Attenuated Antibody Reaction for the Primary Antigen but not for the Recall Antigen of Influenza Vaccination in Patients with Non-Hodgkin B-Cell Lymphoma after the Administration of Rituximab-CHOP

Abstract

To assess the humoral response to the influenza vaccine in patients undergoing R-CHOP therapy (rituximab combined with cyclophosphamide, doxorubicin, vincristine, and predonisolone) for non-Hodgkin lymphoma (NHL), the anti-hemagglutinin (HA) titer in 7 NHL patients undergoing therapy was compared with those in 10 control group subjects in the 2005/2006 season. Four weeks after vaccination, the HA titers against the influenza type A H1N1 and type B antigens, the same antigens that had been used in the previous seasons, were elevated in all patients treated with R-CHOP. In contrast, there was no increase in the geometric mean titer for type A H3N2 antigen, which was newly included in 2005/2006 season, in the patients treated with R-CHOP, while there was a significant increase in the 10 control subjects (p = 0.014). This study showed that vaccination against influenza virus generated an appreciable humoral response to recall antigens in NHL patients treated with R-CHOP therapy, but not to the primary antigen. 〔J Clin Exp Hematopathol 49(1) : 9-13, 2009〕

Vaccination against pandemic H1N1 (2009) in patients after allogeneic hematopoietic stem cell transplantation: a retrospective analysis

“…Prior rituximab therapy completely abrogated subsequent vaccination response in our cohort, which is in line with other results reported elsewhere [13,22,28,29]. Moreover, a patient receiving rituximab as the sole immunosuppressive treatment 8 months before being vaccinated against pandemic H1N1 (2009) virus developed life-threatening pandemic H1N1 (2009) infection despite vaccination, indicating a long-lasting effect of rituximab.…”

“…A very poor response to seasonal influenza vaccination in patients treated with monoclonal antibodies (rituximab or alemtuzumab) for lymphoma has been described by Ljungman et al [26] and confirmed in patients with rheumatoid arthritis [31]. Whether recall antigens can generate an appreciable response to influenza vaccination in patients after rituximab therapy, as described by Takata et al, was not examined in our cohort [29].…”

Immunogenicity of a monovalent influenza A(H1N1)pdm09 vaccine in patients with hematological malignancies

“…Recent studies have also shown the low immunogenicity of influenza vaccines in lymphoma patients and patients on rituximab treatment. [30][31][32][33][34][35][36][37][38][39][40][41][42][43] The results obtained by us here are in agreement with those findings. Subjects having pre-titer ≥ 1:10 did not show any increase in antibody response after the second vaccination.…”

Repeated vaccination is required to optimize seroprotection against H1N1 in the immunocompromised host

“…21 Although the effect of rituximab on the immunogenicity of seasonal influenza vaccination remains unclear, 14,22 it has been suggested that rituximab negatively affects the ability to respond to novel influenza antigens. 22 Indeed, we recently showed that patients treated with rituximab with confirmed H1N1 infection fail to mount an antibody response to H1N1. 9 In our current study none of the patients treated with rituximab within 6 months of vaccination achieved detectable antibody titers to H1N1.…”