Cancer Patients Undergoing Chemotherapy Show Adequate Serological Response to Vaccinations Against Influenza Virus and Streptococcus pneumoniae

Abstract

Cancer patients receiving chemotherapy are prone to develop infections that might postpone treatment and lead to complications. The aim of our study was to investigate whether a heterogeneous population of patients with solid tumors and malignant lymphoma undergoing chemotherapy would respond serologically to vaccination against influenza and pneumococcal disease. There are no established routines in oncology departments in Norway regarding vaccination of these patients. The study included 35 cancer patients with median age 53 yr (range 20-74) and 38 controls with median age 57 yr (range 43-75). The chemotherapy regimens used were mild or moderately immunosuppressive. After one vaccination, 25 patients (72%) and 34 controls (87%) were serologically protected against two or three influenza strains. A higher proportion of patients with solid tumors (81%) than lymphoma (38%) achieved protection. Age, months on chemotherapy, and curative versus palliative treatment did not influence responses to vaccination. After vaccination with a 23-valent polysaccharide vaccine against pneumococci, most patients and controls achieved protective serum levels of antibodies against the different serotypes, with the exception that fewer patients were protected against serotype 4. The responses in controls were, however, generally stronger to all serotypes. Tumor type did not influence this vaccination response. We conclude that our cancer patients achieved adequate responses to influenza virus and Streptococcus pneumoniae. These are not live vaccines and are therefore safe for immunocompromised patients. Routine vaccinations against influenza virus and Streptococcus pneumoniae should be considered in cancer patients undergoing mild to moderately immunosuppressive chemotherapy.

Rituximab blocks protective serologic response to influenza A (H1N1) 2009 vaccination in lymphoma patients during or within 6 months after treatment

“…6 It has been shown that lymphoma patients treated with conventional chemotherapy alone may respond adequately to influenza vaccinations. [7][8][9][10] Rituximab may dramatically impair the humoral response to vaccination in rheumatoid arthritis patients, 11 but only a few studies have addressed this effect in rituximab-treated lymphoma patients. [12][13][14] We have conducted a controlled study where serologic response to the influenza A (H1N1) virus vaccine Pandemrix during the 2009 "swine flu" pandemic was analyzed in 67 lymphoma patients treated with rituximab monotherapy or in combination with chemotherapy within the last 6 months before vaccination and compared it with the response in 51 healthy controls.…”

Immunization with Pneumocystis Cross-Reactive Antigen 1 (Pca1) Protects Mice against Pneumocystis Pneumonia and Generates Antibody to Pneumocystis jirovecii

“…These patients would be ideal candidates for active immunization. Even patients undergoing chemotherapy have been shown to demonstrate adequate antibody responses to polysaccharide, protein, and conjugated vaccines (7,8,33). The vaccination strategy could also be optimized to function in a T cell-independent fashion through adjuvants of conjugation.…”

“…of chemotherapy has been shown to protect them through periods of immunosuppression (7)(8)(9). Pneumocystis is an attractive target for vaccine-based prevention, since patient populations at risk for PcP can often be identified prior to patients becoming immunosuppressed.…”

Transfer of influenza vaccine–primed costimulated autologous T cells after stem cell transplantation for multiple myeloma leads to reconstitution of influenza immunity: results of a randomized clinical trial

“…[17][18][19][20][21][39][40][41] We examined B-cell and T-cell recovery kinetics to understand the landscape of the immune system after ASCT. It is clear that the provision of the autologous T-cell product led to rapid quantitative reconstitution of both the B-cell and T-cell compartments ( Figures 3 and 4).…”