Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)
Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)
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DOI：
10.1016/s1473-3099(18)30600-5
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发表时间：
2019-06-01
影响因子：
56.3
通讯作者：
Wenneras, Christine
中科院分区：
文献类型：
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作者：
Cordonnier, Catherine;Einarsdottir, Sigrun;Wenneras, Christine
感染是造血干细胞移植（HSCT）后的主要问题，也是移植相关死亡的主要原因。其中一些感染可以通过接种疫苗预防。大多数HSCT受者在移植后的第一个月就失去了对各种病原体的免疫力，无论移植前供体或受体是否接种疫苗。接种灭活疫苗在移植后是安全的，是恢复对各种病原体（如流感病毒和肺炎链球菌）的保护的有效方法，特别是对于移植手术增加感染风险的病原体。在移植后的最初几个月或几年内，移植患者对疫苗的反应通常低于同龄健康个体，但随着时间的推移，它会在手术后2-3年内接近正常。然而，由于免疫原性疫苗已被发现在移植后3个月就能诱导相当大比例的患者产生免疫应答，因此我们建议从移植后3个月开始接种灭活疫苗，无论患者是否发生移植物抗宿主病（GvHD）或接受免疫抑制剂。GvHD患者感染的风险更高，可能从疫苗接种中获益。另一个挑战是为HSCT接受者提供与特定国家同龄健康个体相同水平的疫苗保护。由于疫苗诱发疾病的风险，减毒活疫苗的使用应限于特定情况。
Infection is a main concern after haemopoietic stem cell transplantation (HSCT) and a major cause of transplant-related mortality. Some of these infections are preventable by vaccination. Most HSCT recipients lose their immunity to various pathogens as soon as the first months after transplant, irrespective of the pre-transplant donor or recipient vaccinations. Vaccination with inactivated vaccines is safe after transplantation and is an effective way to reinstate protection from various pathogens (eg, influenza virus and Streptococcus pneumoniae), especially for pathogens whose risk of infection is increased by the transplant procedure. The response to vaccines in patients with transplants is usually lower than that in healthy individuals of the same age during the first months or years after transplant, but it improves over time to become close to normal 2-3 years after the procedure. However, because immunogenic vaccines have been found to induce a response in a substantial proportion of the patients as early as 3 months after transplant, we recommend to start crucial vaccinations with inactivated vaccines from 3 months after transplant, irrespectively of whether the patient has or has not developed graft-versus-host disease (GvHD) or received immunosuppressants. Patients with GvHD have higher risk of infection and are likely to benefit from vaccination. Another challenge is to provide HSCT recipients the same level of vaccine protection as healthy individuals of the same age in a given country. The use of live attenuated vaccines should be limited to specific situations because of the risk of vaccine-induced disease.