Search

VZV is an important cause of morbidity and mortality among patients after hematopoietic SCT (HSCT). There is controversy surrounding the use of the live attenuated varicella vaccine (LAVV) in this population due to concerns that the immunization may cause VZ-related disease. The Blood and Marrow Transplant (BMT) group at the University of California, San Francisco (UCSF) Children's Hospital has been recommending the LAVV for immunocompetent HSCT patients since 1995. We retrospectively examined the incidence of post-immunization complications attributable to the LAVV in pediatric patients after HSCT. We also reported seroconversion rates when possible. Among 68 recipients of the LAVV after HSCT, 3 (4.4%; 95% confidence interval (CI)=1.0-12.7%) experienced mild-to-moderate symptoms potentially attributable to vaccination, and there were no severe reactions. Among 28 patients analyzed for seroconversion, 18 (64.3%; 95% CI=45.8-79.4%) seroconverted, 3 (10.7%; 95% CI 2.9-28.0%) possibly seroconverted and 7 (25.0%; 95% CI=12.4-43.6%) failed to seroconvert. It appears safe to administer the LAVV to immunocompetent patients after HSCT. Prospective studies are needed to more accurately determine rates of vaccine complications, efficacy and immunologic responses to vaccination.

We present three cases ofVLBW infants with Candida albicans fungemia who had brainmicroabscesses (

The major limitation of mismatched bone marrow transplantation is fatal graft versus host disease (GVHD). We processed haplotype-identical parental marrow with soybean agglutinin (SBA), sheep erythrocytes (SRBC), and neuraminidase-treated SRBC (N-SRBC) to enrich for marrow stem cells and remove mature T cells. Nine patients with severe combined immunodeficiency disease (SCID) who lacked histocompatible donors received these SBA-negative, SRBC-negative, N-SRBC-negative marrow transplants (0.5-5.0 X 10(8) cells/kg). Seven of the nine patients (78%) had documented T-lymphocyte engraftment based on HLA typing and/or chromosomal analysis. Six patients showed evidence of B-cell immunity on the basis of increased immunoglobulin levels, isohemagglutinins, and/or HLA-DR typing of non-T cells. Three patients received marrow ablative chemotherapy pretransplant for maternal-fetal GVHD; neutrophil engraftment occurred between 9 and 17 days posttransplantation, erythrocytes engrafted within 3-4 weeks of transplantation, and platelet recovery was seen between day 17 and day 49 following the transplants. No immunosuppression was given prophylactically posttransplant. Three patients had no GVHD, two had transient rash and/or fever, and two developed mild focal (stage I) chronic cutaneous GVHD. Of the seven who engrafted, five (71%) are alive and clinically well without GVHD 18-35 months posttransplant. These data demonstrate that SBA- and SRBC/N-SRBC-treated haploidentical marrow transplantation results in functional lymphocyte engraftment in SCID without significant GVHD, and can be used for some patients who otherwise would have no hope for survival.

The limitation of mismatched BMT is fatal graft vs. host disease (GVHD). We processed haplotype mismatched parental marrow with SBA to enrich for stem cells and reduce GVHD and successfully treated 6 patients with severe combined immune deficiency disease. HLA chimerism was found within 3 weeks post BMT. All the patients demonstrate T cell and 2 have evidence of B cell engraftment. T cell numbers and responses to phytohemagglutinin (PHA) and alloantigen pre and post BMT are: In #2,5,6 who required pre BMT immunosuppression for maternal GVHD, neutrophil, RBC, and platelet engraftment occurred by days 11,26,32 respectively. No immunosuppression was given post BMT. 2 patients had no GVHD, 3 had transient rash/fever, and only 1 developed persistent rash. Patients are now 3 to 17mo. post BMT. These results demonstrate that treated mismatched BMT can result in engraftment without significant GVHD and can be used for patients who otherwise have limited hope for survival.