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[异基因造血干细胞受体的新冠病毒疫苗接种]

[COVID-19 vaccination for allogeneic hematopoietic stem cell recipients].

作者信息

Nagafuji Koji

机构信息

Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine.

出版信息

Rinsho Ketsueki. 2022;63(9):1067-1077. doi: 10.11406/rinketsu.63.1067.

Abstract

The novel coronavirus disease 2019 (COVID-19) is caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with COVID-19 due to severe immune dysfunction. Recombinant adenovirus vector-based vaccine, such as AstraZeneca ChAdOx1, and mRNA-based vaccines, such as Pfizer BNT162b2 and Moderna mRNA-1273 have been used in Japan. COVID-19 vaccine administration to HSCT recipients was reported to result in a 68-96.5% seroconversion for the spike protein. Factors associated with the absence of humoral responses were the time-interval from HSCT to vaccination, absolute lymphocyte count, systemic immunosuppressive treatments, graft versus host disease (GVHD), B-cell count, and hypogammaglobulinemia. New onset and exacerbation of chronic GVHD have been reported as an adverse events associated with vaccination. COVID-19 vaccination of HSCT recipients is relatively safe, and recipients should be vaccinated against COVID-19 6 months after transplantation. In the future, it is necessary to consider passive immunotherapy for HSCT patients who do not benefit from COVID1-19 vaccination.

摘要

2019年新型冠状病毒病(COVID-19)由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起。造血干细胞移植(HSCT)受者由于严重的免疫功能障碍,感染COVID-19后死亡和发病风险增加。在日本已使用基于重组腺病毒载体的疫苗,如阿斯利康ChAdOx1,以及基于mRNA的疫苗,如辉瑞BNT162b2和莫德纳mRNA-1273。据报道,对HSCT受者接种COVID-19疫苗后,刺突蛋白的血清转化率为68%-96.5%。与无体液反应相关的因素包括从HSCT到接种疫苗的时间间隔、绝对淋巴细胞计数、全身免疫抑制治疗、移植物抗宿主病(GVHD)、B细胞计数和低丙种球蛋白血症。已有报道称,慢性GVHD的新发和加重是与接种疫苗相关的不良事件。HSCT受者接种COVID-19疫苗相对安全,受者应在移植后6个月接种COVID-19疫苗。未来,有必要考虑对未从COVID-19疫苗接种中获益的HSCT患者进行被动免疫治疗。

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