Kumar Deepali, Chen Maggie Hong, Welsh Brenda, Siegal Deborah, Cobos Isabel, Messner Hans A, Lipton Jeff, Humar Atul
Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
Clin Infect Dis. 2007 Dec 15;45(12):1576-82. doi: 10.1086/523583.
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.
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.
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.
A donor and recipient paired vaccination strategy with PCV7 demonstrated safety and greater immunogenicity than did a similar strategy with PPV23.
成人异基因造血干细胞移植（HSCT）受者发生侵袭性肺炎球菌病的风险很高，但对推荐的肺炎球菌多糖疫苗（PPV23）反应欠佳。肺炎球菌结合疫苗（PCV7）可能会改善该人群的免疫原性，并且供体接种策略可能会使接受HSCT的患者受益。
将计划接受HSCT的64对供体和受者随机分为接受PPV23或PCV7。在移植前给供体接种疫苗，在移植后6个月给受者接种疫苗。在采集时测定供体的血清型特异性抗肺炎球菌滴度，并在移植前以及移植后6个月和12个月测定受者的血清型特异性抗肺炎球菌滴度。
总体而言，两种策略的免疫原性均较差。然而，在6个月时，供体接受PPV23和PCV7的可评估受者中，分别有0/19（0%）和8/21（38.6%）对至少1种血清型有反应（P = 0.003）。在12个月时，接受PPV23和PCV7的HSCT受者中，分别有10/18（55.6%）和20/22（90.9%）有反应（P = 0.02）。多因素逻辑回归显示，在移植后12个月，所接种疫苗的类型是影响反应的唯一显著因素，支持PCV7的优势比为8.85（95%置信区间，1.62 - 47.6；P = 0.012）。
与使用PPV23的类似策略相比，采用PCV7的供体和受者配对接种策略显示出安全性和更强的免疫原性。
