Abstract
Autologous and allogeneic bone marrow transplantation (BMT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children <7 years old), Haemophilus influenzae type b conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time to vaccinate, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers, suggesting that the lack of sufficient data has not permitted the formulation of reliable recommendations. The use of other vaccines and the perspectives for different vaccination protocols are analyzed in this review.
Highlights
The conditioning regimen used in marrow graft recipients ablates normal and abnormal immunohematopoietic elements and prepares the marrow microenvironment for the donor marrow to develop
The loss of protective immunity to agents such as tetanus, poliovirus, and measles has been consistently demonstrated in patients submitted to allogeneic and autologous bone marrow transplantation (BMT), and a reimmunization program is necessary to ensure immunity [2,3,4,5]
Several surveys regarding reimmunization after BMT have demonstrated that vaccination protocols vary greatly among BMT centers, with insufficient data to establish solid recommendations [6,7,8,9]
Summary
The conditioning regimen used in marrow graft recipients ablates normal and abnormal immunohematopoietic elements and prepares the marrow microenvironment for the donor marrow to develop. The recipients lose immune memory of exposure to infectious agents and vaccines accumulated throughout their lives. The loss of protective immunity to agents such as tetanus, poliovirus, and measles has been consistently demonstrated in patients submitted to allogeneic and autologous bone marrow transplantation (BMT), and a reimmunization program is necessary to ensure immunity [2,3,4,5]. The European Group for Blood and Marrow Transplantation, the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation have recommended that the following vaccines be included in reimmunization pro-. C.M. Machado tocols for autologous, syngeneic and allogeneic BMT recipients: diphtheria toxoid, tetanus toxoid, pertussis vaccine (children
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