Immunity and Vaccination Against Measles, Mumps, and Rubella in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients
Immunity and Vaccination Against Measles, Mumps, and Rubella in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients
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DOI：
10.1016/j.jtct.2021.02.027
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发表时间：
2021-05-05
影响因子：
3.2
通讯作者：
Kanda, Yoshinobu
中科院分区：
文献类型：
--
作者：
Kawamura, Koji;Wada, Hidenori;Kanda, Yoshinobu
世界各地偶尔会爆发大规模麻疹或风疹，移植患者的麻疹感染可能会很严重，甚至是致命的。然而，关于同种异基因干细胞移植(allo-HCT)后成人患者对麻疹、腮腺炎和风疹(MMR)的免疫力的数据有限。本研究的目的是评价成人allo-HCT后MMR免疫状态及接种MMR疫苗的效果。这项研究包括135名成年患者，他们在allo-HCT后2年没有复发和新的恶性肿瘤。我们在allo-HCT前和之后每年检测MMR的抗体。按Kaplan-Meier法估计异基因HCT后麻疹、腮腺炎、风疹的血清阳性率，组间比较采用对数列检验。在allo-HCT前血清阳性的患者中，在allo-HCT后2年血清阳性的概率分别为：麻疹60.6%，腮腺炎39.7%，风疹52.2%。慢性移植物抗宿主病病史往往是丧失对麻疹(危险比[HR]1.69，P=.064)和风疹(HR=1.75，P=.056)免疫力的危险因素。为了预测allo-HCT后2年对MMR的免疫力丧失，我们定义了以下HCT前免疫球蛋白指数的截止值：18.2对于麻疹，5.3对于腮腺炎，21.4对于风疹。两年后，低免疫球蛋白人群的血清阳性率显著下降(麻疹分别为39%和82%，P<；.001；腮腺炎分别为13%和59%，P<；.001；风疹分别为33%和90%，P<；.001)。在失去免疫力后，25名患者接受了单次抗-MMR疫苗接种。麻疹、腮腺炎、风疹的阳转率分别为%、36%、72%。对MMR的免疫力丧失通常发生在移植后的头几年。在免疫丧失的患者中，移植后2年接种1剂MMR疫苗的血清转换率次之。(C)2021年美国移植和细胞治疗学会。爱思唯尔公司出版，版权所有。
Large outbreaks of measles or rubella occasionally occur around the world, and measles infection can be severe and even fatal in transplant patients. However, limited data are available on immunity to measles, mumps, and rubella (MMR) in adult patients after allogeneic stem cell transplantation (allo-HCT). The aim of this study was to evaluate the immune status against MMR and the effects of vaccination against MMR in adult patients after allo-HCT. A total of 135 adult patients who were alive without relapse and new malignancy at 2 years after allo-HCT were included in this study. We measured IgG antibody to MMR before allo-HCT and annually thereafter. The probabilities of being seropositive to measles, mumps or rubella after allo-HCT were estimated according to the Kaplan-Meier method and compared among groups with the log-rank test. The probability of being seropositive at 2 years after allo-HCT in patients who were seropositive before allo-HCT was 60.6% for measles, 39.7% for mumps, and 52.2% for rubella. History of chronic graft-versus-host disease tended to be a risk factor for the loss of immunity against measles (hazard ratio [HR] 1.69, P = .064) and rubella (HR 1.75, P = .056). To predict the loss of immunity against MMR at 2 years after allo-HCT, we defined the following cutoff values for the IgG index before HCT: 18.2 for measles, 5.3 for mumps, and 21.4 for rubella using a receiver-operating characteristics curve. The lower-IgG groups experienced a significant loss of seropositivity at 2 years (39% versus 82% for measles, P < .001; 13% versus 59% for mumps, P < .001; and 33% versus 90% for rubella, P < .001). After this loss of immunity, 25 patients received a single vaccination against-MMR. The sero-conversion rates were 64%, 36%, and 72% for measles, mumps, and rubella, respectively. Loss of immunity to MMR commonly occurs in the first several years after transplantation. In the patients who lose the immunity, the seroconversion rate after 1 dose of MMR vaccine given at >= 2 years after transplantation is suboptimal. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.