Clinical Scorecard: Long-Term Immune Response and Safety After RSV Vaccination in High-Risk Transplant Recipients
At a Glance
Category
Detail
Condition
RSV vaccination in lung transplant and allogeneic hematopoietic cell transplant recipients
Key Mechanisms
Adjuvanted RSVPreF3 vaccination elicited neutralizing and binding antibodies and polyfunctional CD4+ T-cell responses; neutralizing antibody titers waned by 12 months, while binding antibodies and CD4+ T-cell responses remained above baseline.
Target Population
Adults aged 18 years or older who received a lung transplant or allogeneic hematopoietic cell transplant
Care Setting
Single-center, nonrandomized clinical trial at University Health Network; immune responses were assessed at baseline and 1, 6, and 12 months after vaccination, with 12 months of follow-up.
Key Highlights
The study enrolled 86 recipients: 40 lung transplant and 46 allogeneic hematopoietic cell transplant recipients.
Neutralizing antibody titers rose after vaccination, remained stable through 6 months, and declined by 12 months.
At 12 months, seroconversion was observed in 24% of lung transplant recipients and 17% of allogeneic hematopoietic cell transplant recipients.
Binding antibody concentrations and polyfunctional CD4+ T-cell frequencies remained above baseline at 12 months; RSV-specific polyfunctional CD8+ T-cell responses were largely undetectable.
No vaccine-related rejection or graft-vs-host disease events occurred during follow-up. The study reported 32 hospitalizations, none attributed to vaccination.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
Adults aged 18 years or older who had received a lung transplant or allogeneic hematopoietic cell transplant; the study excluded allogeneic transplant recipients receiving systemic immunosuppression for graft-vs-host disease.
Participants received one dose of adjuvanted RSVPreF3. Vaccination was reported as well tolerated over 12 months. The study did not compare RSVPreF3 with other licensed RSV vaccines.
Clinical Best Practices
The study authors note that absolute immune correlates of protection against RSV infection remain undefined.
The authors report that neutralizing antibody titers declined by 12 months and call for optimization of subsequent immunization timing.
The authors caution that variable enrollment timing and differing exposure opportunities across RSV seasons complicate interpretation of breakthrough infections.
The authors identify the single-center design, modest sample size, lack of a nontransplant control group, and neutralization testing limited to RSV-A as study limitations.
by Victoria G. Hall, Adrian A. Alexander, Madeline R. Kern-Smith, Faranak Mavandadnejad, Sarayna Bala, Xiaoqing Dang, Rujun Kang, Sapna Humar, Poramed Winichakoon, Rochelle Johnstone, Ailya Salman, Meghan Aversa, Igor Novitzky-Basso, Roni Bitterman, Pascal M. Lavoie, Deepali Kumar, Jonas Mattsson, Victor H. Ferreira
Investigators found that symptom improvement remained possible years after infection, but patients with multisystem symptoms had lower likelihood of improvement.
