Association of Host Factors With Antibody Response to Seasonal Influenza Vaccination in Allogeneic Hematopoietic Stem Cell Transplant Patients.

BACKGROUND: Influenza vaccination efficacy is reduced after hematopoietic stem cell transplantation (HSCT) and patient factors determining vaccination outcomes are still poorly understood. METHODS: We investigated the antibody response to seasonal influenza vaccination in 135 HSCT patients and 69 healthy volunteers (HVs) in a prospective observational multicenter cohort study. We identified patient factors associated with hemagglutination inhibition titers against A/California/2009/H1N1, A/Texas/2012/H3N2, and B/Massachusetts/2012 by multivariable regression on the observed titer levels and on seroconversion/seroprotection categories for comparison. RESULTS: Both regression approaches yielded consistent results but regression on titers estimated associations with higher precision. HSCT patients required 2 vaccine doses to achieve average responses comparable to a single dose in HVs. Prevaccination titers were positively associated with time after transplantation, confirming that HSCT patients can elicit potent antibody responses. However, an unrelated donor, absolute lymphocyte counts below the normal range, and treatment with calcineurin inhibitors lowered the odds of responding. CONCLUSIONS: HSCT patients show a highly heterogeneous vaccine response but, overall, patients benefited from the booster shot and can acquire seroprotective antibodies over the years after transplantation. Several common patient factors lower the odds of responding, urging identification of additional preventive strategies in the poorly responding groups. CLINICAL TRIALS REGISTRATION: NCT03467074.

[Anticoagulation in Venous Thromboembolism: How Long and Which Dose?] / Antikoagulation bei venöser Thromboembolie: wie lange und welche Dosierung?

Anticoagulation in Venous Thromboembolism: How Long and Which Dose? Abstract. Venous thromboembolism is quite common in daily practice. As soon as the diagnosis is confirmed, anticoagulation should be started immediately. Nowadays DOACs are the first choice for treatment of VTE. An important issue is the duration of anticoagulation in an individual patient. Generally, the anticoagulation should be continued for at least three months in any patient. While anticoagulation can be safely stopped after three months in patients with isolated distal DVT it should be continued for an unlimited period in persons with unprovoked proximal DVT and PE. In the vast majority of cases making that decision is not straightforward. Decision making involves assessing risks and benefits on an individual basis. Another important issue is dose reduction of the DOACs during treatment. The goal of this article is to show the factors that must be considered for decision making.