The response to vaccination against influenza A(H1N1) 2009, seasonal influenza and Streptococcus pneumoniae in adult outpatients with ongoing treatment for cancer with and without rituximab
The response to vaccination against influenza A(H1N1) 2009, seasonal influenza and Streptococcus pneumoniae in adult outpatients with ongoing treatment for cancer with and without rituximab
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DOI：
10.3109/0284186x.2014.914243
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发表时间：
2014-09-01
期刊：
影响因子：
3.1
通讯作者：
Pauksens, Karlis
中科院分区：
文献类型：
--
作者：
Berglund, Ake;Willen, Linda;Pauksens, Karlis
接受化疗的癌症患者能否对接种疫苗产生足够的反应还存在争议。材料和方法。对96例接受化疗和/或单抗、酪氨酸激酶抑制剂、放射治疗或皮质类固醇治疗的成年癌症患者进行了研究。接种了两剂甲型H1N1流感/09AS03佐剂裂解病毒粒子疫苗、一剂季节性流感疫苗和一剂23价肺炎球菌多糖疫苗。用血清血凝抑制试验(HI)检测流感病毒株抗体效价。对于肺炎球菌疫苗，用珠状试验xMAP(R)检测了14种不同的血清型特异性抗囊膜抗体。接受利妥昔单抗治疗的患者对疫苗接种没有反应。对于没有接受利妥昔单抗治疗的患者，4%的患者在接种疫苗前(HI>；=40)对大流行毒株A/California nia7/2009HINI产生了假定的保护性抗体。第一针和第二针免疫后，血清保护率(SPR)分别为62%和87%，血清转化率(SCR)分别为62%和84%。接种季节性流感疫苗前，甲型流感/布里斯班/59/2007H1N1和甲型乌拉圭/10/2007H3N1流感的SPR分别为19%和17%。免疫后SPR分别为70%和59%，SCR分别为42%和50%。肺炎球菌疫苗接种前和接种后分别有40%和68%的菌株出现保护性抗体。对肺炎球菌疫苗接种的平均应答率为44%。49%的患者对14种血清型中的至少50%有反应。未见严重不良反应的报道。相当数量的正在接受化疗的成人癌症患者可以对流感和肺炎球菌疫苗接种产生足够的血清学反应，而不会出现严重的不良事件。因此，应推荐接种疫苗。佐剂疫苗可能会改善这一患者群体的疫苗反应。最近接受利妥昔单抗治疗的患者对疫苗接种没有反应。
It is debated whether cancer patients treated with chemotherapy can mount an adequate response to vaccination.Material and methods. Ninety-six adult outpatients with cancer, who were undergoing chemotherapy and/or monoclonal antibody, tyrosine kinase inhibitor, irradiation or corticosteroid treatments, were studied. Two doses of the pandemic influenza A(H1N1)/09 AS03-adjuvanted split virion vaccine, one dose of the seasonal influenza vaccine and one dose of the 23-valent pneumococcal polysaccharide vaccine were given. Serum haemagglutination inhibition (HI) assays were used to determine antibody titres against the influenza strains. For the pneumococcal vaccine 14 different serotype-specific anti-capsular antibodies were measured by bead assay xMAP (R).Results. Patients treated with rituximab did not respond to vaccination. For patients without rituximab treatment 4% had putatively protective antibodies before vaccination (HI >= 40) to the pandemic-like strain A/California7/2009HINI. After the first and second dose of vaccine, seroprotection rates (SPR) were 62% and 87%, and seroconversion rates (SCR) 62% and 84%, respectively. Before seasonal flu vaccination SPR against influenza A/Brisbane/59/2007H1N1 and A/Uruguay/10/2007H3N2 were 19% and 17%, respectively. After vaccination, SPR were 70% and 59% and SCR 42% and 50%, respectively. For the pneumococcal vaccine protective antibodies were found to 40% of the 14 strains before and to 68% after vaccination. The mean response to pneumococcal vaccination was to 44% of the 14 serotypes. A response to at least 50% of the 14 serotypes was found in 49% of the patients. No serious adverse events were reported.Conclusion. A substantial number of adult cancer patients with ongoing chemotherapy treatment could mount an adequate serological response to influenza and pneumococcal vaccination without severe adverse events. Thus, vaccination should be recommended. Adjuvanted vaccines may improve the vaccine response among this patient group. Patients recently treated with rituximab do not respond to vaccination.