小儿及青年患者造血干细胞移植后乙型肝炎疫苗免疫应答。

Immune responses to hepatitis B vaccination after hematopoietic stem cell transplantation in pediatric and young adult patients.

机构信息

Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Clin Transplant. 2020 Oct;34(10):e14024. doi: 10.1111/ctr.14024. Epub 2020 Sep 4.

DOI:10.1111/ctr.14024

PMID:32609899

Abstract

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) recipients require hepatitis B (HBV) revaccination. Hepatitis B surface antibody (anti-HBs) seroconversion rates after revaccination range from 64% to 79% in these patients. The seroconversion rate and factors associated with non-seroconversion have not been clearly elucidated in pediatric and young adult recipients after HSCT.

OBJECTIVES

To evaluate anti-HBs seroconversion rates in pediatric and young adult patients revaccinated after HSCT, and to identify factors associated with non-seroconversion.

METHOD

The current study was prospective and cross-sectional. Post-HSCT recipients aged ≤25 years who had completed a course of three HBV revaccinations were recruited, and their anti-HBs titers were assessed. Non-seroconverted patients were administered a fourth vaccination. Those who subsequently remained seronegative were administered two additional vaccinations. Those who remained seronegative after all six vaccinations were defined as non-responders.

RESULTS

A total of 118 patients were enrolled. The HBV-containing vaccines used included DTaP-IPV-HBV-Hib, DTwP-HBV-Hib, and monovalent vaccines. The anti-HBs seroconversion rate after three revaccinations was 82% (95% confidence interval [CI], 73.7-89.2). One patient (0.8%) was classified as non-responder. Factors associated with non-seroconversion after three revaccinations included cytomegalovirus (CMV) reactivation (odds ratio [OR] 10.63, 95% CI 1.16-97.00), anti-HBs seronegativity before HSCT (OR 7.01, 95% CI 1.55-31.78) and three DTwP-HBV-Hib revaccinations (OR 11.71, 95% CI 1.43-96.26).

CONCLUSION

In the current study the anti-HBs seroconversion rate after three HBV revaccinations was excellent. CMV reactivation, anti-HBs seronegativity before HSCT, and three DTwP-HBV-Hib revaccinations were associated with non-seroconversion, but the non-responder rate was low.

摘要

背景

造血干细胞移植（HSCT）受者需要乙型肝炎（HBV）再接种疫苗。在这些患者中，再接种后乙型肝炎表面抗体（抗-HBs）血清转换率为 64%至 79%。在儿童和年轻成人 HSCT 受者中，血清转换率和与非血清转换相关的因素尚未明确。

目的

评估 HSCT 后再接种疫苗的儿童和年轻成人患者的抗-HBs 血清转换率，并确定与非血清转换相关的因素。

方法

本研究为前瞻性、横断面研究。纳入了完成 3 剂 HBV 再接种疗程且年龄≤25 岁的 HSCT 后受者，并评估其抗-HBs 滴度。未发生血清转换的患者给予第 4 剂接种。随后，对仍为血清阴性的患者给予 2 剂追加接种。对所有 6 剂接种后仍为血清阴性的患者定义为无应答者。

结果

共纳入 118 例患者。使用的 HBV 疫苗包括 DTaP-IPV-HBV-Hib、DTwP-HBV-Hib 和单价疫苗。3 次再接种后的抗-HBs 血清转换率为 82%（95%置信区间[CI]，73.7%至 89.2%）。1 例（0.8%）患者被归类为无应答者。3 次再接种后发生非血清转换的相关因素包括巨细胞病毒（CMV）再激活（比值比[OR]10.63，95%CI 1.16~~97.00）、HSCT 前抗-HBs 阴性（OR 7.01，95%CI 1.55~~31.78）和 3 剂 DTwP-HBV-Hib 再接种（OR 11.71，95%CI 1.43~96.26）。