients were randomized or assigned to one of the following strategies of immunization with Streptococcus pneumoniae polysaccharides, Haemophilus influenzae polysaccharide-protein conjugate, tetanus toxoid (protein recall antigen) and hepatitis B surface antigen (protein neo-antigen): (1) donor on day -20, recipient on days -1, +50 and +365 (D(-20)R(-1,50,365)); (2) donor nil, recipient on days -1, +50 and +365 (D(N)R(-1,50,365)); or (3) donor nil, recipient on day +365 (D(N)R(365)). For H. influenzae and tetanus, IgG levels after grafting were the highest in the D(-20)R(-1,50,365) patients, intermediate in the D(N)R(-1,50,365) patients and the lowest in the D(N)R(365) patients. For S. pneumoniae and hepatitis B, antibody levels appeared to be similar in all three patient groups. The results suggest that for polysaccharide-protein conjugate antigens or protein recall antigens, recipient immunization on days -1 and 50 improves antibody levels and that donor vaccination on day -20 further improves the levels. In contrast, neither recipient immunization on days -1 and 50 nor donor immunization on day -20 appears to be efficacious for polysaccharide antigens and poorly immunogenic protein neo-antigens.
异基因造血细胞移植后会出现体液免疫缺陷。我们评估了在移植前1天和第50天对受者进行疫苗接种是否能提高抗体水平，以及在移植前20天对供者进行疫苗接种是否能进一步提高抗体水平。共有85例患者被随机分组或分配到以下用肺炎链球菌多糖、流感嗜血杆菌多糖-蛋白结合物、破伤风类毒素（蛋白质回忆抗原）和乙型肝炎表面抗原（蛋白质新抗原）进行免疫的策略之一：(1) 供者在移植前20天接种，受者在移植前1天、第50天和第365天接种（D(-20)R(-1,50,365)）；(2) 供者不接种，受者在移植前1天、第50天和第365天接种（D(N)R(-1,50,365)）；或(3) 供者不接种，受者在第365天接种（D(N)R(365)）。对于流感嗜血杆菌和破伤风，移植后IgG水平在D(-20)R(-1,50,365)组患者中最高，在D(N)R(-1,50,365)组患者中居中，在D(N)R(365)组患者中最低。对于肺炎链球菌和乙型肝炎，三组患者的抗体水平似乎相似。结果表明，对于多糖-蛋白结合抗原或蛋白质回忆抗原，在移植前1天和第50天对受者进行免疫可提高抗体水平，而在移植前20天对供者进行疫苗接种可进一步提高抗体水平。相比之下，在移植前1天和第50天对受者进行免疫以及在移植前20天对供者进行免疫，对于多糖抗原和免疫原性差的蛋白质新抗原似乎均无效。
