Ljungman P, Wiklund-Hammarsten M, Duraj V, Hammarström L, Lönnqvist B, Paulin T, Ringdén O, Pepe M S, Gahrton G
Department of Medicine, Karolinska Institute, Huddinge, Sweden.
J Infect Dis. 1990 Aug;162(2):496-500. doi: 10.1093/infdis/162.2.496.
An ELISA was used to study long-term immunity and immunization responses to tetanus toxoid in 48 bone marrow transplant recipients. Among patients who were seropositive to tetanus before transplant, 51% had lost their seropositivity 1 year later. All patients who were not reimmunized with tetanus toxoid were seronegative 2 years after transplant. All patients who were seronegative before transplant remained seronegative 1 year later regardless of the donor's serologic status. There was no difference in the ability to remain seropositive to tetanus toxoid between patients with and without chronic graft-versus-host disease. Of 21 patients immunized with one dose of tetanus toxoid 1 year after transplant, 14 were seronegative at the time of immunization (response rate, 64%). At 1 year after immunization, 7 remained seropositive. Ten patients were reimmunized with two doses of tetanus toxoid. All responded and 90% remained seropositive 1 year later. When 21 patients were primarily immunized with three doses of tetanus toxoid, all patients seronegative at immunization responded and all tested patients remained seropositive 2 years later. The immunization responses were significantly superior in patients receiving three doses compared with those who received one. Reimmunization with tetanus toxoid of long-term survivors after marrow transplant seems necessary. A three-dose immunization schedule is recommended to obtain an adequate immune response.
采用酶联免疫吸附测定法（ELISA）研究了48例骨髓移植受者对破伤风类毒素的长期免疫和免疫反应。在移植前破伤风血清学阳性的患者中，51%在1年后失去了血清学阳性。所有未重新接种破伤风类毒素的患者在移植后2年血清学均为阴性。所有移植前血清学阴性的患者1年后无论供者血清学状态如何仍保持血清学阴性。慢性移植物抗宿主病患者和非慢性移植物抗宿主病患者对破伤风类毒素保持血清学阳性的能力没有差异。在移植后1年接受一剂破伤风类毒素免疫的21例患者中，14例在免疫时血清学为阴性（应答率64%）。免疫后1年，7例仍保持血清学阳性。10例患者用两剂破伤风类毒素进行了再次免疫。所有患者均有反应，90%在1年后仍保持血清学阳性。当21例患者初次用三剂破伤风类毒素免疫时，所有免疫时血清学阴性的患者均有反应，所有检测患者在2年后仍保持血清学阳性。与接受一剂的患者相比，接受三剂的患者免疫反应明显更好。骨髓移植后长期存活者重新接种破伤风类毒素似乎是必要的。建议采用三剂免疫方案以获得足够的免疫反应。
