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Xu B, Gordillo CA, Delille EM, Malandrakis S, Assal A, Mapara MY, Reshef R. Improved serologic responses to DTaP over Tdap vaccination in adult hematopoietic cell transplant recipients. Eur J Haematol 2023. [PMID: 37365676 DOI: 10.1111/ejh.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) recipients have reduced antibody titers to tetanus, diphtheria, and pertussis. Tdap is approved for revaccinating adult HCT recipients in the United States, whereas DTaP is not approved in this population. To our knowledge, no studies to date have compared responses to DTaP versus Tdap in adult HCT patients. We conducted a retrospective study comparing responses to DTaP versus Tdap vaccines in otherwise similar adult HCT patients in order to determine if one of these vaccines elicits superior antibody responses. METHODS We evaluated 43 allogeneic and autologous transplant recipients as a combined cohort and as separate subsets for vaccine specific antibody titers and proportion of strong vaccine responders. Subset analysis focused on the autologous transplant recipients. RESULTS Higher median antibody titers were found to all vaccine components among DTaP recipients (diphtheria p = .021, pertussis p = .020, tetanus p = .007). DTaP recipients also had more strong responders to diphtheria and pertussis (diphtheria p = .002, pertussis p = .006). Among the autologous HCT recipient subset, there were more strong responders to diphtheria (p = .036). CONCLUSIONS Our data shows that post-HCT vaccination with DTaP leads to higher antibody titers and more strong responders, which suggests that DTaP is more effective than Tdap in HCT recipients.
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Affiliation(s)
- Bolong Xu
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Christian A Gordillo
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
| | - Elsa M Delille
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
| | - Stephanie Malandrakis
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
| | - Amer Assal
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
| | - Markus Y Mapara
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York City, New York, USA
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Mehta M, Purpura LJ, McConville TH, Neidell MJ, Anderson MR, Bernstein EJ, Dietz DE, Laracy J, Gunaratne SH, Miller EH, Cheng J, Zucker J, Shah SS, Chaudhuri S, Gordillo CA, Patel SR, Guo TW, Karaaslan LE, Reshef R, Miko BA, Bathon JM, Pereira MR, Uhlemann AC, Yin MT, Sobieszczyk ME. What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. PLoS One 2021; 16:e0249349. [PMID: 33831046 PMCID: PMC8031323 DOI: 10.1371/journal.pone.0249349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease. METHODS In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test. RESULTS We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168). CONCLUSIONS There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.
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Affiliation(s)
- Monica Mehta
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
- * E-mail:
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Thomas H. McConville
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Matthew J. Neidell
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Michaela R. Anderson
- Division of Pulmonary Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Elana J. Bernstein
- Division of Rheumatology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Donald E. Dietz
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Justin Laracy
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shauna H. Gunaratne
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Emily Happy Miller
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Jennifer Cheng
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shivang S. Shah
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shaoli Chaudhuri
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Christian A. Gordillo
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shreena R. Patel
- Division of Pulmonary Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Tai Wei Guo
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lara E. Karaaslan
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Benjamin A. Miko
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Marcus R. Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Michael T. Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
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Bansal R, Gordillo CA, Abramova R, Assal A, Mapara MY, Pereira MR, Reshef R. Extended letermovir administration, beyond day 100, is effective for CMV prophylaxis in patients with graft versus host disease. Transpl Infect Dis 2020; 23:e13487. [PMID: 33034124 DOI: 10.1111/tid.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/05/2020] [Accepted: 10/04/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) reactivation is associated with significant morbidity and mortality after an allogeneic hematopoietic cell transplant (AHCT), and graft versus host disease (GVHD) increases the risk of CMV reactivation. Letermovir is approved for CMV prophylaxis in CMV-seropositive patients, but has only been studied through day 100 post-transplantation in the registration trial. Its efficacy in preventing CMV in patients with GVHD requiring treatment beyond the day 100 milestone has not been studied. METHODS We retrospectively analyzed all patients who underwent an AHCT at a single center over a period of 24 months, and identified a cohort of 20 patients who received extended duration of letermovir (beyond 100 days) after the diagnosis of GVHD. The primary end point was the incidence of clinically significant CMV infection, defined as onset of CMV disease or initiation of preemptive therapy with alternative antiviral agents. RESULTS In this high-risk cohort, only one patient (5%) developed a clinically significant CMV infection, requiring preemptive therapy. No patients developed CMV organ disease. Three additional patients developed CMV viremia of ≥150 IU/mL while on letermovir and after the onset of GVHD, and none required additional treatment. Receipt of post-transplant cyclophosphamide (PTCy) and low CD4 count after the development of GVHD were associated with breakthrough CMV viremia while on extended duration letermovir. CONCLUSIONS Extended duration letermovir was efficacious in preventing clinically significant CMV infections in patients with GVHD.
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Affiliation(s)
- Rajat Bansal
- Division of Hematology/Oncology, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Christian A Gordillo
- Division of Hematology/Oncology, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Abramova
- Department of Pharmacy, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Amer Assal
- Division of Hematology/Oncology, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Markus Y Mapara
- Division of Hematology/Oncology, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus R Pereira
- Division of Infectious Diseases, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ran Reshef
- Division of Hematology/Oncology, Department of Internal Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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