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Vaccine Responses in Adult Hematopoietic Stem Cell Transplant Recipients: A Comprehensive Review

成人造血干細胞移植受者的疫苗反應：綜合綜述

Patients who recently received a stem cell transplantation are at greater risk for infection due to impairment of their immune system. In order to prevent severe infection, these patients are vaccinated after their stem cell transplantation with childhood immunization vaccines. Timing of this vaccination is important in order to be effective and obtain proper immune response. Postponement of vaccination would lead to better immune response but would also cause longer-lasting risk of infection. This review describes available data on the timing of vaccination and its vaccine responses. Optimal timing of vaccination might require an individualized approach per patient.

最近接受干細胞移植的患者由于免疫系統(tǒng)受損而面臨更大的感染風險。為了預防嚴重感染，這些患者在干細胞移植后接種了兒童免疫疫苗。為了有效并獲得適當?shù)拿庖叻磻@種疫苗接種的時機很重要。推遲接種疫苗會導致更好的免疫反應，但也會導致更持久的感染風險。本綜述描述了關(guān)于疫苗接種時間及其疫苗反應的可用數(shù)據(jù)。接種疫苗的最佳時機可能需要對每位患者采取個體化的方法。

細胞搖瓶

Hematopoietic stem cell transplantation (HSCT) is a promising and often the only curative option for patients with hematological malignancies [1]. Post-HSCT, the immune system is temporarily suppressed due to prior conditioning and usage of immunosuppressive medication, resulting in infection-derived complications being a major cause of transplant-related mortality [2]. Furthermore, pre-HSCT established immunity against vaccine-preventable diseases might be diminished through transplantation. To avoid infections, preventive strategies such as antibiotics, antiviral and antifungal prophylaxis and post-HSCT vaccination are recommended. Vaccination regimens for childhood immunization are clearly described in international guidelines, yet optimal timing of the vaccination is less clearly described and variable among guidelines [3,4,5,6,7].

Timing appears to play an important role in vaccine effectiveness. Vaccination before proper immune reconstitution may impair vaccine responses. However, as the risk of infection increases with time, postponing revaccination unnecessarily is undesirable [8,9]. Furthermore, recommendations for allogeneic HSCT (alloHSCT) and autologous HSCT (autoHSCT) recipients are uniform, whereas immunologic memory and immune reconstitution differ [3]. In daily practice, post-autoHSCT recipients are either not vaccinated or receive vaccination conforming with the post-alloHSCT guidelines. Insight into vaccine responses to childhood immunization vaccines related to timing of the vaccination is needed. The aim of the present review was to evaluate the current literature on optimal timing of vaccination, vaccine schedule and vaccine types post-HSCT in relation to vaccine responses.

PETG血清培養(yǎng)基瓶

造血干細胞移植 (HSCT) 是血液系統(tǒng)惡性腫瘤患者的一種有前途且通常是唯一的治愈選擇 [ 1 ]。HSCT 后，由于事先調(diào)理和使用免疫抑制藥物，免疫系統(tǒng)暫時受到抑制，導致感染衍生的并發(fā)癥是移植相關(guān)死亡率的主要原因 [ 2]。此外，HSCT 前建立的針對疫苗可預防疾病的免疫力可能會通過移植而減弱。為避免感染，建議采取預防策略，例如抗生素、抗病毒和抗真菌預防以及 HSCT 后接種疫苗。國際指南中清楚地描述了兒童免疫接種方案，但疫苗接種的最佳時機描述得不太清楚，并且在指南中有所不同 [ 3 , 4 , 5 , 6 , 7 ]。

時間似乎在疫苗有效性中起著重要作用。在適當?shù)拿庖咧亟ㄖ敖臃N疫苗可能會削弱疫苗反應。然而，隨著感染的風險隨著時間的推移而增加，不必要地推遲再次接種是不可取的 [ 8 , 9 ]。此外，對同種異體 HSCT (alloHSCT) 和自體 HSCT (autoHSCT) 受者的建議是一致的，而免疫記憶和免疫重建不同 [ 3]。在日常實踐中，autoHSCT 后接受者要么未接種疫苗，要么接受符合 alloHSCT 后指南的疫苗接種。需要深入了解與疫苗接種時間相關(guān)的兒童免疫疫苗對疫苗的反應。本綜述的目的是評估目前關(guān)于疫苗反應的最佳疫苗接種時間、疫苗時間表和 HSCT 后疫苗類型的文獻。

細胞工廠

In conclusion, vaccine responses to the childhood immunization vaccines in post-HSCT patients are lower as compared with healthy individuals, and therefore, measurement of response might be indicated. Furthermore, timing of vaccination is essential to reach optimal responses. Considering the influence of patient factors such as GVHD and usage of immunosuppressive drugs, an individualized approach might be necessary to optimize vaccine responses. However, guidance on how to initiate this individualized approach is currently lacking and further studies are needed.

Based on the included studies, general recommendations on timing of the childhood immunization vaccines post-alloHSCT are made and shown in Table 4. Due to overall lower response rates compared with healthy populations [47], assessment of response after vaccination is recommended. For autoHSCT recipients, no recommendations could be formed based on our review due to the scarcity of data.

細胞培養(yǎng)瓶

總之，與健康個體相比，HSCT 后患者對兒童免疫疫苗的疫苗反應較低，因此可能需要對反應進行測量。此外，疫苗接種的時機對于達到最佳反應至關(guān)重要?？紤]到 GVHD 和免疫抑制藥物使用等患者因素的影響，可能需要采用個體化方法來優(yōu)化疫苗反應。然而，目前缺乏關(guān)于如何啟動這種個性化方法的指導，需要進一步研究。

根據(jù)納入的研究，就 alloHSCT 后兒童免疫疫苗的時機提出了一般性建議，并顯示在表 4中。由于與健康人群相比總體反應率較低 [ 47 ]，建議評估疫苗接種后的反應。對于 autoHSCT 接受者，由于數(shù)據(jù)稀缺，無法根據(jù)我們的審查形成建議。

關(guān)鍵詞： 造血干細胞移植,疫苗接種,疫苗反應, hematopoietic stem cell transplantation,vaccination, vaccine response

來源：MDPI https://www.mdpi.com/2072-6694/13/23/6140/htm