Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)

doi:10.1016/S1473-3099(18)30600-5

The Lancet Infectious Diseases

Volume 19, Issue 6, June 2019, Pages e200-e212

https://doi.org/10.1016/S1473-3099(18)30600-5 Get rights and content

Summary

Infection is a main concern after haemopoietic stem cell transplantation (HSCT) and a major cause of transplant-related mortality. Some of these infections are preventable by vaccination. Most HSCT recipients lose their immunity to various pathogens as soon as the first months after transplant, irrespective of the pre-transplant donor or recipient vaccinations. Vaccination with inactivated vaccines is safe after transplantation and is an effective way to reinstate protection from various pathogens (eg, influenza virus and Streptococcus pneumoniae), especially for pathogens whose risk of infection is increased by the transplant procedure. The response to vaccines in patients with transplants is usually lower than that in healthy individuals of the same age during the first months or years after transplant, but it improves over time to become close to normal 2–3 years after the procedure. However, because immunogenic vaccines have been found to induce a response in a substantial proportion of the patients as early as 3 months after transplant, we recommend to start crucial vaccinations with inactivated vaccines from 3 months after transplant, irrespectively of whether the patient has or has not developed graft-versus-host disease (GvHD) or received immunosuppressants. Patients with GvHD have higher risk of infection and are likely to benefit from vaccination. Another challenge is to provide HSCT recipients the same level of vaccine protection as healthy individuals of the same age in a given country. The use of live attenuated vaccines should be limited to specific situations because of the risk of vaccine-induced disease.

Introduction

Recipients of haemopoietic stem cell transplant (HSCT) have an increased risk of infections compared with healthy individuals of the same age. Some of these infections are life threatening but preventable by vaccination. This risk is due to complex humoral and cell-mediated deficiencies that evolve over time, transplant procedures, and prevention and treatment of graft-versus-host disease (GvHD) after allogeneic HSCT and the administration of drugs for autologous HSCT. During the first months after transplantation, specific antibody amounts decrease for various pathogens, including Streptococcus pneumoniae,1, 2, 3, 4 Haemophilus influenzae type b,5, 6 and measles. Between 30% and 100% of the patients lose specific humoral immunity 1 year after transplantation.7, 8, 9, 10, 11

HSCT recipients can respond to most vaccines but to a lower extent than healthy individuals during the first months or years after transplantation.12, 13, 14 The recommendation from the Infectious Diseases Society of America to consider HSCT recipients as never vaccinated¹⁵ highlighted the need to offer a full vaccination programme according to age and country recommendations that take into account local epidemiology. Several international guidelines, including recommendations for HSCT recipients, have been published.14, 15, 16 In 2017, the European Conference on Infections in Leukaemia (ECIL 7) decided to provide an update on vaccination of all patients with haematological malignancies, including HSCT recipients.

Section snippets

Guideline development overview

We provide the methods used for developing guidelines in the companion paper.¹⁷ We did the literature search by using the following keywords: “bone marrow” OR “haemopoietic stem cell” OR “peripheral blood stem cell” OR “umbilical cord blood transplantation” AND “immunisation”, “vaccination”, “vaccine”, “immune response”, “donor vaccination”, AND/OR “S pneumoniae”, “H influenzae”, “N meningitidis”, “tetanus, diphtheria”, “pertussis”, “influenza”, “B hepatitis”, “poliomyelitis”, “human

Streptococcus pneumoniae

The ECIL group recommends three doses of pneumococcal conjugate vaccine (PCV) 1 month apart, from 3 months after HSCT, followed by a fourth dose of PCV in case of GvHD, or one dose of pneumococcal 23-valent polysaccharide vaccine (PPSV23) 6 months later.

The risk of invasive pneumococcal disease has been estimated to be 3·8–5·0 of 1000 transplant cases after autologous HSCT and 8·2–9·0 of 1000 transplant cases after allogeneic HSCT, and a higher risk is associated with chronic GvHD after

Inactivated influenza vaccine (IIV)

The ECIL group recommends one dose of seasonal IIV, yearly at the beginning of influenza season, and as long as the patient is assessed to be immunocompromised.

Influenza infection is frequent and could be severe in HSCT recipients. A third of infected patients might develop lower respiratory tract disease, with high mortality despite antivirals.67, 68, 69 The clinical protection offered by one dose of trivalent IIV was shown in a cohort of 177 HSCT recipients who were vaccinated 6 months after

Live-attenuated vaccines

The ECIL group recommends varicella and measles, mumps, and rubella LAVs from 24 months after transplantations, only in seronegative patients with no GvHD, no immuno-suppressants, no relapse, and no recent administration of immunoglobulins.

LAVs are, in general, contraindicated in immunocompromised patients because of the risk of vaccine-transmitted disease.¹⁰⁶ However, when there are no inactivated alternatives, they could be carefully considered on the basis of the risk and benefit balance.

Different vaccination programmes after different HSCTs

Although the infection risks are lower after autologous than allogeneic HSCT, the same revaccination programmes are generally proposed. However, most studies on autologous HSCT were done before the era of rituximab and not in myeloma patients who represent a large proportion of the autologous HSCT population. Vaccination schedules should be reassessed on the basis of current transplant procedures. Two publications,122, 133 which were not available at the time of ECIL 7, showed that vaccination

Specific considerations for the family and close contacts of transplant recipients

To avoid infection transmission to the patient, individuals in close contact with HSCT recipients should be naturally immunised or vaccinated according to country recommendations for their age, especially against VZV and measles, mumps, and rubella, and additionally receive IIV yearly. Table 5 summarises these and other recommendations, contraindications, and precautions for family and close contacts of patients. Recommendations for vaccination of health-care workers in haematology wards are

Areas for future research

Transplant procedures are becoming increasingly diverse, and HSCT is being done in more and more countries that might have specific diseases that could potentially be preventable by vaccination. The ECIL group supports prospective studies and recommends that patient subgroups (eg, recipients of haploidentical or umbilical cord blood transplants) be specifically assessed for their vaccine response. The effect of anti-B monoclonal antibodies before and after transplant should be further

Conclusion

HSCT recipients respond to vaccines. Inactivated vaccines after HSCT are safe and a rigorous vaccination programme should be offered to all allogeneic and autologous HSCT recipients. Postponing vaccination should be restricted to very specific situations. The programme should take into account the risks in a specific community. Vaccines could save lives and avoid unnecessary hospitalisations.

The European Conference on Infections in Leukaemia (ECIL) group, a joint venture of the Infectious

References (142)

JF Sheridan et al.
Immunoglobulin G subclass deficiency and pneumococcal infection after allogeneic bone marrow transplantation
Blood
(1990)
A Meerveld-Eggink et al.
Antibody response to polysaccharide conjugate vaccines after nonmyeloablative allogeneic stem cell transplantation
Biol Blood Marrow Transplant
(2009)
M Pao et al.
Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT)
Biol Blood Marrow Transplant
(2008)
P Ljungman et al.
Long-term immunity to measles, mumps, and rubella after allogeneic bone marrow transplantation
Blood
(1994)
C Machado et al.
Measles in bone marrow transplant recipients during an outbreak in Sao Paulo, Brazil
Blood
(2002)
P Ljungman
Vaccination of immunocompromised patients
Clin Microbiol Infect
(2012)
M Cuenca-Estrella et al.
ESCMID guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures
Clin Microbiol Infect
(2012)
R Meisel et al.
Pneumococcal conjugate vaccine provides early protective antibody responses in children after related and unrelated allogeneic hematopoietic stem cell transplantation
Blood
(2007)
K Debbache et al.
The epidemiology of invasive Streptococcus pneumoniae infections in onco-haematology and haematopoietic stem cell transplant patients in France. Are the serotypes covered by the available anti-pneumococcal vaccines?
Clin Microbiol Infect
(2009)
C Cordonnier et al.
Immune response to the 23-valent polysaccharide vaccine after the 7-valent conjugate vaccine in allogeneic stem cell transplant recipients: results from the EBMT IDWP01 trial
Vaccine
(2010)

DC Molrine et al.

Donor immunization with pneumococcal conjugate vaccine and early protective antibody responses following allogeneic hematopoietic cell transplantation

Blood

(2003)

GL Shah et al.

Robust vaccine responses in adult and pediatric cord blood transplantation recipients treated for hematologic malignancies

Biol Blood Marrow Transplant

(2015)

JH Antin et al.

Protective antibody responses to pneumococcal conjugate vaccine after autologous hematopoietic stem cell transplantation

Biol Blood Marrow Transplant

(2005)

K Atkinson et al.

Analysis of late infections in 89 long-term survivors of bone marrow transplantation

Blood

(1979)

P Aucouturier et al.

Long lasting IgG subclass and antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation

Blood

(1987)

AM van der Velden et al.

Vaccination responses and lymphocyte subsets after autologous stem cell transplantation

Vaccine

(2007)

DC Molrine et al.

Donor immunization with Haemophilus influenzae type b (HIB)-conjugate vaccine in allogeneic bone marrow transplantation

Blood

(1996)

MB Mahler et al.

Safety and immunogenicity of the tetravalent protein-conjugated meningococcal vaccine (MCV4) in recipients of related and unrelated allogeneic hematopoietic stem cell transplantation

Biol Blood Marrow Transplant

(2012)

R Whittaker et al.

The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004–2014

Vaccine

(2017)

TN Small et al.

Pertussis immunity and response to tetanus-reduced diphtheria-reduced pertussis vaccine (Tdap) after autologous peripheral blood stem cell transplantation

Biol Blood Marrow Transplant

(2009)

E Papadopoulos et al.

Use of the tetanus toxoid, reduced dose diphtheria and pertussis vaccine (Tdap) in allogeneic transplant (alloHCT) recipients

Blood

(2008)

SM Choi et al.

Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients

Blood

(2011)

NA Karras et al.

A randomized trial of one versus two doses of influenza vaccine after allogeneic transplantation

Biol Blood Marrow Transplant

(2013)

N Dhédin et al.

Comparable humoral response after two doses of adjuvanted influenza A/H1N1pdm2009 vaccine or natural infection in allogeneic stem cell transplant recipients

Vaccine

(2014)

D Engelhard et al.

The humoral immune response of hematopoietic stem cell transplantation recipients to AS03-adjuvanted A/California/7/2009 (H1N1)v-like virus vaccine during the 2009 pandemic

Vaccine

(2011)

NC Issa et al.

Seroprotective titers against 2009 H1N1 influenza A virus after vaccination in allogeneic hematopoietic stem cell transplantation recipients

Biol Blood Marrow Transplant

(2011)

NB Halasa et al.

Randomized double-blind study of the safety and immunogenicity of standard-dose trivalent inactivated influenza vaccine versus high-dose trivalent inactivated influenza vaccine in adult hematopoietic stem cell transplantation patients

Biol Blood Marrow Transplant

(2016)

V Mallet et al.

Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5)

Lancet Infect Dis

(2016)

D Jaffe et al.

Immunogenicity of recombinant hepatitis B vaccine (rHBV) in recipients of unrelated or related allogeneic hematopoietic cell (HC) transplants

Blood

(2006)

P Kaloyannidis et al.

Allografted recipients immunized against hepatitis B virus are at high risk of gradual surface antibody (HbsAb) disappearance post transplant, regardless of adoptive immunity transfer

Biol Blood Marrow Transplant

(2007)

CK Hui et al.

Occult hepatitis B virus infection in hematopoietic stem cell donors in a hepatitis B virus endemic area

J Hepatol

(2005)

Q Le et al.

Lamivudine prophylaxis and hepatitis B vaccination for prevention of hepatitis B virus reverse seroconversion in long-term survivors after allogeneic stem cell transplantation

Biol Blood Marrow Transplant

(2009)

M Onozawa et al.

HB vaccination in the prevention of viral reactivation in allogeneic hematopoietic stem cell transplantation recipients with previous HBV infection

Biol Blood Marrow Transplant

(2008)

BN Savani et al.

Increased risk of cervical dysplasia in long-term survivors of allogeneic stem cell transplantation-implications for screening and HPV vaccination

Biol Blood Marrow Transplant

(2008)

GS Giebink et al.

Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine

J Infect Dis

(1986)

DJ Winston et al.

Pneumococcal vaccination of recipients of bone marrow transplants

Arch Intern Med

(1983)

DJ Winston et al.

Pneumococcal infections after human bone-marrow transplantation

Ann Intern Med

(1979)

P Ljungman et al.

Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine

J Infect Dis

(1989)

K Pauksen et al.

Immunity to and immunization against measles, rubella and mumps in patients after autologous bone marrow transplantation

Bone Marrow Transplant

(1992)

B Wahren et al.

Transfer and persistence of viral antibody-producing cells in bone marrow transplantation

J Infect Dis

(1984)

S Cesaro et al.

Guidelines on vaccinations in paediatric haematology and oncology patients

Biomed Res Int

(2014)

P Ljungman et al.

Vaccination of hematopoietic cell transplant recipients

Bone Marrow Transplant

(2009)

LG Rubin et al.

2013 IDSA clinical practice guideline for vaccination of the immunocompromised host

Clin Infect Dis

(2014)

P Ljungman et al.

Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT

Bone Marrow Transplant

(2005)

M Mikulska et al.

Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7)

Lancet Infect Dis

(2018)

D Engelhard et al.

Early and late invasive pneumococcal infection following stem cell transplantation: a European bone marrow transplantation survey

Br J Haematol

(2002)

S Youssef et al.

Streptococcus pneumoniae infections in 47 hematopoietic stem cell transplantation recipients: clinical characteristics of infections and vaccine-breakthrough infections, 1989–2005

Medicine (Baltimore)

(2007)

C Cordonnier et al.

Randomized study of early versus late immunization with pneumococcal conjugate vaccine after allogeneic stem cell transplantation

Clin Infect Dis

(2009)

L Olarte et al.

Invasive pneumococcal infections in children following transplantation in the pneumococcal conjugate vaccine era

Transpl Infect Dis

(2017)

T Parkkali et al.

A comparison of early and late vaccination with Haemophilus influenzae type b conjugate and pneumococcal polysaccharide vaccines after allogeneic BMT

Bone Marrow Transplant

(1996)

Cited by (216)

International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update
2024, Transplantation and Cellular Therapy
As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the number of HCTs performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pretransplantation, peritransplantation, and post-transplantation exposures and other underlying risk factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and then updated in 2012. An international group of experts was convened to review the contemporary literature and update the recommendations while considering the changing practices of HCT and cellular therapy. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed, but cGVHD management is not covered in detail. These guidelines emphasize the special needs of patients with distinct underlying HCT indications or comorbidities (eg, hemoglobinopathies, older adults) but do not replace more detailed group-, disease-, or condition-specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.
Facilitators and Barriers to Successful Revaccination after Hematopoietic Stem Cell Transplantation among Adult Survivors: A Scoping Review
2024, Transplantation and Cellular Therapy
Post-transplantation revaccination uptake of childhood vaccines in adult hematopoietic stem cell transplantation (HSCT) survivors is suboptimal, increasing the risk of infectious morbidity and mortality within this population. We systematically reviewed the literature for factors related to revaccination uptake, as well as the barriers and facilitators that affect successful revaccination. We conducted a scoping review searching PubMed, CINAHL, Embase, and Web of Science in March 2023. Two independent reviewers performed study selection using the complete dual review process. Data were extracted using a standard form. Factors were characterized as demographic, clinical, or social determinants of health that affected revaccination uptake. Barriers and facilitators were categorized using the constructs from the World Health Organization Behavioural and Social Drivers Framework. Our searches yielded 914 sources, from which 15 publications were selected (5 original research and 10 quality improvement initiatives). More than one-half of the reports listed factors associated with poorer uptake, predominately clinical factors, followed by social determinants of health, then demographic factors. Nearly all the reports described barriers to successful revaccination uptake, with most of these falling into the “practical issues” construct. Most of the reports described facilitators, nearly all related to health care system improvements associated with improved revaccination uptake. Although this review provides a good starting point for understanding impediments to successful revaccination after HSCT, this review reveals that we lack sufficient evidence to drive targeted interventions to improve uptake. More research is needed, focusing on survivors’ voices to inform our knowledge of barriers and facilitators to complete revaccination after HSCT, exploring behavioral and social drivers within this population, and examining the care delivery models that may complicate vaccine delivery in this population.
French protocol for the diagnosis and management of hematopoietic stem cell transplantation in autoimmune diseases
2024, Revue de Medecine Interne
Hematopoietic stem cell transplantation (HSCT) for severe ADs was developed over the past 25 years and is now validated by national and international medical societies for severe early systemic sclerosis (SSc) and relapsing-remitting multiple sclerosis (MS) and available as part of routine care in accredited center. HSCT is also recommended, with varying levels of evidence, as an alternative treatment for several ADs, when refractory to conventional therapy, including specific cases of connective tissue diseases or vasculitis, inflammatory neurological diseases, and more rarely severe refractory Crohn's disease. The aim of this document was to provide guidelines for the current indications, procedures and follow-up of HSCT in ADs. Patient safety considerations are central to guidance on patient selection and conditioning, always validated at the national MATHEC multidisciplinary team meeting (MDTM) based on recent (less than 3 months) thorough patient evaluation. HSCT procedural aspects and follow-up are then carried out within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and SFGM-TC accredited centres in close collaboration with the ADs specialist. These French recommendations were performed according to HAS/FAI2R standard operating procedures and coordinated by the Île-de-France MATHEC Reference Centre for Rare Systemic Autoimmune Diseases (CRMR MATHEC) within the Filière FAI2R and in association with the Filière MaRIH. The task force consisted of 3 patients and 64 clinical experts from various specialties and French centres. These data-derived and consensus-derived recommendations will help clinicians to propose HSCT for their severe ADs patients in an evidence-based way. These recommendations also give directions for future clinical research in this area. These recommendations will be updated according to newly emerging data. Of note, other cell therapies that have not yet been approved for clinical practice or are the subject of ongoing clinical research will not be addressed in this document.
La greffe de cellules souches hématopoïétiques (GCSH) pour les maladies auto-immunes (MAI) sévères s’est développée au cours des 25 dernières années et est maintenant validée par les sociétés savantes nationales et internationales pour la sclérodermie systémique sévère précoce et la sclérose en plaques récurrente-rémittente et est disponible dans le cadre des soins courants dans des centres accrédités. La GCSH est également recommandée, avec des niveaux de preuve variables, comme traitement alternatif pour plusieurs MAI, lorsqu’elles sont réfractaires aux thérapies conventionnelles, comprenant des cas spécifiques de connectivites ou de vascularites ; des maladies neuro-inflammatoires ; et plus rarement les maladies de Crohn réfractaires sévères. L’objectif de ce document est de fournir des recommandations sur les indications actuelles, les procédures et le suivi de la GCSH dans les MAI. La sécurité des patients reste l’élément majeur guidant la sélection et le conditionnement des patients, toujours validées lors de la réunion de concertation pluridisciplinaire nationale MATHEC sur la base d’une évaluation exhaustive et récente (moins de 3 mois) du patient. La GCSH et le suivi sont ensuite effectués dans des centres expérimentés et accrédités par le Joint Accreditation Committee of International Society for Cellular Therapy et la SFGM-TC, en étroite collaboration avec le spécialiste des MAI. Ces recommandations françaises ont été réalisées conformément aux procédures opérationnelles standard de la HAS/FAI2R et coordonnées par le Centre de référence des maladies auto-immunes systémiques rares d’Île-de-France MATHEC (CRMR MATHEC) au sein de la Filière FAI2R et en association avec la Filière MaRIH. Le groupe de travail était composé de 3 patients et de 64 cliniciens experts issus de différentes spécialités et de différents centres français. Ces recommandations issues des données publiées et de consensus d’experts aideront les cliniciens à proposer la GCSH à leurs patients atteints de MAI sévère. Ces recommandations ouvrent également des perspectives de recherche clinique. Ces recommandations seront régulièrement mises à jour en fonction des nouvelles données publiées. Il convient de noter que les autres thérapies cellulaires qui n’ont pas encore été approuvées par les autorités de santé ou qui font l’objet d’essais cliniques en cours ne seront pas abordées dans ce document.
Vaccination of allogeneic haematopoietic stem cell transplant recipients: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)
2024, Bulletin du Cancer
Au cours de la phase de reconstitution immunitaire après allogreffe de cellules souches hématopoïétiques (allo-CSH), la (re)vaccination des receveurs d’allo-CSH est recommandée. Dans le cadre des ateliers d’harmonisation des pratiques organisés par la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC) à Lille en septembre 2022, des recommandations pratiques actualisées concernant la vaccination des receveurs d’allo-CSH ont été élaborées, basées sur les données de la littérature, les recommandations nationales et internationales existantes et le consensus des participants lorsqu’il n’existe pas de données formellement prouvées.
During immune reconstitution following allogeneic haematopoietic stem cell transplantation (allo-HSCT), (re)vaccination of allo-HSCT recipients is recommended. Herein, we propose an update of practical recommendations regarding vaccination of allo-HSCT recipients. These recommendations, based on data from the literature, national and international guidelines and the consensus of the participants when no formally proven data are available, were elaborated during the workshop of practice harmonization organized by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) in Lille in September 2022.
Consensus document of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Association of Pediatrics for vaccination of immunosuppressed individuals
2023, Anales de Pediatria
El número de personas con inmunodepresión está aumentando considerablemente debido a su mayor supervivencia y al empleo de nuevas terapias inmunosupresoras en diversas patologías crónicas. Se trata de un grupo heterogéneo de pacientes en los que la vacunación como arma preventiva supone uno de los pilares básicos de su bienestar, por su elevado riesgo a padecer infecciones. Este consenso, elaborado conjuntamente entre la Sociedad Española de Infectología Pediátrica (SEIP) y el Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP), aporta unas directrices para programar un calendario adaptado a cada paciente en situaciones especiales que incluye recomendaciones generales, vacunación en pacientes con trasplante de médula y trasplante de órgano sólido, vacunación en niños con errores innatos de la inmunidad, vacunación en el paciente oncológico, vacunación en pacientes con enfermedades crónicas o sistémicas y vacunación en niños viajeros inmunodeprimidos.
The number of people with immunosuppression is increasing considerably due to their greater survival and the use of new immunosuppressive treatments for various chronic diseases. This is a heterogeneous group of patients in whom vaccination as a preventive measure is one of the basic pillars of their wellbeing, given their increased risk of contracting infections. This consensus, developed jointly by the Sociedad Española de Infectología Pediátrica (Spanish Society of Pediatric Infectious Diseases) and the Advisory Committee on Vaccines of the Asociación Española de Pediatría (Spanish Association of Paediatrics), provides guidelines for the development of a personalised vaccination schedule for patients in special situations, including general recommendations and specific recommendations for vaccination of bone marrow and solid organ transplant recipients, children with inborn errors of immunity, oncologic patients, patients with chronic or systemic diseases and immunosuppressed travellers.
A machine learning and explainable artificial intelligence approach for predicting the efficacy of hematopoietic stem cell transplant in pediatric patients
2023, Healthcare Analytics
Cancer is a fatal disease that affects people of all ages, including children. It is one of the leading causes of death worldwide. According to World Health Organization, an estimated 400,000 children develop cancer yearly. Bone marrow transplantation (BMT) is a specialized treatment for patients suffering from certain types of cancer, such as myeloma, lymphoma, leukemia, and others. It usually includes extracting healthy cells from the donor’s bone marrow and replacing the existing ones in the patient’s body. However, the treatment can also cause complications such as graft-versus-host disease, organ damage, stem cell failure, new cancers, and infections. In this study, we use machine learning and explainable artificial intelligence (XAI) techniques to predict the survival rate of children undergoing Hematopoietic Stem Cell Transplants. Three feature selection techniques have been utilized for feature selection: Harris Hawks optimization, salp swarm optimization, and mutual information. The final custom stacked model delivered optimal results with accuracy, precision (89%), recall (88%), f1-score (88%), area under curve (AUC) (92%), and average precision (86%). In addition, XAI techniques such as Shapley additive values (SHAP), local interpretable model-agnostic explanations (LIME), ELI5, and QLattice have been used to make the models more precise, understandable, and interpretable. According to XAI, the most important features were relapse, donor age, recipient age, and platelet recovery time. The promising results point to the potential use of artificial intelligence in understanding the effectiveness of bone marrow transplants in children.

View all citing articles on Scopus

View full text

SeriesVaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)

Summary

Introduction

Section snippets

Guideline development overview

Streptococcus pneumoniae

Inactivated influenza vaccine (IIV)

Live-attenuated vaccines

Different vaccination programmes after different HSCTs

Specific considerations for the family and close contacts of transplant recipients

Areas for future research

Conclusion

Blood

Biol Blood Marrow Transplant

Biol Blood Marrow Transplant

Blood

Blood

Clin Microbiol Infect

Clin Microbiol Infect

Blood

Clin Microbiol Infect

Vaccine

Blood

Biol Blood Marrow Transplant

Biol Blood Marrow Transplant

Blood

Blood

Vaccine

Blood

Biol Blood Marrow Transplant

Vaccine

Biol Blood Marrow Transplant

Blood

Blood

Biol Blood Marrow Transplant

Vaccine

Vaccine

Biol Blood Marrow Transplant

Biol Blood Marrow Transplant

Lancet Infect Dis

Blood

Biol Blood Marrow Transplant

J Hepatol

Biol Blood Marrow Transplant

Biol Blood Marrow Transplant

Biol Blood Marrow Transplant

Titers of antibody to pneumococci in allogeneic bone marrow transplant recipients before and after vaccination with pneumococcal vaccine

J Infect Dis

Pneumococcal vaccination of recipients of bone marrow transplants

Arch Intern Med

Pneumococcal infections after human bone-marrow transplantation

Ann Intern Med

Efficacy and safety of vaccination of marrow transplant recipients with a live attenuated measles, mumps, and rubella vaccine

J Infect Dis

Immunity to and immunization against measles, rubella and mumps in patients after autologous bone marrow transplantation

Bone Marrow Transplant

Transfer and persistence of viral antibody-producing cells in bone marrow transplantation

J Infect Dis

Guidelines on vaccinations in paediatric haematology and oncology patients

Biomed Res Int

Vaccination of hematopoietic cell transplant recipients

Bone Marrow Transplant

2013 IDSA clinical practice guideline for vaccination of the immunocompromised host

Clin Infect Dis

Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT

Bone Marrow Transplant

Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7)

Lancet Infect Dis

Early and late invasive pneumococcal infection following stem cell transplantation: a European bone marrow transplantation survey

Br J Haematol

Streptococcus pneumoniae infections in 47 hematopoietic stem cell transplantation recipients: clinical characteristics of infections and vaccine-breakthrough infections, 1989–2005

Medicine (Baltimore)

Randomized study of early versus late immunization with pneumococcal conjugate vaccine after allogeneic stem cell transplantation

Clin Infect Dis

Invasive pneumococcal infections in children following transplantation in the pneumococcal conjugate vaccine era

Transpl Infect Dis

A comparison of early and late vaccination with Haemophilus influenzae type b conjugate and pneumococcal polysaccharide vaccines after allogeneic BMT

Bone Marrow Transplant

Series
Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)