A randomized trial of one versus two doses of influenza vaccine after allogeneic transplantation.

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Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, ISSN: 1523-6536, Vol: 19, Issue: 1, Page: 109-16

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10.1016/j.bbmt.2012.08.015; 10.3410/f.717958350.793462913; 10.3410/f.717958350.793470347
Karras, Nicole A; Weeres, Matthew; Sessions, Wendy; Xu, Xiyan; Defor, Todd; Young, Jo-Anne H; Stefanski, Heather; Brunstein, Claudio; Cooley, Sarah; Miller, Jeffrey S; Blazar, Bruce R; Wagner, John E; Verneris, Michael R Show More Hide
Faculty of 1000, Ltd.; Elsevier BV
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article description
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.