Immunogenicity of high-dose influenza vaccination in patients with primary central nervous system malignancy

Author:

Strowd Roy E1,Russell Gregory2,Hsu Fang-Chi2,Carter Annette F3,Chan Michael4,Tatter Stephen B5,Laxton Adrian W5,Alexander-Miller Martha A6,High Kevin7,Lesser Glenn J3

Affiliation:

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

Abstract

Abstract Background 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. Methods A prospective cohort study was designed to evaluate the immunogenicity of the Fluzone® 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 µg). 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. Results 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. Conclusions 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.

Funder

Comprehensive Cancer Center of Wake Forest University

Publisher

Oxford University Press (OUP)

Subject

Medicine (miscellaneous)

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