| 1. |
- Hammarström, Viera
(författare)
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B-cell immunity in patients with hematological malignancies and after stem cell transplantation : studies with special reference to tetanus and pneumococcal immunity
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Treatment of malignancies with cytotoxic chemotherapy and/or bone marrow or stem cell transplantation also suppress the immune system which becomes incapable of controlling infections. Therefore infections can remain a serious problem for an extended period in these patients. The aims of these studies was to assess the immunological status against tetanus and pneumococci and the need of revaccinations. It was hypothesized that the immunity of the donor replaces the immunity of the patient after allogeneic bone marrow transplantation (BMT). However, recipients of allogeneic marrow grafts frequently lost pretransplant immunity against tetanus after transplantation. After reimmunization with tetanus toxoid all patients responded with an adequate antibody production. Our further studies have shown similar findings in recipients of autologous grafts; the tetanus. immunity was defective both after autologous bone marrow transplantation (ABMT) and autologous peripheral stem cell transplantation (APBSCT). None of the patients who were seronegative seroconverted spontaneously without vaccination. Also patients treated for hematological malignancies with cytotoxic chemotherapy were in a high frequency unprotected against tetanus. The risk factors for loss of immunity against tetanus were increasing age, lymphoid malignancy and advanced disease stage. All these patient groups can therefore benefit from tetanus vaccination; a three dose immunization schedule was superior to obtain a long-lasting immunity. Serologic studies of pneumococcal immunity showed that ABMT recipients retained pretransplant immunity, while it was lost in BMT patients. Immunization with pneumococcal polysaccharide vaccine was effective in BMT patients without chronic graft-versus-host disease (GVHD), while patients with chronic GVHD responded with an immature antibody pattern or did not respond at all. The poor antigenicity of the polysaccharide based vaccines was noted previously in immunocompromised patients. Therefore vaccines with polysaccharide conjugated to peptide were developed. The pneumococcal conjugate vaccine seems to elicit better immune response than polysaccharide vaccine in BMT patients with chronic GVHD. The immune system matures slowly after transplantation and the patients have usually normalized levels of immunoglobulins within one year. The specific immunity is defective in immunocompromised patients and there is no correlation between levels of specific antibodies and total immunoglobulin levels.
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| 2. |
- Hammarström, Viera, et al.
(författare)
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Serum immunoglobulin levels in relation to levels of specific antibodies in allogeneic and autologous bone marrow transplant recipients
- 2000
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Ingår i: Transplantation. - : Ovid Technologies (Wolters Kluwer Health). - 0041-1337 .- 1534-6080. ; 69:8, s. 1582-1586
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to investigate the correlation of total levels of immunoglobulins to levels of specific antibodies after allogeneic and autologous bone marrow transplantation. Autologous transplant patients had normal levels of IgA and IgG antibodies already at 6 months after transplantation. In allogeneic transplanted patients without chronic graft versus host disease the immunological recovery was slower. The IgA and IgG levels were at the limit for deficiency at 6 months after transplantation. In allogeneic transplant patients with chronic chronic graft versus host disease the immunological recovery was delayed further. The total IgG levels were low at 12 months after transplantation and the IgG subclass pattern did not normalize until 24 months after transplantation. IgA levels remained low at 24 months after transplantation in all allogeneic transplanted patients with chronic chronic graft versus host disease. Protective levels of specific antibodies against tetanus and pneumococci decreased during the first year after transplantation regardless of the total immunoglobulin levels, regardless of the donors immunity. Pneumococcal antibodies decreased only in allogeneic transplanted patients, although autologous transplant patients retained pretransplant immunity against pneumococci. There was no difference in levels of specific antibodies between patients with and without chronic chronic graft versus host disease at 12 months after transplantation. There was no correlation between total immunoglobulin levels to levels of specific antibodies against tetanus and pneumococci after transplantation in our study. Taken together, normalized immunoglobulin levels do not predict normalization of levels of specific antibodies against tetanus and pneumococci after transplantation.
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| 3. |
- Hammarström, Viera, et al.
(författare)
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Tetanus immunity in autologous bone marrow and blood stem cell transplant recipients
- 1998
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Ingår i: Bone Marrow Transplantation. - : Springer Science and Business Media LLC. - 0268-3369 .- 1476-5365. ; 22:1, s. 67-71
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to assess long-term immunity and reimmunization responses against tetanus toxoid in recipients of autologous stem cell grafts and to compare immune status in patients who underwent ABMT or autologous blood stem cell transplantation (APBSCT). Ninety patients were included in the study; 52 had received ABMT and 38 APBSCT. Thirty of 52 ABMT patients (58%) and 25 of 38 APBSCT patients (66%) had protective antibody levels against tetanus before transplantation (P = NS). The rate of seropositivity had decreased at 1 year after transplantation; 15 of 52 (29%) ABMT patients and 18 of 38 (47%) APBSCT patients (P = NS) were still positive after 1 year. There were no cases of spontaneous recovery in seronegative patients. Most patients were reimmunized with three doses of tetanus toxoid given at 12, 13, 14 and or 18 months after transplantation. All immunized patients had protective immunity against tetanus at 1 year after vaccination. These results suggest that humoral immunity is defective both after ABMT and after APBSCT and in both cases the loss of immunity seems to be similar. Reimmunization of patients who have undergone ABMT or APBSCT is necessary to obtain protective immunity against tetanus.
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| 4. |
- Hammarström, Viera, et al.
(författare)
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Tetanus immunity in patients with hematological malignancies
- 1998
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Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 6:5, s. 469-472
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate long-term immunity to tetanus toxoid among patients with hematological disease who had been treated with conventional doses of chemotherapy. Altogether 206 patients with different hematological malignancies were included in the study. There were marked differences between the rates of seronegativity against tetanus, varying from 20% to 70% in different groups of study patients. We found that 21 of 80 (36%) patients with AML, 45 of 80 (56%) with ALL, 12 of 22 (54%) with lymphoma, 4 of 13 (31%) with myeloma and 2 of 11 (18%) with CML were not immune to tetanus. In a multivariate logistic regression model increasing age (P = 0.0001), lymphoid malignancy (P = 0.0005) and advanced disease stage (P = 0.0001) were independent risk factors for loss of tetanus immunity in patients with hematological malignancies.
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| 5. |
- Pauksen, Karlis, et al.
(författare)
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Granulocyte-macrophage colony-stimulating factor as immunomodulating factor together with influenza vaccination in stem cell transplant patients
- 2000
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Ingår i: Clinical Infectious Diseases. - : Oxford University Press (OUP). - 1058-4838 .- 1537-6591. ; 30:2, s. 342-348
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Tidskriftsartikel (refereegranskat)abstract
- The effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on the serological response at influenza vaccination was studied in 117 patients who had undergone stem cell transplantation (SCT). The vaccine response was evaluated as significant increases in levels of influenza hemagglutination-inhibition (HAI) antibodies and of IgG antibodies measured by enzyme-linked immunosorbent assay (ELISA). There was no difference in antibody response to either influenza A or B in 64 patients who received GM-CSF at vaccination, compared with the 53 who did not. In the subgroup of allogeneic SCT patients, HAI showed that the response rate to the influenza B vaccine was significantly higher in the treatment group (P<.05). ELISA showed that autologous SCT patients with breast cancer who received GM-CSF had a better response to influenza A (P<.05) and B (P<.01). At early vaccination, 4-12 months after stem cell transplantation, these responses were more pronounced. GM-CSF appears to improve the response to influenza vaccination in some groups of SCT patients, but only to a limited extent.
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