Hung Te-Yu, Kotecha Rishi S, Blyth Christopher C, Steed Sarah K, Thornton Ruth B, Ryan Anne L, Cole Catherine H, Richmond Peter C
Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
Cancer. 2017 Nov 1;123(21):4215-4223. doi: 10.1002/cncr.30764. Epub 2017 Jul 11.
Children receiving immunosuppressive treatment for cancer are at high risk for invasive pneumococcal disease. The 13-valent pneumococcal conjugate vaccine (PCV13) can prevent pneumococcal disease in healthy children; however, there is an absence of literature regarding the benefit of PCV13 in immunocompromised children with cancer.
A prospective, open-label cohort study recruited children between ages 1 and 18 years who were receiving active immunosuppressive therapy (AIT) or were within 12 months after completing immunosuppressive therapy (CIT). Blood samples were taken before and 4 weeks after the administration of single-dose PCV13. Serotype-specific immunoglobulin G antibody titers were measured, and titers ≥0.35 μg/mL were considered protective. Solicited side effects were recorded in a 7-day diary after vaccination.
Eighty-five children were recruited. At baseline, ≤50% had protective antibody titers against Streptococcus pneumoniae for 10 serotypes in the AIT group and for 8 serotypes in the CIT group. Postvaccination, ≥70% had protective antibody titers for 9 and 11 serotypes in the AIT and CIT groups, respectively. Both groups had comparable responses to PCV7 serotypes, whereas a significantly higher proportion in the CIT group achieved protective antibody titers to PCV13 serotypes. There was a low rate of serious adverse events (3.5%).
A single-dose of PCV13 is safe and immunogenic in children diagnosed with cancer. All children who are receiving therapy for cancer should receive a single dose of PCV13 as soon as possible after diagnosis, regardless of prior PCV exposure. The current data support the recommendation for an additional dose of PCV13 after the completion of immunosuppressive therapy to provide additional protection against invasive pneumococcal disease. Cancer 2017;123:4215-4223. © 2017 American Cancer Society.
接受癌症免疫抑制治疗的儿童患侵袭性肺炎球菌疾病的风险很高。13价肺炎球菌结合疫苗（PCV13）可预防健康儿童患肺炎球菌疾病；然而，关于PCV13对免疫功能低下的癌症儿童的益处，目前尚无相关文献。
一项前瞻性、开放标签队列研究招募了1至18岁正在接受积极免疫抑制治疗（AIT）或在完成免疫抑制治疗（CIT）后12个月内的儿童。在单剂量PCV13接种前和接种后4周采集血样。检测血清型特异性免疫球蛋白G抗体滴度，滴度≥0.35μg/mL被视为具有保护性。接种疫苗后7天的日记中记录了主动报告的副作用。
共招募了85名儿童。基线时，AIT组中针对10种血清型的肺炎链球菌具有保护性抗体滴度的儿童≤50%，CIT组中针对8种血清型的儿童≤50%。接种疫苗后，AIT组和CIT组中分别有≥70%的儿童针对9种和11种血清型具有保护性抗体滴度。两组对PCV7血清型的反应相当，而CIT组中达到PCV13血清型保护性抗体滴度的比例明显更高。严重不良事件发生率较低（3.5%）。
单剂量PCV13对诊断为癌症的儿童是安全且具有免疫原性的。所有接受癌症治疗的儿童在诊断后应尽快接种单剂量PCV13，无论之前是否接触过PCV。目前的数据支持在免疫抑制治疗完成后额外接种一剂PCV13的建议，以提供针对侵袭性肺炎球菌疾病的额外保护。《癌症》2017年；123:4215 - 4223。©2017美国癌症协会。
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