tetano
Editor, Senior Moderator
Neurooncol Pract. 2018 Aug;5(3):176-183. doi: 10.1093/nop/npx035. Epub 2018 Jan 6.
[h=1]Immunogenicity of high-dose influenza vaccination in patients with primary central nervous system malignancy.[/h] Strowd RE[SUP]1[/SUP], Russell G[SUP]2[/SUP], Hsu FC[SUP]2[/SUP], Carter AF[SUP]3[/SUP], Chan M[SUP]4[/SUP], Tatter SB[SUP]5[/SUP], Laxton AW[SUP]5[/SUP], Alexander-Miller MA[SUP]6[/SUP], High K[SUP]7[/SUP], Lesser GJ[SUP]3[/SUP].
[h=3]Author information[/h] 1 Department of Neurology and Internal Medicine Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC. 2 Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, 1 Medical Center Boulevard, Winston Salem, NC. 3 Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 4 Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 5 Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 6 Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, NC. 7 Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem NC.
[h=3]Abstract[/h] [h=4]Background:[/h] For cancer patients, rates of influenza-associated hospitalization and death are 4 times greater than that of the general population. Previously, we reported reduced immunogenicity to the standard-dose influenza vaccine in patients with central nervous system malignancy. In other poorly responding populations (eg, elderly patients), high-dose vaccination has improved efficacy and immunogenicity.
[h=4]Methods:[/h] A prospective cohort study was designed to evaluate the immunogenicity of the Fluzone[SUP]?[/SUP] high-dose influenza vaccine in brain tumor patients. Data on diagnosis, active oncologic treatment, and immunologic status (eg, CD4 count, CD8 count, CD4:CD8 ratio) were collected. All patients received the high-dose vaccine (180 ?g). Hemagglutination inhibition titers were measured at baseline, day 28, and 3 months following vaccination to determine seroconversion (≥4-fold rise) and seroprotection (titer ≥1:40), which were compared to our prior results.
[h=4]Results:[/h] Twenty-seven patients enrolled. Diagnoses included high-grade glioma (85%), CNS lymphoma (11%), and meningioma (4%). Treatment at enrollment included glucocorticoids (n = 8, 30%), radiation (n = 2, 7%), and chemotherapy (n = 9, 33%). Posttreatment lymphopenia (PTL, CD4 ≤ 200) was observed in 4 patients (15%). High-dose vaccination was well tolerated with no grade III-IV toxicity. Overall, seroconversion rates for the A/H1N1, A/H3N2, and B vaccine strains were significantly higher than in our prior study: 65% vs 37%, 69% vs 23%, and 50% vs 23%, respectively (all P < .04). Seroconversion was universally poor in patients with PTL. While seroprotection at 3 months declined in our prior study, no drop was observed following high-dose vaccination in this cohort.
[h=4]Conclusions:[/h] The immunologic response to HD influenza vaccination was higher in this cohort than standard-dose influenza vaccination in our prior report. These findings mirror those in elderly patients where high-dose vaccination is the standard of care and raise the possibility of an immunosenescence phenotype.
[h=4]KEYWORDS:[/h] glioma; immunogenicity; influenza vaccination; lymphopenia; vaccination
PMID: 31385974 PMCID: PMC6655350 DOI: 10.1093/nop/npx035
Free PMC Article
[h=1]Immunogenicity of high-dose influenza vaccination in patients with primary central nervous system malignancy.[/h] Strowd RE[SUP]1[/SUP], Russell G[SUP]2[/SUP], Hsu FC[SUP]2[/SUP], Carter AF[SUP]3[/SUP], Chan M[SUP]4[/SUP], Tatter SB[SUP]5[/SUP], Laxton AW[SUP]5[/SUP], Alexander-Miller MA[SUP]6[/SUP], High K[SUP]7[/SUP], Lesser GJ[SUP]3[/SUP].
[h=3]Author information[/h] 1 Department of Neurology and Internal Medicine Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC. 2 Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, 1 Medical Center Boulevard, Winston Salem, NC. 3 Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 4 Department of Radiation Oncology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 5 Department of Neurosurgery, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem, NC. 6 Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, NC. 7 Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston Salem NC.
[h=3]Abstract[/h] [h=4]Background:[/h] For cancer patients, rates of influenza-associated hospitalization and death are 4 times greater than that of the general population. Previously, we reported reduced immunogenicity to the standard-dose influenza vaccine in patients with central nervous system malignancy. In other poorly responding populations (eg, elderly patients), high-dose vaccination has improved efficacy and immunogenicity.
[h=4]Methods:[/h] A prospective cohort study was designed to evaluate the immunogenicity of the Fluzone[SUP]?[/SUP] high-dose influenza vaccine in brain tumor patients. Data on diagnosis, active oncologic treatment, and immunologic status (eg, CD4 count, CD8 count, CD4:CD8 ratio) were collected. All patients received the high-dose vaccine (180 ?g). Hemagglutination inhibition titers were measured at baseline, day 28, and 3 months following vaccination to determine seroconversion (≥4-fold rise) and seroprotection (titer ≥1:40), which were compared to our prior results.
[h=4]Results:[/h] Twenty-seven patients enrolled. Diagnoses included high-grade glioma (85%), CNS lymphoma (11%), and meningioma (4%). Treatment at enrollment included glucocorticoids (n = 8, 30%), radiation (n = 2, 7%), and chemotherapy (n = 9, 33%). Posttreatment lymphopenia (PTL, CD4 ≤ 200) was observed in 4 patients (15%). High-dose vaccination was well tolerated with no grade III-IV toxicity. Overall, seroconversion rates for the A/H1N1, A/H3N2, and B vaccine strains were significantly higher than in our prior study: 65% vs 37%, 69% vs 23%, and 50% vs 23%, respectively (all P < .04). Seroconversion was universally poor in patients with PTL. While seroprotection at 3 months declined in our prior study, no drop was observed following high-dose vaccination in this cohort.
[h=4]Conclusions:[/h] The immunologic response to HD influenza vaccination was higher in this cohort than standard-dose influenza vaccination in our prior report. These findings mirror those in elderly patients where high-dose vaccination is the standard of care and raise the possibility of an immunosenescence phenotype.
[h=4]KEYWORDS:[/h] glioma; immunogenicity; influenza vaccination; lymphopenia; vaccination
PMID: 31385974 PMCID: PMC6655350 DOI: 10.1093/nop/npx035
Free PMC Article