Vaccination against infectious disease following hematopoietic stem cell transplantation

David Avigan, Liise-anne Pirofski, Hillard M. Lazarus

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Patients undergoing hematopoietic stem cell transplantation (HSCT) experience a prolonged period of dysfunctional immunity associated with an increased risk of bacterial and viral infections. Effective approaches toward vaccinating patients against common pathogens are being explored but are limited by poor levels of responsiveness. Relevant studies examining the nature of reconstitution of cellular and humoral immunity and its impact on vaccination strategies against infectious pathogens are reviewed. Following transplantation, deficiencies in cellular immunity are characterized by the inversion of CD4/CD8 ratios, a decreased proliferative response to mitogens, and the development of anergy to recall antigens as measured by delayed-type hypersensitivity testing. The impact on humoral immunity consists of decreased levels of circulating immunoglobulin, impaired immunoglobulin class switching, and a loss of complexity in immunoglobulin gene rearrangement patterns. In this setting, a loss of protective immunity has been demonstrated against viral and bacterial pathogens previously targeted by childhood vaccination. Infections due to encapsulated bacterial organisms such as Streptococcus pneumoniae and Haemophilus influenzae type B remain prevalent even in the late posttransplantation period. The efficacy of vaccination following HSCT is influenced by the time elapsed since transplantation, the nature of the hematopoietic graft, the use of serial immunization, and the presence of graft-versus-host disease. Strategies to enhance vaccine efficacy include pretransplantation immunization of the stem cell donor and the use of cytokine adjuvants.

Original languageEnglish (US)
Pages (from-to)171-183
Number of pages13
JournalBiology of Blood and Marrow Transplantation
Volume7
Issue number3
StatePublished - 2001
Externally publishedYes

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Hematopoietic Stem Cell Transplantation
Communicable Diseases
Vaccination
Humoral Immunity
Cellular Immunity
Immunity
Immunization
Transplantation
Immunoglobulin Class Switching
CD4-CD8 Ratio
Immunoglobulin Genes
Gene Rearrangement
Haemophilus influenzae
Delayed Hypersensitivity
Graft vs Host Disease
Virus Diseases
Streptococcus pneumoniae
Mitogens
Bacterial Infections
Immunoglobulins

Keywords

  • Posttransplantation immunization
  • Posttransplantation infection
  • Reconstitution of immunity

ASJC Scopus subject areas

  • Transplantation

Cite this

Vaccination against infectious disease following hematopoietic stem cell transplantation. / Avigan, David; Pirofski, Liise-anne; Lazarus, Hillard M.

In: Biology of Blood and Marrow Transplantation, Vol. 7, No. 3, 2001, p. 171-183.

Research output: Contribution to journalArticle

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