MicroAbstract
The goal of the present study was to evaluate a novel prospective influenza vaccination strategy in patients with plasma cell disorders. Fifty-one patients were treated with a two dose series of high-dose inactivated trivalent influenza vaccine. This vaccination strategy was well tolerated led to very high rates of seroprotection against influenza.
Background
Patients with multiple myeloma (MM) and other plasma cell disorders are highly susceptible to influenza infections, which are major causes of morbidity in this population despite routine administration of seasonal influenza vaccination. Existing data are limited by small and retrospective studies, which suggest poor seroprotection rates of less than 20% following standard influenza vaccination in MM.
Methods
Patients with plasma cell dyscrasia (N=51) were treated with a two dose series of high-dose inactivated trivalent influenza vaccine over the 2014–2015 influenza season. Laboratory-confirmed influenza infections were identified through seasonal surveillance, sera were collected for influenza hemagglutination inhibition (HAI) titer assays, and logistic regression models were used to identify clinical correlates of HAI serologic responses.
Findings
Influenza vaccine was well tolerated without any vaccine-related ≥grade two adverse events. Only three patients (6%) experienced laboratory-confirmed influenza. Rates of HAI seroprotection against all three vaccine strains (influenza B, H1N1, and H3N2) increased from 4% at baseline to 49% and 65% following one and two doses, respectively. Risk factors associated with lower likelihood of HAI serologic response included plasma cell disorder requiring therapy, disease response assessment < partial response, or active conventional chemotherapy. Alternatively, active therapy with an immunomodulatory drug alone or with proteasome inhibitor was associated with a higher likelihood of HAI serologic response.
Conclusions
These data demonstrate that in contrast to historically poor results with standard influenza vaccination, this novel high-dose booster vaccination strategy leads to high rates of seroprotection. Randomized controlled studies are needed to compare this to standard vaccination strategy.