Einarsdottir Sigrun, Sverrisdottir Ingigerdur, Vaht Krista, Bergström Tomas, Brune Mats, Andersson P-O, Wenneras Christine, Ljungman Per
Department of Hematology and Coagulation, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Hematology and Coagulation, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Transplant Cell Ther. 2023 Apr;29(4):275.e1-275.e5. doi: 10.1016/j.jtct.2023.01.023. Epub 2023 Jan 28.
Revaccination against tetanus and diphtheria after allogeneic hematopoietic stem cell transplantation (HCT) is usually effective, but the duration of the immunity is unknown. We conducted this study to evaluate humoral immunity to tetanus and diphtheria in long-term survivors and to provide knowledge regarding the need for boosters. The median time from HCT to blood sampling was 14 years (range, 8 to 40 years). All patients had received at least 3 doses of vaccines against both tetanus and diphtheria, either monovalent or combination vaccines containing a full dose of the diphtheria toxoid component. In addition, 1 or more booster doses were administered to 21 of the 146 patients (14%). On enzyme-linked immunosorbent assay, levels <.1 IU/mL for diphtheria and <.01 IU/mL for tetanus were considered low or seronegative. Values between .01 and .5 IU/mL for tetanus and between .1 and 1.0 IU/mL for diphtheria were considered to represent partial protection, and levels >.5 and >1.0 IU/mL were considered high and protective, respectively. In all, 39% of patients were seronegative against diphtheria, 52% had some protection, and 9% had a high titer. In contrast, no patient had become seronegative to tetanus, 32% had "partial protection" against tetanus and 68% had a high titer. In multivariate analysis, active graft-versus-host-disease, sex, or time from sampling did not affect the probability of becoming seronegative or seropositive. Younger age was associated with lower antibody levels to tetanus toxoid, but age was not correlated with antibody levels against diphtheria toxoid. Tetanus immunity was maintained after vaccination in most long-term survivors, but immunity against diphtheria was poor, and boosters should be considered.
异基因造血干细胞移植（HCT）后再次接种破伤风和白喉疫苗通常是有效的，但免疫持续时间尚不清楚。我们开展这项研究以评估长期存活者对破伤风和白喉的体液免疫，并提供有关加强免疫必要性的知识。从HCT到采血的中位时间为14年（范围8至40年）。所有患者均接受过至少3剂破伤风和白喉疫苗，包括单价疫苗或含全剂量白喉类毒素成分的联合疫苗。此外，146例患者中有21例（14%）接受了1剂或更多剂加强免疫。酶联免疫吸附测定中，白喉水平<.1 IU/mL和破伤风水平<.01 IU/mL被视为低水平或血清阴性。破伤风水平在.01至.5 IU/mL之间以及白喉水平在.1至1.0 IU/mL之间被视为具有部分保护作用，而水平>.5 IU/mL和>1.0 IU/mL分别被视为高水平且具有保护作用。总体而言，39%的患者对白喉血清阴性，52%有一定保护作用，9%有高滴度。相比之下，没有患者对破伤风血清阴性，32%对破伤风有“部分保护”，68%有高滴度。多因素分析中，活动性移植物抗宿主病、性别或采血时间不影响血清阴性或血清阳性的概率。年龄较小与破伤风类毒素抗体水平较低相关，但年龄与白喉类毒素抗体水平无关。大多数长期存活者接种疫苗后破伤风免疫得以维持，但对白喉的免疫较差，应考虑加强免疫。
