ORIGINAL PAPER
The evaluation of immune reconstitution in the context of making decisions on revaccinations for children and young adults after haematopoietic stem cell transplantation: real-life analysis
Publication date: 2018-03-07
Pediatr Pol 2017;92(5):494-501
KEYWORDS
ABSTRACT
Aim:
The aim of the study was to evaluate immune reconstitution before making deci¬sions of revaccination for patients after haematopoietic stem cell transplantation (HSCT). The reasons for the derogations from our algorithm were also analyzed.
Patients:
The study included 81 patients aged 1.5 to 25.2 years, with 31 women and 50 men, and 55 allo-HSCT and 26 auto-HSCT patients. We analyzed time and degree of immunological reconstitution after HSCT and decisions that have been made with respect to revaccination, its postponement or implementation of immunoglobulin substitution.
Results:
Time between HSCT and immunological assessment ranged from 5.1 to 27.4 months (median 11 months, including 8.6 months after auto-HSCT and 11.5 months after allo¬HSCT). For patients for whom auto-HSCT was the last phase of oncological treatment, this median time was 6.7 months. Evaluation of immune system up to 8 months after HSCT was performed for 15/81 (18.5%) patients. Among the remaining 66 patients, the most common cause of delay was immunosuppression (22.7%), and in 16/66 (24.2%) cases, no cause was found in the medical records. After first evaluation of the immune system, 64/81 (79%) patients were advised to resume vaccination.
Conclusions:
Immunological reconstitution analysis after HSCT was delayed in 81.5% of patients. In order to improve the effectiveness of the post-HSCT vaccination program, it seems appropriate to accelerate the first immunological evaluation and to differentiate the recommendations according to the type of transplantation and post-HSCT therapy, i.e. 3–6 months after auto-HSCT or last phase of oncological treatment and 6-12 months after allo-HSCT.
The aim of the study was to evaluate immune reconstitution before making deci¬sions of revaccination for patients after haematopoietic stem cell transplantation (HSCT). The reasons for the derogations from our algorithm were also analyzed.
Patients:
The study included 81 patients aged 1.5 to 25.2 years, with 31 women and 50 men, and 55 allo-HSCT and 26 auto-HSCT patients. We analyzed time and degree of immunological reconstitution after HSCT and decisions that have been made with respect to revaccination, its postponement or implementation of immunoglobulin substitution.
Results:
Time between HSCT and immunological assessment ranged from 5.1 to 27.4 months (median 11 months, including 8.6 months after auto-HSCT and 11.5 months after allo¬HSCT). For patients for whom auto-HSCT was the last phase of oncological treatment, this median time was 6.7 months. Evaluation of immune system up to 8 months after HSCT was performed for 15/81 (18.5%) patients. Among the remaining 66 patients, the most common cause of delay was immunosuppression (22.7%), and in 16/66 (24.2%) cases, no cause was found in the medical records. After first evaluation of the immune system, 64/81 (79%) patients were advised to resume vaccination.
Conclusions:
Immunological reconstitution analysis after HSCT was delayed in 81.5% of patients. In order to improve the effectiveness of the post-HSCT vaccination program, it seems appropriate to accelerate the first immunological evaluation and to differentiate the recommendations according to the type of transplantation and post-HSCT therapy, i.e. 3–6 months after auto-HSCT or last phase of oncological treatment and 6-12 months after allo-HSCT.
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