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A Randomized Trial of One versus Two Doses of Influenza Vaccine after Allogeneic Transplantation

2012; Elsevier BV; Volume: 19; Issue: 1 Linguagem: Inglês

10.1016/j.bbmt.2012.08.015

1523-6536

Nicole Karras, Matthew Weeres, Wendy Sessions, Xiyan Xu, Todd E. DeFor, Jo‐Anne H. Young, Heather E. Stefanski, Claudio G. Brunstein, Sarah Cooley, Jeffrey S. Miller, Bruce R. Blazar, John E. Wagner, Michael R. Verneris,

Immunotherapy and Immune Responses

Influenza infection after allogeneic hematopoietic cell transplantation (allo-HCT) can result in severe complications. The effectiveness of the annual vaccine depends on age, immune competence, and the antigenic potential of the 3 strains included. We hypothesized that a second vaccine dose, the standard of care for vaccine-naïve children, might improve post hematopoietic cell transplantation (HCT) immune responses. Patients >60 days post-HCT were randomized to receive either 1 (n = 33) or 2 (n = 32) influenza vaccine doses separated by 1 month. The primary endpoint was whether 2 vaccinations induced superior immunity; however, we found no difference. Secondary endpoints were to identify variables associated with responses. Both hemagglutination inhibition (HI; P < .005) and ELISpot responses (P = .03) were greater for patients vaccinated ≥1 year posttransplantation. Umbilical cord blood (UCB) recipients showed less IFN-γ responses (P < .001). Interestingly, there was a positive correlation between the total number of CD19+ cells before vaccination and seroconversion (P = .01) and an inverse correlation for IFN-γ responses (P = .05). Variables not associated with vaccine responses included prevaccine CD4+ cell counts (total, naïve, or memory), steroid usage at vaccination, age, or conditioning intensity. Time from transplantation to vaccination and absolute CD19+ cell counts were the strongest predictors of vaccine responses. Methods to improve influenza vaccine responses after allo-HCT are needed.