Memorial Sloan Kettering Cancer Center, New York, NY
Darren R. Feldman , Akeem Ronell Lewis , Andrea Knezevic , David Ali , Maria Bromberg , Julia Aronson , Samuel Aaron Funt , Deaglan Joseph McHugh , Robert J. Motzer , Dean F. Bajorin , Sujata Patil , Gunjan L. Shah , Monika Shah , Susan Seo , Mini Kamboj , Miguel-Angel Perales , Genofeva Papanicolaou
Background: HDCT/ASCT represents a curative salvage treatment for patients with GCT but is rarely used for other solid tumors. Patients undergoing HDCT/ASCT for hematologic neoplasms require revaccination for their childhood immunizations. Whether this is necessary in patients with GCT is unknown. Methods: In this prospective longitudinal study, patients with GCT undergoing HDCT-ASCT from 11/2010 to 5/2018 had serologies for Measles, Mumps, Rubella, Diphtheria, Tetanus, Polio, and Varicella Zoster measured before HDCT and at 3, 6, and in a subset, 12+ months after the last HDCT with results at these timepoints compared using descriptive statistics. In addition, titer levels at ≥6 months post-transplant were matched 1:1 for age and gender with HL patients who underwent HDCT/ASCT during the same time period. Immunity was compared between cohorts using the Cochran-Mantel-Haenszel test. Results: Of 80 patients with GCT (median age 30, 84% nonseminoma), 91% received 3 sequential transplants and 68 had repeat titers at ≥6 months. Immunity at baseline was >95% for Diphtheria, Tetanus and Polio and 89% for Varicella Zoster but lower for Measles (74%), Mumps (85%), and Rubella (83%) (Table). Compared to baseline, proportional immunity for all infections was similar at 3, 6, and 12 months post-transplant in the GCT population (≥6 months shown in Table). Matching resulted in 58 GCT-HL pairs. One-year immunity was numerically lower for most infections in the HL vs. GCT patients and significantly decreased for Measles and Rubella (Table). Conclusions: To our knowledge, this is the first study to assess vaccine titers following HDCT/ASCT for GCT. We demonstrate that HDCT/ASCT does not result in loss of immunity to childhood vaccines and that GCT patients retain protective titers more frequently than those with HL. However, 15-31% of GCT patients lack MMR immunity at baseline and at 1-year post-ASCT. Therefore, we recommend checking MMR titers at 1-year post-ASCT with revaccination of those lacking immunity. Titer evaluation and revaccination is not necessary for other childhood immunizations.
Disease/Vaccine | GCT Cohort | Matched GCT/HL Cohorts at ≥ 6 months | |||||||
---|---|---|---|---|---|---|---|---|---|
Baseline | ≥ 6 months | GCT | HL | P | |||||
N | N (%) | N | N (%) | N | N (%) | N | N (%) | ||
Diphtheria | 78 | 78 (100) | 68 | 68 (100) | 58 | 58 (100) | 58 | 57 (98) | 0.32 |
Tetanus | 80 | 78 (98) | 67 | 66 (99) | 58 | 57 (98) | 57 | 54 (95) | 0.30 |
Polio 1 | 79 | 75 (95) | 68 | 64 (94) | 58 | 55 (95) | 58 | 52 (90) | 0.29 |
Polio 3 | 79 | 77 (98) | 68 | 68 (100) | 58 | 58 (100) | 58 | 58 (100) | - |
Measles | 80 | 59 (74) | 65 | 47 (69) | 58 | 42 (72) | 58 | 28 (48) | 0.03 |
Mumps | 79 | 67 (85) | 68 | 56 (82) | 58 | 49 (85) | 58 | 43 (74) | 0.37 |
Rubella | 80 | 80 (83) | 68 | 52 (77) | 58 | 48 (83) | 58 | 37 (64) | 0.05 |
Var. zoster | 80 | 71 (89) | 68 | 58 (87) | 58 | 50 (86) | 55 | 45 (82) | 0.57 |
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