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HPV Vaccination Feasible After Haematopoietic Stem Cell Transplantation

A strong response to human papillomavirus vaccination is reported among women who have received a haematopoietic stem cell transplant
02 Mar 2020
Cancer Prevention;  Cancer in Special Situations/ Populations

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: The quadrivalent human papillomavirus (HPV) vaccine has induced a strong antibody response in a study of women using immunosuppressive therapy after haematopoietic stem cell transplantation (HSCT).  

“Given the high HPV incidence and generally later occurrence of HPV disease after transplant, our results suggest that vaccinating women up to age 50 years, an expanded age range recently approved by the FDA for HPV vaccine use, combined with periodic cytology/HPV screening could be a practical approach to reduce incident HPV infections”, the authors report in JAMA Oncology.

Pamela Stratton, from the National Institutes of Health in Bethesda, Maryland, USA, and co-workers believe vaccination against HPV-6, -11, -16 and -18 could avoid HPV-associated genital neoplasia, “a frequent late complication” after HSCT in women, as well as related malignancy.

The study included 23 women receiving immunosuppressive therapy a median of 1.2 years after HSCT and 21 women a median of 2.5 years after HSCT who no longer required immunosuppression, the majority (61.4%) of whom received HSCT for malignancy. A third group of 20 healthy women was also vaccinated. These cohorts were aged a median of 34.3, 32.2 and 32.9 years, respectively. 

The participants underwent vaccination on days 1 and 2 and again after 6 months; this induced an antibody response to all four HPV strains in 78.3% of the immunosuppressed patients, 95.2% of the HSCT patients who were no longer on immunosuppression and 100% of the healthy controls.  

Five patients using immunosuppression and one patient no longer using immunosuppression achieved an antibody response to some but not all types of HPV, the researchers say, but the change in antibody levels between baseline and measurements taken at 7 and 12 months was comparable across the three groups of participants.  

Receipt of rituximab was “the strongest factor associated with impaired response to the HPV vaccine”, which the researchers say is “consistent” with its method of action against peripheral B cell memory. Nevertheless, 63% of eight patients achieved some level of anti-HPV response despite having used rituximab at least 6 months earlier. 

Finally, the researchers describe the adverse events associated with HPV vaccination as “time-limited and mild”, mainly injection site reactions, and report that the course was not associated with graft versus host disease flares even when used alongside other vaccinations. 

“As recommended after transplant, the full vaccine series should be administered”, Pamela Stratton et al advise, noting that men at risk of oropharyngeal and anogenital HPV infection may also benefit from HPV vaccination after HSCT.

“Importantly, the current use of immunosuppression or prior use of rituximab after transplant should not preclude vaccination”, they write.

“However, to maximize vaccine immunogenicity, one could consider delaying HPV vaccination until immunosuppression is discontinued and CD19 lymphopenia has resolved”, they suggest.

Reference 

Stratton P, Battiwalla M, Tian X, et al. Immune response following quadrivalent human papillomavirus vaccination in women after hematopoietic allogeneic stem cell transplant. A nonrandomized clinical trial. JAMA Oncol; Advance online publication 27 February 2020. doi:10.1001/jamaoncol.2019.6722

 

medwireNews (www.medwireNews.com ) is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

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