UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Immune responses post haematopoietic stem cell transplant: clinical studies of vaccination and autoimmunity

Miller, Paul D.E.; (2019) Immune responses post haematopoietic stem cell transplant: clinical studies of vaccination and autoimmunity. Doctoral thesis (M.D(Res)), UCL (University College London).

[img] Text
Miller_10066833_thesis_sig_removed.pdf
Access restricted to UCL open access staff until 1 March 2020.

Download (4MB)

Abstract

For months to years after haematopoietic stem cell transplant (HSCT), recipients may experience immune complications including graft versus host disease (GvHD), infections, and autoimmune phenomenon. These manifestations of impaired and dysregulated immunity contribute substantially to the burden of morbidity and mortality amongst HSCT recipients. In the general population, vaccination is an effective strategy for prevention of a number of infectious diseases. In HSCT recipients, the same immune impairment that renders them susceptible to infections may also blunt the adaptive immune response essential for effective immunisation. The optimum approach to vaccination of HSCT recipients is largely unclear. The first study in this thesis explores how current evidence and recommendations for vaccination of HSCT recipients translate into clinical care. A national survey of vaccination practice at allogeneic HSCT programmes was conducted on behalf of the British Society of Blood and Marrow Transplantation(BSBMT). We identified marked heterogeneity in all aspects of practice. The second study uses two serological assays to investigate the immunogenicity of the seasonal inactivated influenza vaccine administered to recipients of reduced intensity conditioning allogeneic HSCT in the first-year posttransplant. Immunogenicity was universally poor by both assays. The third study in this thesis identifies specific patient demographics and patterns of health belief that are associated with low vaccination intent amongst HSCT recipients. These findings may help to develop targeted patient education programmes. The final study in this thesis moves away from vaccination and explores the immune-mediated complication autoimmune cytopenia (AIC) following transplant for acquired aplastic anaemia (aAA). This study was supported by the European Society for Blood and Marrow Transplantation (EBMT). Cumulative incidence of AIC at 10 years post HSCT was 5.1%. Peripheral blood stem cell (PBSC) source, was associated with a higher incidence of AIC and myeloablative conditioning with a lower incidence in a multivariable Cox analysis.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: Immune responses post haematopoietic stem cell transplant: clinical studies of vaccination and autoimmunity
Event: UCL (University College London)
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10066833
Downloads since deposit
2Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item