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Measles, mumps, and rubella revaccination in children after completion of chemotherapy and hematopoietic stem cell transplantation: a single-center prospective efficacy and safety analysis

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Abstract

Background

Chemotherapy and hematopoietic stem cell transplantation (HSCT) can damage the immune system, and may result in a loss of protection from infectious diseases. This study aimed to evaluate the impact of these treatments on the decrease in antibody titers of the measles, mumps, and rubella (MMR) vaccine and seroconversion post-revaccination of MMR.

Methods

After completion of treatment for primary diseases, participants received an MMR revaccination. Antibody titers for MMR before revaccination were analyzed for all 110 children. After revaccination, 68 participants received a follow-up evaluation of  antibody titer and adverse reaction.

Results

Multivariable analysis showed that therapeutic schedules were the only factor correlated with lack of antibody titers for measles after completing treatment (P = 0.008), while for mumps and rubella, no statistically significant difference was observed. Importantly, our study clearly demonstrated positive seroconversion rates for measles (97.5%), mumps (81.0%), and rubella (93.2%), with antibody levels rising across the board and peaking at around 6 months following revaccination. However, 6 months after revaccination, a downtrend of antibody titer levels was observed, which is comparatively earlier than the waning immunity observed in healthy children. Furthermore, we found MMR revaccination to be safe, with only a single adverse reaction (local pain at the injection site) reported.

Conclusions

MMR revaccination is immunogenic for the population. We suggest periodic monitoring of antibody titers, in addition to a booster vaccination, although the optimal timing of booster vaccination remains to be investigated further.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Toft N, Birgens H, Abrahamsson J, Griskevicius L, Hallbook H, Heyman M, et al. Results of nopho all2008 treatment for patients aged 1–45 years with acute lymphoblastic leukemia. Leukemia. 2018;32:606–15.

    Article  CAS  PubMed  Google Scholar 

  2. Mussolin L, Le Deley M-C, Carraro E, Damm-Welk C, Attarbaschi A, Williams D, et al. Prognostic factors in childhood anaplastic large cell lymphoma: long term results of the international alcl99 trial. Cancers. 2020;12:2747.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baronciani D, Angelucci E, Potschger U, Gaziev J, Yesilipek A, Zecca M, et al. Hemopoietic stem cell transplantation in thalassemia: a report from the european society for blood and bone marrow transplantation hemoglobinopathy registry, 2000–2010. Bone Marrow Transplant. 2016;51:536–41.

    Article  CAS  PubMed  Google Scholar 

  4. Miyamoto S, Yanagimachi M, Umeda K, Iguchi A, Sasahara Y, Takada H, et al. Hematopoietic stem cell transplantation for severe combined immunodeficiency in japan: a nationwide retrospective analysis. Bone Marrow Transplant. 2020;55:443–543.

    Google Scholar 

  5. Perkins JL, Harris A, Pozos TC. Immune dysfunction after completion of childhood leukemia therapy. J Pediatr Hematol Oncol. 2017;39:1–5.

    Article  CAS  PubMed  Google Scholar 

  6. Friman V, Winqvist O, Blimark C, Langerbeins P, Chapel H, Dhalla F. Secondary immunodeficiency in lymphoproliferative malignancies. Hematol Oncol. 2016;34:121–32.

    Article  PubMed  Google Scholar 

  7. Goswami M, Prince G, Biancotto A, Moir S, Kardava L, Santich BH, et al. Impaired b cell immunity in acute myeloid leukemia patients after chemotherapy. J Transl Med. 2017;15:155.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Garonzi C, Balter R, Tridello G, Pegoraro A, Pegoraro M, Pacenti M, et al. The impact of chemotherapy after pediatric malignancy on humoral immunity to vaccine-preventable diseases. Mediterr J Hematol Infect Dis. 2020;12:e2020014.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuter BJ, Marshall GS, Fergie J, Schmidt E, Pawaskar M. Prevention of measles, mumps and rubella: 40 years of global experience with m-m-r-ii. Hum Vaccin Immunother. 2021;17:5372–83.

    Article  CAS  PubMed  Google Scholar 

  10. Measles vaccines. Who position paper—april 2017. Wkly Epidemiol Rec. 2017;92:205–27.

    Google Scholar 

  11. Mumps virus vaccines. Wkly Epidemiol Rec. 2007;82:51–60.

  12. Progress in rubella and congenital rubella syndrome control and elimination—worldwide 2000–2016. Wkly Epidemiol Rec. 2017; 92:707–15.

  13. Toret E, Yel SE, Suman M, Duzenli Kar Y, Ozdemir ZC, Dinleyici M, et al. Immunization status and re-immunization of childhood acute lymphoblastic leukemia survivors. Hum Vaccin Immunother. 2021;17:1132–5.

    Article  CAS  PubMed  Google Scholar 

  14. Kawamura K, Wada H, Nakasone H, Akahoshi Y, Kawamura S, Takeshita J, et al. Immunity and vaccination against measles, mumps, and rubella in adult allogeneic hematopoietic stem cell transplant recipients. Transplant Cell Ther. 2021;27:436.e1–e8.

    Article  CAS  PubMed  Google Scholar 

  15. Koochakzadeh L, Khosravi MH, Pourakbari B, Hosseinverdi S, Aghamohammadi A, Rezaei N. Assessment of immune response following immunization with dtp/td and mmr vaccines in children treated for acute lymphoblastic leukemia. Pediatr Hematol Oncol. 2014;31:656–63.

    Article  CAS  PubMed  Google Scholar 

  16. Bochennek K, Allwinn R, Langer R, Becker M, Keppler OT, Klingebiel T, et al. Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer. Vaccine. 2014;32:3357–61.

    Article  CAS  PubMed  Google Scholar 

  17. Esposito S, Prada E, Lelii M, Castellazzi L. Immunization of children with secondary immunodeficiency. Hum Vaccin Immunother. 2015;11:2564–70.

    Article  PubMed  PubMed Central  Google Scholar 

  18. He HQ, Li Q, Yan R, Zhou Y, Tang XW, Deng X, et al. Antibody persistence following on different vaccination strategies of domestic measles, mumps and rubella combined attenuated live vaccine: a 3-year follow-up study. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51:336–40.

    CAS  PubMed  Google Scholar 

  19. Olkinuora H, Kayhty H, Davidkin I, Roivainen M, Olander R-M, Kantele JM, et al. Immunity after (re)vaccination of paediatric patients following haematopoietic stem cell transplantation. Acta Paediatr. 2012;101:e373–7.

    Article  PubMed  Google Scholar 

  20. Patel SR, Ortin M, Cohen BJ, Borrow R, Irving D, Sheldon J, et al. Revaccination with measles, tetanus, poliovirus, haemophilus influenzae type b, meningococcus c, and pneumococcus vaccines in children after hematopoietic stem cell transplantation. Clin Infect Dis. 2007;44:625–34.

    Article  CAS  PubMed  Google Scholar 

  21. Zignol M, Peracchi M, Tridello G, Pillon M, Fregonese F, D’elia R, et al. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis b, measles, rubella, and mumps in children after chemotherapy. Cancer. 2004;101:635–41.

    Article  PubMed  Google Scholar 

  22. Yildirim ZK, Buyukavci M. Assessment of humoral immunity to hepatitis b, measles, rubella, and mumps in children after chemotherapy. J Pediatr Hematol Oncol. 2018;40:E99–102.

    Article  Google Scholar 

  23. Fouda AE, Kandil SM, Boujettif F, Salama YS, Fayea NY. Humoral immune response of childhood acute lymphoblastic leukemia survivors against the measles, mumps, and rubella vaccination. Hematology. 2018;23:590–5.

    Article  PubMed  Google Scholar 

  24. Viana SS, Araujo GS, Faro GBDA, Da Cruz-Silva LL, Araujo-Melo CA, Cipolotti R. Antibody responses to hepatitis b and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia. Rev Bras Hematol Hemoter. 2012;34:275–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ek T, Josefson M, Abrahamsson J. Multivariate analysis of the relation between immune dysfunction and treatment intensity in children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2011;56:1078–87.

    Article  PubMed  Google Scholar 

  26. Inaba H, Hartford CM, Pei D, Posner MJ, Yang J, Hayden RT, et al. Longitudinal analysis of antibody response to immunization in paediatric survivors after allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2012;156:109–17.

    Article  PubMed  Google Scholar 

  27. Shah GL, Shune L, Purtill D, Devlin S, Lauer E, Lubin M, et al. Robust vaccine responses in adult and pediatric cord blood transplantation recipients treated for hematologic malignancies. Biol Blood Marrow Transplant. 2015;21:2160–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. King SM, Saunders EF, Petric M, Gold R. Response to measles, mumps and rubella vaccine in paediatric bone marrow transplant recipients. Bone Marrow Transplant. 1996;17:633–6.

    CAS  PubMed  Google Scholar 

  29. Spoulou V, Giannaki M, Vounatsou M, Bakoula C, Grafakos S. Long-term immunity to measles, mumps and rubella after mmr vaccination among children with bone marrow transplants. Bone Marrow Transplant. 2004;33:1187–90.

    Article  CAS  PubMed  Google Scholar 

  30. Aytac S, Yalcin SS, Cetin M, Yetgin S, Gumruk F, Tuncer M, et al. Measles, mumps, and rubella antibody status and response to immunization in children after therapy for acute lymphoblastic leukemia. Pediatr Hematol Oncol. 2010;27:333–43.

    Article  CAS  PubMed  Google Scholar 

  31. Shaw PJ, Bleakley M, Burgess M. Safety of early immunization against measles/mumps/rubella after bone marrow transplantation. Blood. 2002;99:3486–586.

    Article  CAS  PubMed  Google Scholar 

  32. Gouveia-Alves F, Gouveia R, Ginani VC, Seber A, Kuramoto DA, Murad GFA, et al. Adherence and immune response to revaccination following hematopoietic stem cell transplantation at a pediatric onco-hematology reference center. Transpl Infect Dis. 2018;20:e12903.

    Article  PubMed  Google Scholar 

  33. Aurpibul L, Puthanakit T, Sirisanthana T, Sirisanthana V. Persistence of measles, mumps, and rubella protective antibodies 3 years after revaccination in hiv-infected children receiving antiretroviral therapy. Clin Infect Dis. 2010;50:1415–8.

    Article  PubMed  Google Scholar 

  34. Schenk J, Abrams S, Theeten H, Van Damme P, Beutels P, Hens N. Immunogenicity and persistence of trivalent measles, mumps, and rubella vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2021;21:286–95.

    Article  CAS  PubMed  Google Scholar 

  35. Pandit A, Leblebjian H, Hammond SP, Laubach JP, Richardson PG, Baden LR, et al. Safety of live-attenuated measles-mumps-rubella and herpes zoster vaccination in multiple myeloma patients on maintenance lenalidomide or bortezomib after autologous hematopoietic cell transplantation. Bone Marrow Transpl. 2018;53:942–5.

    Article  CAS  Google Scholar 

  36. Desjardins M, Mitre X, Sherman AC, Walsh SR, Cheng MP, Kanjilal S, et al. Safety of live-attenuated measles, mumps, and rubella vaccine administered within 2 years of hematopoietic cell transplant. Open Forum Infect Dis. 2021;8:504.

    Article  Google Scholar 

  37. Aoki T, Kamimura T, Yoshida S, Mori Y, Kadowaki M, Kohno K, et al. Safety and seropositivity after live attenuated vaccine in adult patients receiving hematopoietic stem cell transplantation. Biol Blood Marrow Transpl. 2019;25:1576–85.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors appreciate the assistance from the Department of Immunology, Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China and Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. We would like to thank Editage (www.editage.cn) for English language editing.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Pudong District, Shanghai, 200127, China

    Min Wang, Qing Yuan, Hua Zhang, Fen Zhou, Jing Chen & Yi-Jin Gao

  2. Center for Diseases Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136, China

    Peng-Fei Deng & Yi Fei

  3. Department of Infectious Diseases, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Wen-Juan Chen & Qing Cao

Authors
  1. Min Wang
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  2. Qing Yuan
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  3. Peng-Fei Deng
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  4. Yi Fei
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  5. Hua Zhang
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Contributions

WM and YQ contributed equally to this work. GYJ: conceptualization, writing–review and editing, supervision. CJ: conceptualization. ZH, ZF, CWJ and CQ: data curation. DPF and FY: investigation. WM: formal analysis, writing–original draft. YQ: formal analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jing Chen or Yi-Jin Gao.

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Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Ethical approval

The study was approved by the Ethics Committee of Shanghai Children’s Medical Center (SCMCIRB‑K2017028) and registered at www.clinicaltrials.gov (NCT03373656). Informed consent to participate in the study have been obtained from parent or legal guardian of the participants (and themselves in the case of children over 8).

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Wang, M., Yuan, Q., Deng, PF. et al. Measles, mumps, and rubella revaccination in children after completion of chemotherapy and hematopoietic stem cell transplantation: a single-center prospective efficacy and safety analysis. World J Pediatr 19, 1062–1070 (2023). https://doi.org/10.1007/s12519-023-00721-x

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  • DOI: https://doi.org/10.1007/s12519-023-00721-x

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