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How I vaccinate blood and marrow transplant recipients

Paul A. Carpenter and Janet A. Englund

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  • RE: How I vaccinate blood and marrow transplant recipients
    • Paul D E Miller, Haematology Specialist Registrar Anthony Nolan Research Institute, London
    • Other Contributors:
      • Thushan I de Silva, Honorary Consultant in Infectious Diseases
      • Roderick Skinner, Consultant in Paediatric and Adolescent Haematology and Oncology
      • Maria Gilleece, Director, Yorkshire Blood and Marrow Transplant Programme
      • Andrew Peniket, Director of Haematology and Bone Marrow Transplantation
      • Angela Hamblin, Haematology Specialist Registrar
      • Diana Greenfield, Macmillan Consultant Nurse
      • Chloe Anthias, Consultanat Haematologist and Medical Director
      • Karl Peggs, Honorary Consultant in Haematology and Transplantation
      • Alejandro Madrigal, Consultant Haematologist and Scientific Director
      • John A Snowden, Consultant Haematologist and Director of Blood and Marrow Transplantation

    In this edition of Blood, Carpenter and Englund(1) offer practical guidance on vaccination of blood and marrow transplantation (BMT) recipients, highlighting the difficulties of managing vaccination schedules when faced with complex clinical scenarios, a limited evidence base, and the restrictions of national vaccine licensing. The authors suggest that there is poor alignment of clinical practice with current guidelines. This is borne out by our recent exploration of post-BMT vaccination practice in the United Kingdom(2).

    We mapped a 26 question online survey to current guidelines(3–5). Questions were grouped into four themes: service organization, vaccine selection, commencement and delay of vaccination and monitoring of vaccine response. We distributed the survey to adult and paediatric allogeneic BMT programmes. The response rate was 100%(n=27/27) and 83%(n=10/12) respectively.

    We identified heterogeneity in practice across all survey themes. Programmes commence vaccination from a range of time-points post HSCT (range 3-18 months). Vaccine selection is inconsistent across programmes with regard to diseases targeted and vaccine sub-types, with some programmes recommending formulations known to be poorly immunogenic in this patient group. Programmes also vary in their approach to administration of both live attenuated and inactivated vaccines in recipients with Graft versus Host Disease (GvHD) and/or receiving immunosuppressive therapy.

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    Conflict of Interest:
    None declared.