Reimmunization After HSCT

Most recipients of HSCT will lose their immunity to the vaccinations they have received prior to HSCT. In addition, patients with chronic GVHD are at risk for infections with streptococcus pneumoniae and H. in-fluenzae. Therefore, re-immunization of HSCT recipients is essential. A recent guideline was published detailing the rationale for vaccination schedules [40]. In general, at 12 months post HSCT in patients without chronic GVHD, vaccinations can be given on a schedule similar to that used with normal infants; however,the 23-valent pneumococcal polysaccharide vaccine may not result in adequate antibody response, even when administration is delayed to 12months [14]. The 7-valent pneumococcal conjugate vaccine is linked to a protein carrier and may enhance immune response. A recent study showed early immunization with this 7-valent vaccine resulted in protection in most patients. The authors of the study suggest an administration schedule of 3,6 and 12 months [26].Vaccines that are contraindicated include BCG, oral polio and varicella (see Table 17.5).

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