Granulocyte-macrophage colony-stimulating factor as an adjuvant to hepatitis B vaccination in maintenance hemodialysis patients

Patients on maintenance hemodialysis (HD) have poor seroconversion rate aft er hepatitis B vaccination. The present study was designed to test the effi cacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adj uvant to hepatitis B vaccination for improving seroconversion rate in maint enance HD patients. Twelve chronic HD patients were randomly assigned to re ceive either hepatitis B vaccination alone or hepatitis B vaccination 24 h after 1 dose of GM-CSF for primary immunization. A group of 16 chronic HD p atients who had not seroconverted after a standard two-dose hepatitis B vac cination were randomly assigned either to a booster dose of hepatitis B vac cine alone or a booster dose given 24 h after one dose of GM-CSF. In the pr imary immunization group only 2 of 6 patients (33%) who had received vaccin ation alone, versus 5 of 6 patients (83%) who had received hepatitis B vacc ine after one dose of GM-CSF, developed seroprotective antibody titers. Mor eover, seroprotective antibody titers (IU/ml) were significantly higher in the latter group (275 +/- 286.5 vs. 14 +/- 22, p < 0.05). In patients who h ad not seroconverted with prior hepatitis B vaccination, GM-CSF adjuvant th erapy significantly increased the seroconversion rate versus booster dose a lone (87.5 vs. 25%, respectively, p < 0.02), with significantly higher sero protective antibody titers (84 +/- 80 vs. 19 +/- 33 IU/ml, respectively, p < 0.05). These findings suggest that administration of one dose of GM-CSF, as adjuvant therapy, prior to primary or booster dose hepatitis B vaccinati on may significantly increase seroconversion rate and seroprotective antibo dy titers in chronic HD patients. Copyright (C) 2000 S. Karger AG, Basel.