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Vaccination after Haematopoietic Stem Cell Transplantation (HSCT) is a recommended standard of care. However, prior therapy, immunosuppression and Chronic Graft Versus Host Disease (cGvHD) impacts restoration of immunity and response to vaccination. We investigated the serological response to vaccination with pneumococcal and tetanus vaccines in post-transplant patients. Retrospective analysis was performed on 156 HSCT recipients who survived at least 6 months post-transplantation. Patients were transplanted for all indications from 2004 to 2015. Vaccination was given as per institutional protocol routinely to most HSCT recipients. Vaccine response was defined as an increase in anti-pneumococcal antibody titres from baseline (~6 months) to greater than or equal to 15 mg/L of IgG2 specific pneumococcal antibodies and anti-tetanus toxoid titres greater than 0.1 IU/L. Two-tailed Student T-test Annalise Martin1,2*, Melita Cirillo1,3,4, Lloyd D’Orsogna5, Ester Jack4, Matthew Wright1,3, Paul Cannell1,3, Julian Cooney1,3 and Duncan Purtill1,3 1Department of Haematology, Fiona Stanley Hospital, Murdoch, Australia 2Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia 3PathWest, Western Australia 4Department of Haematology, Royal Perth Hospital, Perth, Australia 5Department of Immunology, Fiona Stanley Hospital, Murdoch, Australia Serological Response to Pneumococcal and Tetanus Vaccination after Allogeneic Hematopoietic Stem Cell Transplantation was used for continuous variables or Fishers exact test to determine non-random association between two variables. Protective levels of antibodies to pneumococcal and tetanus toxoid antigens were retained prior to vaccination in 20% (n=23 of 114) and 76% (n=82 of 108) respectively. One hundred and twenty-one patients of the cohort (77%) received vaccinations at a median time of 12.16 months post transplantation (range 5.1 to 65.1 months). Of the vaccinated patients, vaccine responses were evaluated in patients with paired serology before and after pneumococcal (n=63, 52%) and tetanus vaccinations (n=57, 47%). Protective levels of antibodies were seen in 39 out of 63 (61.9%) after pneumococcal vaccinations compared with 52 of 57 patients (91.2%) after tetanus vaccination. Poor response to vaccination was seen in patients on a daily dose of 10 mg or more of prednisolone (4 responders out of 12 on steroids versus 35 out of 51 patients not on prednisolone, p=0.04) and chronic GvHD (8 responders out of 26 patients with cGvHD versus 31 out of 37with no evidence of cGvHD, p<0.001). Three patients out of 24 with non-protective pneumococcal antibody levels developed community acquired invasive Streptococcus pneumonia infection compared to none out of 39 patients with protective levels of IgG2 specific Pneumococcal antibodies (p=0.034). In conclusion, at 6 months post-transplant, protective antibody titres to pneumococcal antigens was not maintained post transplantation. In contrast, most patients retained immunity to tetanus antigens. Vaccination appeared effective in most patients where post-vaccination titres were available. Prednisolone and GvHD negatively influenced immune responses to pneumococcal vaccination. Consideration of chemoprophylaxis with penicillin in susceptible, immune suppressed patients with un-protective levels of pneumococcal antibodies is recommended.