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5/2017
vol. 92 abstract:
Original paper
The evaluation of immune reconstitution in the context of making decisions on revaccinations for children and young adults after haematopoietic stem cell transplantation: real-life analysis
Anna Urbańczyk
,
Ewelina Pukownik
,
Elżbieta Grześk
,
Piotr Księżniakiewicz
,
Anna Dąbrowska
,
Krzysztof Czyżewski
,
Robert Dębski
,
Jan Styczyński
,
Sylwia Kołtan
PEDIATRIA POLSKA 92 (2017) 494-501
Online publish date: 2018/03/07
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Aim
The aim of the study was to evaluate immune reconstitution before making deci¬sions of revaccination for patients after haematopoietic stem cell transplantation (HSCT). The reasons for the derogations from our algorithm were also analyzed. Patients The study included 81 patients aged 1.5 to 25.2 years, with 31 women and 50 men, and 55 allo-HSCT and 26 auto-HSCT patients. We analyzed time and degree of immunological reconstitution after HSCT and decisions that have been made with respect to revaccination, its postponement or implementation of immunoglobulin substitution. Results Time between HSCT and immunological assessment ranged from 5.1 to 27.4 months (median 11 months, including 8.6 months after auto-HSCT and 11.5 months after allo¬HSCT). For patients for whom auto-HSCT was the last phase of oncological treatment, this median time was 6.7 months. Evaluation of immune system up to 8 months after HSCT was performed for 15/81 (18.5%) patients. Among the remaining 66 patients, the most common cause of delay was immunosuppression (22.7%), and in 16/66 (24.2%) cases, no cause was found in the medical records. After first evaluation of the immune system, 64/81 (79%) patients were advised to resume vaccination. Conclusions Immunological reconstitution analysis after HSCT was delayed in 81.5% of patients. In order to improve the effectiveness of the post-HSCT vaccination program, it seems appropriate to accelerate the first immunological evaluation and to differentiate the recommendations according to the type of transplantation and post-HSCT therapy, i.e. 3–6 months after auto-HSCT or last phase of oncological treatment and 6-12 months after allo-HSCT. keywords:
Immune reconstitution, Haematopoietic stem cell transplantation, Vaccinations |
POLSKI
