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Immunosuppressants/Pneumococcal-13-valent-CRM197-vaccine-conjugate/pneumococcalvaccines

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Invasive pneumococcal disease and vaccination failure: 13 case reports In a retrospective, single-center observational study conducted between 1 January 2004 and 31 December 2015, 13 patients [sexes not stated] aged 27–73 years were described. Eleven out of thirteen patients developed invasive pneumococcal disease while receiving immunosuppression therapy with antithymocyte globulin, bortezomib, ciclosporin, cyclophosphamide, dexamethasone, interferon, lenalidomide, methotrexate, mycophenolate, prednisolone, tacrolimus or thalidomide, and seven out of these eleven patients developed vaccination failure following vaccination with pneumococcal-13 valent CRM197 vaccine conjugate or pneumococcal vaccine. The remaining two patients developed vaccination failure following vaccination with pneumococcal vaccine [routes, dosages and durations of treatments to reactions onsets not stated]. The patients with non-Hodgkin lymphoma, acute lymphoblastic leukaemia, mantle cell lymphoma, multiple myeloma or acute myeloid leukaemia underwent haematopoietic stem cell transplantation. Following transplant, the patients started receiving immunosuppression therapy with dexamethasone and lenalidomide (2 patients), dexamethasone and thalidomide (2 patients), lenalidomide (1 patient), interferon (1 patient), bortezomib and prednisolone (1 patient), antithymocyte globulin and cyclophosphamide (1 patient), mycophenolate, prednisolone and tacrolimus (1 patient), methotrexate, ciclosporin and prednisolone (1 patient) and prednisolone (1 patient). Seven patients were scheduled to receive pneumococcal-vaccine [PPV23] at 12 months and 24 months after the transplant, followed by a booster every 5 years, and two patients were scheduled to receive pneumococcal-13 valent CRM197 vaccine conjugate [PCV13] at 14 months if graft versus host disease (GVHD) was present, followed by pneumococcal vaccine at 24 months. The patients also received antibiotic prophylaxis with cotrimoxazole [Bactrim]. At 0–60.7 months after the transplantation, 11 patients developed invasive pneumococcal disease (IPD), which was complicated by pneumococcal pneumonia (five patients), febrile neutropenia (three patients), otitis media (one patient), sepsis (one patient) and pharyngitis (one patient). Seven out of the eleven patients who developed IPD had undergone pneumococcal vaccination with pneumococcal-13 valent CRM197 vaccine conjugate or pneumococcal vaccine, and developed vaccination failure. The remaining two patients developed vaccination failure following vaccination with pneumococcal vaccine. For pneumococcal infections, patients were treated with unspecified therapy, to which ten patients patients responded, while one patient did not respond [not all outcomes stated]. Roberts MB, et al. Clinical Effectiveness of Conjugate Pneumococcal Vaccination in Hematopoietic Stem Cell Transplantation Recipients. Biology of Blood and Marrow 803449784 Transplantation 26: 421-427, No. 2, Feb