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Title: Immune responses post haematopoietic stem cell transplant : clinical studies of vaccination and autoimmunity
Author: Miller, Paul D. E.
ISNI:       0000 0004 7660 5620
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available