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Does the introduction explain the objective of the research presented in the preprint?

Yes

The introduction clearly explains the research objective by first highlighting the increased risk of severe RSV infection in hematopoietic stem cell transplant (HSCT) recipients and their reduced immune responses to RSV vaccination.Then, it identifies two important knowledge gaps. One is the durability of vaccine-induced antibody responses and the other is potential benefits of seasonal revaccination, particularly in patients vaccinated early after transplantation. To address these gaps, the authors aim to evaluate antibody responses over a 12-month period and assess the potential benefits of revaccination in 71 HSCT recipients.

Are the methods well-suited for this research?

Somewhat appropriate

The methods are appropriate for evaluating antibody responses following RSV vaccination and revaccination in HSCT recipients. The 12-month follow-up and stratification by time since transplantation are particularly relevant to the research objectives. However, the small revaccination sample (n=22) and lack of multivariable adjustment limit the strength of the findings. In particular, immune recovery over time after HSCT may confound the observed association between revaccination and increased antibody responses. Also, the pre- and post-vaccination comparison provides only preliminary evidence regarding clinical effectiveness.

Are the conclusions supported by the data?

Somewhat unsupported

The conclusions are partly supported by the observed antibody responses like the improved humoral responses following revaccination in patients vaccinated early after HSCT. However, some conclusions appear stronger than the available evidence supports. The revaccination subgroup was small (n=22), and potential confounding from immune reconstitution over time was not addressed. Also, increased antibody titers do not necessarily establish clinical protection against RSV infection.

Are the data presentations, including visualizations, well-suited to represent the data?

Somewhat appropriate and clear

The data presentations appear somewhat appropriate for the study objectives. Figure 1 is organized to illustrate antibody responses over time and changes following revaccination, and Table 1 provides relevant patient characteristics. However, I think the presentation could be improved by clearly reporting sample sizes at each time point and showing individual patient-level responses or measures of variability.

How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research?

Somewhat clearly

The authors provide a clear discussion of their main findings, including the differences in antibody responses between patients vaccinated early and later after HSCT. They also acknowledge important limitations, including the small sample size and lack of multivariable analyses, and identify relevant directions for future research. However, I think some interpretations could be more cautious. For example, the improved antibody responses following revaccination may partly reflect immune recovery over time, and higher antibody titers do not necessarily indicate better clinical protection. The authors could also more clearly distinguish their preliminary immunogenicity findings from recommendations for systematic seasonal revaccination.

Is the preprint likely to advance academic knowledge?

Moderately likely

This preprint is likely to contribute to academic knowledge by addressing an important gap in understanding the durability of RSV vaccine-induced immunity and the potential benefits of seasonal revaccination in HSCT recipients. The 12-month follow-up and comparison of patients vaccinated at different intervals after transplantation provide valuable preliminary evidence. This findings suggest that revaccination may improve antibody responses among patients who responded poorly to their initial vaccination. However, the small sample size and potential confounding by immune reconstitution limit the strength and generalizability of the conclusions. Further studies with larger cohorts and clinical outcomes are needed to confirm these findings.

Would it benefit from language editing?

No

Would you recommend this preprint to others?

Yes, it’s of high quality

Is it ready for attention from an editor, publisher or broader audience?

Yes, after minor changes

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they used generative AI to come up with new ideas for their review.