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Pneumococcal vaccination during chemotherapy in children treated for acute lymphoblastic leukemia
Sarah Dorval1, Soren Gantt1, Jean-Marie Leclerc2
1Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, Quebec, Canada.
Insights
Children with acute lymphoblastic leukemia (ALL) have low pneumococcal immunity post-chemotherapy. A booster dose of pneumococcal conjugate vaccine (PCV) after treatment is effective in restoring protective antibody levels against invasive pneumococcal disease (IPD).
Area of Science:
- Pediatric Oncology
- Immunology
- Infectious Diseases
Background:
- Children undergoing acute lymphoblastic leukemia (ALL) treatment face a heightened risk of invasive pneumococcal disease (IPD).
- Prior routine immunization with pneumococcal conjugate vaccine (PCV) does not guarantee sustained immunity following chemotherapy.
- Assessing pneumococcal immunity is crucial for managing IPD risk in this vulnerable population.
Purpose of the Study:
- To evaluate S. pneumoniae immunity in children after ALL treatment.
- To determine the impact of pneumococcal immunization administered during and after chemotherapy on immunity.
- To identify optimal vaccination strategies for preventing IPD in pediatric ALL survivors.
Main Methods:
- An observational retrospective study involving 71 children treated for ALL.
- Comparison of two groups: Group 1 received PCV13 during maintenance and a booster post-chemotherapy; Group 2 received only a post-chemotherapy PCV13 dose.
- Serologic testing was conducted post-chemotherapy and post-booster to assess serotype-specific antibody levels and seroprotection.
Main Results:
- At the end of chemotherapy, seroprotection rates were significantly higher in Group 1 (53.1%) compared to Group 2 (25.6%).
- Following the post-chemotherapy booster, seroprotection rates dramatically increased to 96.9% in Group 1 and 100% in Group 2.
- These findings highlight the effectiveness of PCV in restoring protective immunity.
Conclusions:
- Pneumococcal seroprotection rates are low in children with ALL after chemotherapy, even with prior immunization.
- A PCV booster during chemotherapy might offer transient protection but is not essential for achieving high immunity.
- A single PCV dose post-chemotherapy is sufficient to induce high rates of seroprotection against IPD.
Background:
Children treated for acute lymphoblastic leukemia (ALL) are at high risk of invasive pneumococcal disease (IPD). We assessed immunity to S. pneumoniae among children after ALL treatment, and the impact of pneumococcal immunization during and after chemotherapy.
Methods:
We performed an observational retrospective study of children treated for ALL at a single center. All children were fully immunized with three routine doses of pneumococcal conjugate vaccine (PCV) prior to ALL diagnosis. Children from Group 1 received a 13-valent PCV (PCV13) dose during the maintenance phase as well as a PCV13 booster after completing chemotherapy, while Group 2 only received the postchemotherapy dose. Serologic testing was performed after chemotherapy and again after the postchemotherapy dose. A serotype-specific antibody level ≥0.35 μg/ml was considered protective, and patients with protective levels for ≥70% of serotypes in the PCV7 vaccine were defined as seroprotected.
Results:
A total of 71 children (median age 46 months, range 12-160) were included. At the end of chemotherapy, 53.1% of children in Group 1 (17/32) and 25.6% in Group 2 (10/39) were seroprotected (p = .018). After the postchemotherapy booster, seroprotection rates increased to 96.9% in Group 1 (31/32) and 100% in Group 2.
Conclusions:
Rates of pneumococcal seroprotection among children with ALL are low following chemotherapy, despite prior routine immunization. A PCV booster during chemotherapy may shorten the period of susceptibility to IPD in some children. However, irrespective of a booster during chemotherapy, a PCV dose postchemotherapy appears sufficient to confer high rates of seroprotection against IPD.
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