Reimmunization after blood or marrow stem cell transplantation

Protective immunity to diseases preventable by routine vaccination is lost over time following allogeneic and autologous blood and marrow transplantat ion. Adoptive transfer of immunity from donors to recipients after allogene ic transplantation is not sufficient to prevent this decline, Systematic re immunization is necessary at appropriate time intervals following transplan tation to re-establish immunity. Response to vaccination depends upon the t ype of transplant, the source of cells, the immune status of the patient, a nd the vaccine being used. While inactivated or subunit vaccines are safe i n all transplant recipients, live vaccines are generally contraindicated. R eimmunization practices vary widely amongst transplant centers. This compre hensive review summarizes published data on post-transplant vaccination, an d based upon these, suggests guidelines which may he used as a framework fo r development of reimmunization protocols.