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Ivanov N, Krastev B, Miteva DG, Batselova H, Alexandrova R, Velikova T. Effectiveness and safety of COVID-19 vaccines in patients with oncological diseases: State-of-the-art. World J Clin Oncol 2023; 14:343-356. [PMID: 37771630 PMCID: PMC10523189 DOI: 10.5306/wjco.v14.i9.343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/06/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
Although the coronavirus disease 2019 (COVID-19) pandemic was declared to be no longer “a public health emergency of international concern” with its wide range of clinical manifestations and late complications, severe acute respiratory syndrome coronavirus 2 infection proved to be a serious threat, especially to the elderly and patients with comorbidities. Patients with oncologic diseases are vulnerable to severe infection and death. Indeed, patients with oncohematological diseases have a higher risk of severe COVID-19 and impaired post-vaccination immunity. Unfortunately, cancer patients are usually excluded from vaccine trials and investigations of post-vaccinal immune responses and the effectiveness of the vaccines. We aimed to elucidate to what extent patients with cancer are at increased risk of developing severe COVID-19 and what is their overall case fatality rate. We also present the current concept and evidence on the effectiveness and safety of COVID-19 vaccines, including boosters, in oncology patients. In conclusion, despite the considerably higher mortality in the cancer patient group than the general population, countries with high vaccination rates have demonstrated trends toward improved survival of cancer patients early and late in the pandemic.
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Affiliation(s)
- Nedelcho Ivanov
- Department of Clinical Immunology with Stem Cell Bank, University Hospital Alexanrovska, Sofia 1431, Bulgaria
| | - Boris Krastev
- Medical Center Nadezhda, Medical Center Nadezhda, Sofia 1407, Bulgaria
| | | | - Hristiana Batselova
- Department of Epidemiology and Disaster Medicine, Medical University, Plovdiv, University Hospital St. George, Plovdiv 6000, Bulgaria
| | - Radostina Alexandrova
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia 1000, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
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2
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Lin EPY, Huang LC, Whisenant J, York S, Osterman T, Lewis J, Iams W, Skotte E, Cass A, Hsu CY, Shyr Y, Horn L. Associations of influenza vaccination with severity of immune-related adverse events in patients with advanced thoracic cancers on immune checkpoint inhibitors. ERJ Open Res 2022; 8:00684-2021. [PMID: 36225333 PMCID: PMC9549316 DOI: 10.1183/23120541.00684-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Whether influenza vaccination (FV) is associated with the severity of immune-related adverse events (IRAEs) in patients with advanced thoracic cancer on immune checkpoint inhibitors (ICIs) is not fully understood. Methods Patients enrolled in this retrospective cohort study were identified from the Vanderbilt BioVU database and their medical records were reviewed. Patients with advanced thoracic cancer who received FV within 3 months prior to or during their ICI treatment period were enrolled in the FV-positive cohort and those who did not were enrolled in the FV-negative cohort. The primary objective was to detect whether FV is associated with decreased IRAE severity. The secondary objectives were to evaluate whether FV is associated with a decreased risk for grade 3-5 IRAEs and better survival times. Multivariable ordinal logistic regression was used for the primary analysis. Results A total of 142 and 105 patients were enrolled in the FV-positive and FV-negative cohorts, respectively. There was no statistically significant difference in patient demographics or cumulative incidences of IRAEs between the two cohorts. In the primary analysis, FV was inversely associated with the severity of IRAEs (OR 0.63; p=0.046). In the secondary analysis, FV was associated with a decreased risk for grade 3-5 IRAEs (OR 0.42; p=0.005). Multivariable Cox regression showed that FV was not associated with survival times. Conclusions Our study showed that FV does not increase toxicity for patients with advanced thoracic cancer on ICIs and is associated with a decreased risk for grade 3-5 IRAEs. No statistically significant survival differences were found between patients with and without FV.
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Affiliation(s)
- Emily Pei-Ying Lin
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Dept of Medical Research, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Pulmonary Medicine, Dept of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Dept of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Ching Huang
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Whisenant
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally York
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis Osterman
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Dept of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Lewis
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wade Iams
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Skotte
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Cass
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chih-Yuan Hsu
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- These authors contributed equally
| | - Leora Horn
- Division of Hemato-oncology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
- These authors contributed equally
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Echavarria I, Carrión Galindo JR, Corral J, Diz Taín MP, Henao Carrasco F, Iranzo González-Cruz V, Mielgo-Rubio X, Quintanar T, Rivas Corredor C, Pérez Segura P. SEOM clinical guidelines for the prophylaxis of infectious diseases in cancer patients (2021). Clin Transl Oncol 2022; 24:724-732. [PMID: 35230619 PMCID: PMC8886704 DOI: 10.1007/s12094-022-02800-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Abstract
Infections are still a major cause of morbi-mortality in patients with cancer. Some of these infections are preventable through specific measures, such as vaccination or prophylaxis. This guideline aims to summarize the evidence and recommendations for the prevention of infections in cancer patients, devoting special attention to the most prevalent preventable infectious disease. All the evidences will be graded according to The Infectious Diseases Society of America grading system.
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Affiliation(s)
- Isabel Echavarria
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), CIBERONC, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | | | - Jesús Corral
- Department of Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | - Vega Iranzo González-Cruz
- Department of Medical Oncology, Hospital General Universitario de Valencia, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Valencia, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Teresa Quintanar
- Department of Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | | | - Pedro Pérez Segura
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
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4
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Infection risk and prophylaxis in patients with lymphoid cancer. Blood 2021; 139:1517-1528. [PMID: 34748625 DOI: 10.1182/blood.2019003687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/05/2021] [Indexed: 11/20/2022] Open
Abstract
Infections are a common cause of morbidity and mortality in patients with lymphoid cancer. With evolving cancer therapeutics, including new targeted and immunotherapies, clinicians need to be aware of additional risk factors and infections that may arise in patients treated with these agents. This "How I Treat" article will highlight fundamental issues including risk factors for infection, infectious diseases screenings and antimicrobial prophylaxis recommendations in patients with lymphoid cancers. We present 4 scenarios of patients with lymphoid cancers with varied infections and describe a treatment approach based on a combination of evidence-based data and experience, as there are limitations in objective infection data especially with newer agents. The goal of this discussion is to provide a framework for institutions and health care providers to develop their own approach in preventing and treating infections in patients with lymphoid cancer.
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Allegra A, Tonacci A, Musolino C, Pioggia G, Gangemi S. Secondary Immunodeficiency in Hematological Malignancies: Focus on Multiple Myeloma and Chronic Lymphocytic Leukemia. Front Immunol 2021; 12:738915. [PMID: 34759921 PMCID: PMC8573331 DOI: 10.3389/fimmu.2021.738915] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Secondary immunodeficiency is reported in most patients with hematological malignancies such as chronic lymphocytic leukemia and multiple myeloma. The aim of our review was to evaluate the existing literature data on patients with hematological malignancies, with regard to the effect of immunodeficiency on the outcome, the clinical and therapeutic approach, and on the onset of noninfectious complications, including thrombosis, pleural effusion, and orofacial complications. Immunodeficiency in these patients has an intense impact on their risk of infection, in turn increasing morbidity and mortality even years after treatment completion. However, these patients with increased risk of severe infectious diseases could be treated with adequate vaccination coverage, but the vaccines' administration can be associated with a decreased immune response and an augmented risk of adverse reactions. Probably, immunogenicity of the inactivated is analogous to that of healthy subjects at the moment of vaccination, but it undertakes a gradual weakening over time. However, the dispensation of live attenuated viral vaccines is controversial because of the risk of the activation of vaccine viruses. A particular immunization schedule should be employed according to the clinical and immunological condition of each of these patients to guarantee a constant immune response without any risks to the patients' health.
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MESH Headings
- Animals
- Humans
- Immunocompromised Host
- Immunogenicity, Vaccine
- Immunologic Deficiency Syndromes/epidemiology
- Immunologic Deficiency Syndromes/immunology
- Immunologic Deficiency Syndromes/therapy
- Incidence
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Multiple Myeloma/epidemiology
- Multiple Myeloma/immunology
- Multiple Myeloma/therapy
- Opportunistic Infections/epidemiology
- Opportunistic Infections/immunology
- Opportunistic Infections/prevention & control
- Risk Factors
- Vaccination
- Vaccine Efficacy
- Vaccines/administration & dosage
- Vaccines/adverse effects
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Caterina Musolino
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Sebastiano Gangemi
- School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Spagnolo F, Boutros A, Croce E, Cecchi F, Arecco L, Tanda E, Pronzato P, Lambertini M. Influenza vaccination in cancer patients receiving immune checkpoint inhibitors: A systematic review. Eur J Clin Invest 2021; 51:e13604. [PMID: 34021591 PMCID: PMC8365730 DOI: 10.1111/eci.13604] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a concern that influenza vaccination may increase the incidence of immune-related adverse events in patients receiving immune checkpoint inhibitors (ICIs). The aim of this systematic review was to summarize the available data on the safety and efficacy of influenza vaccination in cancer patients receiving ICIs. METHODS Studies reporting safety and efficacy outcomes of influenza vaccination in cancer patients receiving ICIs were included. Only descriptive statistics were conducted to obtain a pooled rate of immune-related adverse events in vaccinated patients. RESULTS Ten studies assessing the safety and eight assessing the efficacy of influenza vaccination in cancer patients receiving ICIs were identified, for a total of 1124 and 986 vaccinated patients, respectively. Most patients had melanoma or lung cancer and received a single agent anti-PD-1, but also other tumour types and immunotherapy combinations were represented. No severe vaccination-related toxicities were reported. The pooled incidence of any grade immune checkpoint inhibitor-related adverse events was 28.9%. In the 6 studies specifying the incidence of grade 3-4 toxicities, the pooled incidence was 7.5%. No grade 5 toxicities were reported. No pooled descriptive analysis was conducted in studies reporting efficacy outcomes due to the heterogeneity of endpoints and data reporting. Nevertheless, among the eight studies included, seven reported positive efficacy outcomes of influenza vaccination. CONCLUSION The results of this systematic review support the safety and efficacy of influenza vaccination in cancer patients receiving ICIs. These results are particularly relevant in the context of the SARS-CoV-2 pandemic.
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Affiliation(s)
- Francesco Spagnolo
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Boutros
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Elena Croce
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Federica Cecchi
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Enrica Tanda
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Pronzato
- Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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7
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Abdel-Rahman O. Patterns and association of vaccination among adults with a history of cancer in the USA: a population-based study. J Comp Eff Res 2021; 10:899-907. [PMID: 34114478 DOI: 10.2217/cer-2020-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the association of vaccination status among adults with history of cancer in a population-based cohort in the USA. Materials & methods: National Health Interview Survey datasets (2008-2018) have been accessed and information about the patterns and associations of the following vaccinations were collected (influenza vaccination, pneumococcal vaccination, hepatitis B vaccination, hepatitis A vaccination and shingles vaccination). Association of different sociodemographic variables with each of the above types of vaccination was studied through multivariable logistic regression analysis. Results: Private health insurance (vs no private insurance) was associated with higher percentages of recommended vaccination (influenza vaccination: 65 vs 59.7%; pneumococcal vaccination: 74.9 vs 68.8%; hepatitis B vaccination: 22.9 vs 19.3%; hepatitis A vaccination: 10.1 vs 8.6%; shingles vaccination: 33.8 vs 26.7%; p < 0.001 for all comparisons). Within multivariable logistic regression analyses, African American race, lower education and lower income were associated with less probability of adherence to recommended vaccination (for influenza vaccination; odds ratio (OR) for black race vs white race: 0.785; 95% CI: 0.717-0.859; OR for ≤high school vs >high school education: 0.763; 95% CI: 0.723-0.805; OR for income ≤US$45,000 vs >US$45,000: 0.701; 95% CI: 0.643-0.764). Conclusion: There is evidence of socio-economic disparities in adherence to recommended vaccination among this cohort of cancer survivors in the USA. More efforts need to be done to ensure that recommended vaccination is being delivered to all cancer survivors in need (including enhancing coverage and awareness to under-represented groups of the society).
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB T4G1Z2, Canada
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8
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Abstract
Immunotherapy has revolutionized cancer treatment, but efficacy remains limited in most clinical settings. Cancer is a systemic disease that induces many functional and compositional changes to the immune system as a whole. Immunity is regulated by interactions of diverse cell lineages across tissues. Therefore, an improved understanding of tumour immunology must assess the systemic immune landscape beyond the tumour microenvironment (TME). Importantly, the peripheral immune system is required to drive effective natural and therapeutically induced antitumour immune responses. In fact, emerging evidence suggests that immunotherapy drives new immune responses rather than the reinvigoration of pre-existing immune responses. However, new immune responses in individuals burdened with tumours are compromised even beyond the TME. Herein, we aim to comprehensively outline the current knowledge of systemic immunity in cancer.
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Affiliation(s)
- Kamir J Hiam-Galvez
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology & Immunology, University of California, San Francisco, San Francisco, CA, USA
- Graduate Program in Biomedical Sciences, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, San Francisco, CA, USA
| | - Breanna M Allen
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Microbiology & Immunology, University of California, San Francisco, San Francisco, CA, USA
- Graduate Program in Biomedical Sciences, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, San Francisco, CA, USA
| | - Matthew H Spitzer
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Department of Microbiology & Immunology, University of California, San Francisco, San Francisco, CA, USA.
- Graduate Program in Biomedical Sciences, University of California, San Francisco, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
- Chan Zuckerberg Biohub, San Francisco, San Francisco, CA, USA.
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9
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Chong CR, Park VJ, Cohen B, Postow MA, Wolchok JD, Kamboj M. Safety of Inactivated Influenza Vaccine in Cancer Patients Receiving Immune Checkpoint Inhibitors. Clin Infect Dis 2021; 70:193-199. [PMID: 30874791 DOI: 10.1093/cid/ciz202] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cancer patients are at a higher risk for developing influenza (flu)- related complications. It is unclear if the flu vaccine exacerbates immune events in patients treated with immune checkpoint inhibitors (ICIs). METHODS We conducted an institutional review board-IRB-approved retrospective review of advanced cancer patients on ICIs who received the flu vaccine during three 3 consecutive seasons: 2014-2015, 2015-2016, and 2016-2017. The primary outcome assessed was any "new onset" immune-related adverse event (IRAE). A subset analysis of vaccinated patients newly treated with anti-programmed cell death protein 1 (PD-1) agents (nivolumab or pembrolizumab) was conducted to assess overall IRAE rates for comparison with published clinical trials. RESULTS During the three 3 seasons, 370 patients met criteria for ICI and vaccination within ~ twoapproximately 2 months (65 days). The most common underlying cancers were lung (46%) and melanoma (19%); 61% of patients received an anti-PD-1 agent only. In the entire cohort, 20% experienced an IRAE (any grade); incidence of grade 3 or 4 toxicity was 8%. No grade 5 events occurred. In the subset of 170 patients newly treated with anti-PD-1 agents, the overall IRAE rate was 18% and, grade 3/4 events occurred in 7.6%. Influenza was diagnosed in 2 patients. CONCLUSIONS No increase in incidence or severity of IRAEs was detected in patients on ICIs who received the inactivated influenza vaccine within ~ approximately 2 months of ICI. For newly treated patients on anti-PDI-1 agents, IRAE rates were comparable to those from published clinical trials and did not vary with order of administration. Routine seasonal flu vaccination is encouraged in patients on ICIs.
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Affiliation(s)
- Curtis R Chong
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Vivian J Park
- Department of Pharmacy, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bevin Cohen
- Office of Nursing Research, Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, New York.,School of Nursing, Columbia University Medical Center
| | - Michael A Postow
- Melanoma & Immunotherapeutics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jedd D Wolchok
- Melanoma & Immunotherapeutics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mini Kamboj
- Infection Control, Memorial Sloan-Kettering Cancer Center, New York, New York.,Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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10
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Ferdjallah A, Young JAH, MacMillan ML. A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Front Pediatr 2021; 9:634449. [PMID: 34386464 PMCID: PMC8353083 DOI: 10.3389/fped.2021.634449] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.
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Affiliation(s)
- Asmaa Ferdjallah
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Transplant Infectious Disease, University of Minnesota, Minneapolis, MN, United States
| | - Margaret L MacMillan
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
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11
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Maeda T, Sasaki H, Togawa A, Tanaka T, Arima H, Takata T, Takamatsu Y. Surveillance of the current situation regarding influenza vaccination according to medical oncologists in Japan. Cancer Sci 2021; 112:433-443. [PMID: 33215475 PMCID: PMC7780033 DOI: 10.1111/cas.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022] Open
Abstract
This study aimed to clarify the attitude of oncologists toward influenza vaccination and the current situation and issues regarding influenza vaccination for patients on chemotherapy in Japan. A web-based survey of medical oncologists certified by the Japanese Society of Medical Oncology was conducted between November 1 and December 31, 2019. Of the 1369 medical oncologists who were invited to participate, 415 (30.3%) responded to our survey. The questionnaire comprised 4 sections: "oncologist characteristics," "oncologist attitude toward influenza vaccines and the current status of influenza vaccination for cancer patients undergoing chemotherapy," "incidence of influenza infection and associated treatment complications," and "treatment policy for influenza infection." In total, 153 (36.9%) physicians replied that they did not actively encourage influenza vaccination for patients undergoing chemotherapy. The primary reasons given were lack of evidence (48/153, 31.4%) and uncertainty of appropriate timing (46/153, 30.1%). There was diverse variation in the timing of vaccination and in the levels of encouragement based on the cancer location and medication type. Two hundred eighty-three (68.2%) oncologists reported that their cancer patients had experienced influenza infection while undergoing chemotherapy, and 169 (40.7%) responded that their patients had experienced an administration delay or discontinuation of medication because of influenza infection. Our surveillance revealed some oncologists considered evidence regarding the administration of influenza vaccine to cancer patients undergoing chemotherapy (particularly the optimal timing and level of recommendation by cancer location and medication) to be lacking. It also exposed the adverse impact of influenza infection in cancer patients.
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Affiliation(s)
- Toshiki Maeda
- Department of Preventive Medicine and Public HealthFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Hidenori Sasaki
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Atsushi Togawa
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Toshihiro Tanaka
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public HealthFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Tohru Takata
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
| | - Yasushi Takamatsu
- Department of Oncology, Hematology and Infectious DiseasesFaculty of MedicineFukuoka UniversityFukuokaJapan
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12
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Abdel-Rahman O. Prevalence and healthcare utilization of acute respiratory infections among cancer survivors in the United States: a population-based study. Expert Rev Respir Med 2020; 15:697-704. [PMID: 33331199 DOI: 10.1080/17476348.2021.1865811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To examine the prevalence and healthcare use of acute respiratory tract infections (RTIs) among cancer survivors in the United States in a population-based cohort.Methods: Medical Expenditure Panel Survey for 2013, 2015, and 2017 was accessed and adults (>20 years) with known status of cancer diagnosis were reviewed. Multivariable logistic regression analysis was then used to examine factors associated with the likelihood of influenza and pneumonia as well as the likelihood of hospitalization secondary to acute RTIs.Results: A total of 75,665 participants were included (including 6397 cancer survivors and 68,733 participants without a cancer history). Within the cohort of cancer survivors, upper RTIs were recorded in 10.6% and influenza and pneumonia were recorded in 7.8%. Within the cohort of cancer survivors, individuals with influenza and pneumonia have a higher total healthcare expenditure (mean: 19,387.59 $ versus 12,714.57 $; P < 0.001) and total out-of-pocket expenditure (mean: 1494.61 $ versus 1159.27 $; P < 0.001). Multivariable logistic regression analysis showed that a history of cancer was associated with a higher likelihood of influenza and pneumonia (OR: 1.119; 95% CI: 1.005-1.247; P = 0.041) as well as hospitalization following acute RTIs (1.586; 95% CI: 1.197-2.103; P = 0.001).Conclusions: Within the studied cohort, cancer Survivors were more likely to be diagnosed with influenza and pneumonia and they were more likely to be hospitalized because of acute RTIs.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
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13
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Abdel-Rahman O. Influenza and pneumonia-attributed deaths among cancer patients in the United States; a population-based study. Expert Rev Respir Med 2020; 15:393-401. [PMID: 33107375 DOI: 10.1080/17476348.2021.1842203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: To assess the patterns and trends of influenza and pneumonia-attributed deaths among cancer patients in the United States.Methods: Surveillance, Epidemiology and End Results (SEER) database was accessed and cancer patients diagnosed 1975-2016 who have been included in the SEER-9 registries were included. The primary endpoint of the study is standardized mortality rate (SMR; calculated as observed/ Expected (O/E) ratio for death from influenza and pneumonia among cancer patients).Results: The current study evaluates a total of 3,579,199 cancer patients (diagnosed 1975-2016) within the SEER-9 registries; and influenza and pneumonia-attributed deaths represent 1.5% of the recorded deaths for this cohort. SMR for influenza/ pneumonia-attributed death within the first year following cancer diagnosis was 1.88 (1.83-1.94);while SMR for influenza/pneumonia-attributed death following the first year was 1.11 (1.10-1.12). Within the first year following cancer diagnosis, SMR from influenza/pneumonia was higher among individuals with black race (SMR for white race: 1.75 (95% CI: 1.69-1.81) while SMR for black race: 2.90 (95% CI: 2.65-3.16), lung cancer (SMR for lung cancer: 4.39 (95% CI: 4.11-4.69)), head and neck cancer (SMR for oral cavity/ pharynx cancer: 4.02 (95% CI: 3.50-4.59)), lymphomas (SMR for lymphoma: 3.28 (95% CI: 2.92-3.68)), leukemias (SMR for leukemia: 3.32 (95% CI: 2.89-3.80)) and myeloma (SMR for myeloma: 3.91 (95% CI: 3.28-4.63)).Conclusions: Cancer patients are more likely to have influenza/ pneumonia-attributed death compared to the general US population. This risk is higher among patients with lung cancer, head and neck cancer, and hematological malignancies.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
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14
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Alimam S, Ann Timms J, Harrison CN, Dillon R, Mare T, DeLavallade H, Radia D, Woodley C, Francis Y, Sanchez K, Kordasti S, McLornan DP. Altered immune response to the annual influenza A vaccine in patients with myeloproliferative neoplasms. Br J Haematol 2020; 193:150-154. [PMID: 33159465 DOI: 10.1111/bjh.17096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022]
Abstract
The seasonal influenza A vaccine is recommended for patients with myeloproliferative neoplasms (MPNs). We hypothesised that immune deregulation associated with MPNs may affect the immune response gained following vaccinations when compared to healthy controls. Using deep immunophenotyping with high-dimensional single-cell analysis and mass cytometry we could demonstrate an altered immune response in MPN patients following vaccination. We found that prior to vaccination, MPN patients had reduced numbers of naive CD4 T cells. Furthermore, at 3-weeks and 3-months post-vaccination there was evidence of both delayed and impaired B- and T-memory cells responses. Thus, although, the immune systems of MPN patients can 'recognise' the Influenza A vaccine, the response appears inferior compared to healthy controls.
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Affiliation(s)
- Samah Alimam
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Medical and Molecular Genetics, King's College, London, UK
| | - Jessica Ann Timms
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Richard Dillon
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Medical and Molecular Genetics, King's College, London, UK
| | - Tracey Mare
- Viapath, Department of Specialist Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Hugues DeLavallade
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Haematological Medicine, King's College Hospital, London, UK
| | - Deepti Radia
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Claire Woodley
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Yvonne Francis
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Katy Sanchez
- Haematological Medicine, King's College Hospital, London, UK.,Viapath, King's College Hospital, London, UK
| | - Shahram Kordasti
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - Donal P McLornan
- Department of Haematology, Guy's and St Thomas NHS Foundation Trust, London, UK.,Systems Cancer Immunology, Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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15
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Joona TB, Digkas E, Wennstig AK, Nyström K, Nearchou A, Nilsson C, Pauksens K, Valachis A. Influenza vaccination in breast cancer patients during subcutaneous trastuzumab in adjuvant setting. Breast Cancer Res Treat 2020; 184:45-52. [PMID: 32737713 PMCID: PMC7568724 DOI: 10.1007/s10549-020-05815-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/17/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite the current recommendation for influenza vaccination in cancer patients with active oncological therapy, limited data are available on the efficacy of vaccination in cancer patients receiving targeted therapies. We aimed to investigate the immunogenicity and tolerability of influenza vaccination in breast cancer patients treated with trastuzumab in adjuvant setting. METHODS A prospective open-label multicenter study was performed including patients with breast cancer during trastuzumab treatment in adjuvant setting and healthy controls. Blood samples were taken before, 4 weeks after, and 12 weeks after a single dose of trivalent influenza vaccine containing inactivated A/California/7/2009 (H1N1) pdm09, A/Hongkong4801/2014 (H3N2), and B/Brisbane/60/2008. Levels of serum antibody titers to hemagglutinin for H1N1 and influenza B strains were measured. RESULTS Twenty breast cancer patients and 37 controls were included in the study. No difference in seroprotection rate between trastuzumab-treated patients and controls was observed for either H1N1 (100% in both groups) or B strain (78.9% vs. 89.2%, p value = 0.423). A statistically significant increase in geometric mean titers from baseline was seen in both groups and was evident both 4 weeks and 12 weeks after vaccination. Adverse events in the trastuzumab-treated group were uncommon and mild with only one serious adverse event not related to vaccination. CONCLUSION Breast cancer patients treated with trastuzumab in adjuvant setting seem to benefit from influenza vaccination in terms of immunogenicity without increasing the risk for adverse events. The current data support the recommendation to offer influenza vaccination in breast cancer patients treated with this type of targeted therapy.
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Affiliation(s)
| | | | | | - Karin Nyström
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182, Örebro, SE, Sweden
| | | | - Cecilia Nilsson
- Department of Oncology, Västerås Central Hospital, Västerås, Sweden
| | - Karlis Pauksens
- Department of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, 70182, Örebro, SE, Sweden.
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16
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Ayoola A, Sukumaran S, Jain K, Kumar R, Gordon D, Honda-Okubo Y, Quinn S, Roy A, Vatandoust S, Koczwara B, Kichenadasse G, Richards A, Mead K, Karapetis C. Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study. Support Care Cancer 2020; 28:5411-5417. [PMID: 32144585 DOI: 10.1007/s00520-020-05384-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy). METHODS A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks. Primary endpoint: seroconversion rate (SCR) at 3 weeks. Secondary endpoints: late SCR at 6 weeks. rate of sustained sero-protection titres (SPR) at 24 weeks. Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40. RESULTS The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks. The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively. CONCLUSIONS Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.
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Affiliation(s)
- A Ayoola
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia.
| | - S Sukumaran
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - K Jain
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - R Kumar
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - D Gordon
- Department of Microbiology and Infectious Diseases, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - Y Honda-Okubo
- Department of Endocrinology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - S Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, 3122, Australia
| | - A Roy
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - S Vatandoust
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - B Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - G Kichenadasse
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
| | - A Richards
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - K Mead
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
| | - C Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Adelaide, 5042, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Adelaide, 5042, Australia
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17
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Okoli GN, Lam OLT, Abdulwahid T, Neilson CJ, Mahmud SM, Abou-Setta AM. Seasonal influenza vaccination among cancer patients: A systematic review and meta-analysis of the determinants. Curr Probl Cancer 2020; 45:100646. [PMID: 32917396 DOI: 10.1016/j.currproblcancer.2020.100646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
Cancer patients are among high-risk individuals for whom seasonal influenza vaccine (SIV) is recommended, but rates of vaccination in this subpopulation remain suboptimal; even in jurisdictions with universal influenza vaccination programs. We sought to summarize the evidence to better understand the determinants of SIV uptake (vaccine receipt) among cancer patients. We searched MEDLINE, Embase, and CINAHL from 2000 to February 12, 2020, focusing on articles on the determinants of seasonal influenza vaccination among cancer patients, published in English. Study selection was conducted independently by 2 reviewers. One reviewer extracted data from the included studies and another reviewer checked the extracted data for errors. Outcomes were sociodemographic and health-related factors. We pooled adjusted results from studies using the inverse variance, random-effects method, and reported the odds ratios (OR) and their 95% confidence intervals (CI). Out of 2664 citations, 10 studies (mostly from USA and South Korea) met our eligibility criteria. Overall, being older (OR 2.23, 95% CI 1.46-3.38; I2 92.3%, [6 studies]), a nonsmoker (1.43, 1.32-1.51; I2 0%, [4 studies]), having a chronic illness (1.18, 1.07-1.29; I2 15.7%, [5 studies]), having had a medical check-up in the past year (1.75, 1.65-1.86; I2 0%, [2 studies]), and having health insurance (1.39, 1.13-1.72; I2 21.8%, [3 studies]) were associated with increased SIV uptake. Compared with being African-American, being Caucasian was also associated with increased SIV uptake (1.79, 1.47-2.13; I2 10.7%, [3 studies]). Limited evidence suggests seasonal influenza vaccination among cancer patients may be determined by some sociodemographic and health-related factors.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, MB, Canada; George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada.
| | - Otto L T Lam
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada
| | - Tiba Abdulwahid
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada
| | - Christine J Neilson
- Neil John Maclean Health Sciences Library, University of Manitoba, MB, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, MB, Canada; Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada; Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada
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18
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Ludwig H, Boccadoro M, Moreau P, San-Miguel J, Cavo M, Pawlyn C, Zweegman S, Facon T, Driessen C, Hajek R, Dimopoulos MA, Gay F, Avet-Loiseau H, Terpos E, Zojer N, Mohty M, Mateos MV, Einsele H, Delforge M, Caers J, Weisel K, Jackson G, Garderet L, Engelhardt M, van de Donk N, Leleu X, Goldschmidt H, Beksac M, Nijhof I, Abildgaard N, Bringhen S, Sonneveld P. Recommendations for vaccination in multiple myeloma: a consensus of the European Myeloma Network. Leukemia 2020; 35:31-44. [PMID: 32814840 PMCID: PMC7787974 DOI: 10.1038/s41375-020-01016-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022]
Abstract
Vaccination is one of the most successful medical interventions that has saved the life of millions of people. Vaccination is particularly important in patients with multiple myeloma, who have an increased risk of infections due to the disease-inherent immune suppression, and because of the immune suppressive effects of therapy. Hence, all appropriate measures should be exploited, to elicit an effective immune response to common pathogens like influenza, pneumococci, varicella zoster virus, and to those bacteria and viruses (haemophilus influenzae, meningococci, and hepatitis) that frequently may pose a significant risk to patients with multiple myeloma. Patients after autologous, and specifically after allogeneic transplantation have severely reduced antibody titers, and therefore require a broader spectrum of vaccinations. Response to vaccination in myeloma often is less vigorous than in the general population, mandating either measurement of the postvaccination antibody titers and/or repeating the vaccination. Here, we compile the existing data on vaccination in multiple myeloma and provide recommendations for clinical practice.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, c/o 1st Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Vienna, Austria.
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Philippe Moreau
- Service hematologie et thérapie cellulaire, PRC. cic 1402 Inserm, CHU poitiers, Poitiers, France
| | - Jesus San-Miguel
- CIMA, IDISNA, CIBERONC, Clínica Universidad de Navarra, Pamplona, Spain
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Thierry Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - Christoph Driessen
- Department of Medical Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Melitios A Dimopoulos
- Hematology & Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Evangelos Terpos
- Hematology & Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Niklas Zojer
- 1st Department of Medicine, Center for Hematology, Oncology, and Palliatic Care, Clinic Ottakring, Vienna, Austria
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Hospital Saint-Antoine, Sorbonne University, Paris, France
| | | | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Jo Caers
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
| | - Katja Weisel
- II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Graham Jackson
- NCCC, Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, UK
| | - Laurent Garderet
- INSERM, UMR_S 938, Centre de Recherche Saint-Antoine-Team Proliferation and Differentiation of Stem Cells, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Service d'Hématologie, Sorbonne Université, Paris, France
| | - Monika Engelhardt
- Interdisciplinary Tumor Center, Faculty of Freiburg, University of Freiburg, Freiburg, Germany
| | - Niels van de Donk
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Inger Nijhof
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pieter Sonneveld
- Erasmus MC Cancer Institute, Erasmus University of Rotterdam, Rotterdam, The Netherlands
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19
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Pophali PA, Larson MC, Allmer C, Farooq U, Link BK, Maurer MJ, Cerhan JR, Thompson CA. Compliance with cancer screening and influenza vaccination guidelines in non-Hodgkin lymphoma survivors. J Cancer Surviv 2020; 14:316-321. [PMID: 31897876 PMCID: PMC7261247 DOI: 10.1007/s11764-019-00846-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/06/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Compliance with US Preventive Services Task Force (USPSTF) age-appropriate cancer screening and immunization guidelines in lymphoma survivors is not known. We sought to measure compliance in non-Hodgkin lymphoma (NHL) survivors and identify any differences based on patient, disease, and treatment characteristics. METHODS Eligible NHL survivors were identified from the Molecular Epidemiology Resource (MER) prospective cohort study. Survivors self-reported colorectal, breast, and prostate cancer screening and influenza immunization in a questionnaire 3 years post-diagnosis (FU3). The USPSTF guidelines were used to define compliance. Chi-square tests were used to compare characteristics of compliant versus non-compliant survivors. RESULTS A total of 1833 MER participants from 2005 to 2012 completed a FU3. Rates of breast and prostate cancer screening were 96% and 72%, respectively. No differences in compliance based on patient or disease characteristics or treatment were observed. Ninety-two percent of survivors were compliant with colorectal cancer screening. Older age, indolent lymphoma histology, and 2008-2012 year of diagnosis were associated with higher compliance. Eighty-two percent of survivors were compliant with influenza vaccination and older age was associated with higher compliance. CONCLUSION NHL survivors have high compliance with USPSTF recommendations for cancer screening and immunization. Survivors who are younger or have aggressive lymphomas are less likely to meet the colorectal cancer screening guidelines. Older survivors are more likely to receive influenza vaccination. IMPLICATIONS FOR CANCER SURVIVORS Measures to further improve preventive care for NHL survivors, especially those younger in age, are necessary.
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Affiliation(s)
- Priyanka A Pophali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Melissa C Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IA, 52242, USA
| | - Brian K Link
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IA, 52242, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Carrie A Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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20
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Influenza vaccination in caregivers of childhood cancer survivors. J Cancer Surviv 2019; 13:993-1001. [DOI: 10.1007/s11764-019-00825-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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21
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Blanchette PS, Chung H, Pritchard KI, Earle CC, Campitelli MA, Buchan SA, Schwartz KL, Crowcroft NS, Gubbay JB, Karnauchow T, Katz K, McGeer AJ, McNally JD, Richardson DC, Richardson SE, Rosella LC, Simor A, Smieja M, Zahariadis G, Campigotto A, Kwong JC. Influenza Vaccine Effectiveness Among Patients With Cancer: A Population-Based Study Using Health Administrative and Laboratory Testing Data From Ontario, Canada. J Clin Oncol 2019; 37:2795-2804. [PMID: 31465264 DOI: 10.1200/jco.19.00354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Seasonal influenza vaccination is recommended for patients with cancer despite concerns of disease or treatment-associated immunosuppression. The objective of this study was to evaluate vaccine effectiveness (VE) against laboratory-confirmed influenza for patients with cancer. PATIENTS AND METHODS We conducted an observational test-negative design study of previously diagnosed patients with cancer 18 years of age and older who underwent influenza testing during the 2010-2011 to 2015-2016 influenza seasons in Ontario, Canada. We linked individual-level cancer registry, respiratory virus testing, and health administrative data to identify the study population and outcomes. Vaccination status was determined from physician and pharmacist billing claims. We used multivariable logistic regression to estimate VE, adjusting for age, sex, rurality, income quintile, cancer characteristics, chemotherapy exposure, comorbidities, previous health care use, influenza season, and calendar time. RESULTS We identified 26,463 patients with cancer who underwent influenza testing, with 4,320 test-positive cases (16%) and 11,783 (45%) vaccinated. Mean age was 70 years, 52% were male, mean time since diagnosis was 6 years, 69% had solid tumor malignancies, and 23% received active chemotherapy. VE against laboratory-confirmed influenza was 21% (95% CI, 15% to 26%), and VE against laboratory-confirmed influenza hospitalization was 20% (95% CI, 13% to 26%). For patients with solid tumor malignancies, VE was 25% (95% CI, 18% to 31%), compared with 8% (95% CI, -5% to 19%) for patients with hematologic malignancies (P = .015). Active chemotherapy usage did not significantly affect VE, especially among patients with solid tumor cancer. CONCLUSION Our results support recommendations for influenza vaccination for patients with cancer. VE was decreased for patients with hematologic malignancies, and there was no significant difference in VE among patients with solid tumor cancer receiving active chemotherapy. Strategies to optimize influenza prevention among patients with cancer are warranted.
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Affiliation(s)
- Phillip S Blanchette
- University of Western Ontario, London, Ontario, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.,ICES London and Toronto, Ontario, Canada
| | | | | | - Craig C Earle
- ICES London and Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Sarah A Buchan
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kevin L Schwartz
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy Karnauchow
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Katz
- University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Allison J McGeer
- University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Ontario, Canada
| | - James D McNally
- Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Susan E Richardson
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | | | | | - Aaron Campigotto
- University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES London and Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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22
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Ryan AL, Kerr F, Gough H, Carter TL, Kotecha RS. Vaccine-preventable disease following allogeneic haematopoietic stem cell transplant in Western Australia. J Paediatr Child Health 2019; 55:343-348. [PMID: 30184291 DOI: 10.1111/jpc.14204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
AIM Infection is an important and frequent cause of mortality and morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). This study was conducted to determine the epidemiology and clinical phenotype of vaccine-preventable disease in children who have undergone HSCT following the implementation of a standard revaccination programme. METHODS Children receiving first allogeneic HSCT in Western Australia between January 2005 and December 2014 were eligible for recruitment. Patients received standard antimicrobial prophylaxis and were vaccinated according to the West Australian post-HSCT immunisation schedule, commencing 6 months following HSCT. Children who developed any illness post-HSCT were reviewed, and investigations for infectious disease were undertaken as clinically indicated. Positive identification of vaccine-preventable disease was documented with the clinical course of the illness. RESULTS A total of 71 patients were enrolled in the study. The overall incidence of vaccine-preventable disease following HSCT was 19.7%; influenza accounted for 50% of all cases, herpes zoster for 42.9%. All episodes occurred late, beyond day 100 post-HSCT. Overall survival for matched-sibling donor transplants was 83.3 and 75.0% at 1 and 5 years, respectively, and was 72.3 and 63.3% for alternative donor transplants. Mortality due to vaccine-preventable disease was low, with one death from disseminated herpes zoster. CONCLUSIONS There is a high incidence of vaccine-preventable morbidity post-allogeneic HSCT in West Australian children. Viral aetiology constitutes the main burden, namely, influenza infection and varicella zoster virus reactivation. Further efforts are required to identify the most appropriate preventative strategies.
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Affiliation(s)
- Anne L Ryan
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Fiona Kerr
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Hazel Gough
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Tina L Carter
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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23
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Abstract
BACKGROUND Influenza leads to significant morbidity and mortality in patients with cancer. Patients with cancer receiving chemotherapy may not mount an adequate immune response to the vaccine. We performed this pilot study to evaluate the immunogenicity of influenza vaccination in patients with cancer receiving chemotherapy. MATERIALS AND METHODS During the 2011 to 2012 influenza season, patients undergoing chemotherapy for solid tumors were given trivalent inactivated influenza vaccine either on the day of chemotherapy (schedule A) or a week before chemotherapy (schedule B) by a single 0.5 mL injection in the deltoid muscle region. This was not a randomized trial. Hemagglutination inhibition assays were performed on blood samples from these patients taken at baseline, and 4 weeks postvaccination. Seroconversion rate (>4-fold increase in titers) and seroprotection rates (postvaccination titers of >1:40) were calculated for each vaccine component: influenza A (H1N1), A (H3N2) and B. RESULTS A total of 18 patients received influenza vaccination as part of this pilot study. Of these, 8 patients received the vaccine on schedule A and 10 patients received the vaccine on schedule B. Geometric mean titers against each strain significantly improved after vaccination for both groups, as measured by signed rank test. Seroconversion to at least 1 strain was observed in 75% of patients on schedule A, and 70% of patients vaccinated on schedule B. Seroprotection to at least 1 strain was observed in 100% of patients in the schedule A group, and 60% of patients vaccinated on schedule B. Seroconversion and seroprotection rates against the 3 influenza strains were not significantly different between the 2 groups. CONCLUSIONS Patients with nonhematological malignancies who are receiving chemotherapy mount an immune response to influenza vaccination. Timing of influenza vaccination in relation to chemotherapy does not seem to matter.
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24
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Olshefski RS, Bibart M, Frost R, Wood E, Hampl J, Mangum R, Ardura M, Guinipero T, Cripe TP. A multiyear quality improvement project to increase influenza vaccination in a pediatric oncology population undergoing active therapy. Pediatr Blood Cancer 2018; 65:e27268. [PMID: 29856533 DOI: 10.1002/pbc.27268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND In an effort to reduce morbidity and mortality from vaccine preventable influenza infection, national consensus guidelines recommend vaccination of patients who are immunocompromised as a result of receiving cancer therapy. Quality improvement (QI) processes are a proven method used to improve vaccination rates. PROCEDURE We conducted a QI initiative aimed at increasing influenza vaccination in oncology patients undergoing active treatment. Primary drivers for the project focused on patient education, staff and provider education, and communication regarding vaccine-eligible patients. We performed a retrospective analysis of influenza infection among the vaccine-eligible population. This approach has validity at our institution because of the consistent follow-up and hospital admission pattern of cancer patients on active therapy such that nearly all follow-up care is delivered at our institution. RESULTS We successfully achieved greater than 87% vaccination of eligible patients each vaccine season (September to March). During the recommended timeframe for delivering influenza vaccine between September and December of each vaccine season, we offered the vaccine to 100% of patients on active therapy and vaccinated >90%. Barriers to success, including vaccine refusals, increased late in the vaccine season. Influenza infection was documented in 0.5-7.3% of the vaccine-eligible group. CONCLUSION A robust influenza vaccination program implemented using a standardized QI approach can sustain a high vaccination rate in a pediatric oncology population receiving active treatment. The influenza infection rate was under 10% in the vaccinated group.
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Affiliation(s)
- Randal S Olshefski
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mindy Bibart
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Randall Frost
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio
| | - Eric Wood
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio
| | - Joshua Hampl
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio
| | - Ross Mangum
- Pediatric Residency Program, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Monica Ardura
- Division of Infectious Diseases, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Terri Guinipero
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timothy P Cripe
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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25
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Doganis D, Kafasi A, Dana H, Spanakis N, Baka M, Pourtsidis A, Sdogou T, Vintila A, Rafailidou V, Chantzi P, Servitzoglou M, Bouhoutsou D, Varvoutsi M, Kosmidis H, Tsolia M. Immune response to influenza vaccination in children with cancer. Hum Vaccin Immunother 2018; 14:2310-2317. [PMID: 29708816 DOI: 10.1080/21645515.2018.1470734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The aim of this study was to evaluate the ability of influenza immunization to evoke a protective immune response among children with cancer. We evaluated 75 children with cancer who received influenza vaccination. Hemagglutination Inhibition Antibody titers were determined before and after vaccination. The protective rates after vaccination were 79% for H1N1, 75% for H3N2 and 59% for influenza B virus whereas the seroconversion rates were 54%, 44% and 43% respectively. The differences pre- and post-vaccination were significant regardless the method which was used: seroprotection changes, seroconversion and geometric mean titers analyses. Variables such as the pre-vaccination antibody titers, the time when the responses were measured after the vaccination, the age and the type of malignancy as well as the absolute lymphocyte count were found to be correlated with the immune response but the findings were different for each vaccine subunit. In conclusion, influenza vaccination provides protection in a remarkable proportion of pediatric cancer patients whereas this protection is more obvious against H1N1 and H3N2 compared to influenza B. The immune response after vaccination is significant and seems to be influenced by a variety of factors.
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Affiliation(s)
- Dimitrios Doganis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Athanasia Kafasi
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Helen Dana
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Nikolaos Spanakis
- b Department of Microbiology , National and Kapodistrian University of Athens (NKUA), School of Medicine , Athens , Greece
| | - Margarita Baka
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | | | - Triantafyllia Sdogou
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Artemis Vintila
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
| | - Vaia Rafailidou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Panagiota Chantzi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Marina Servitzoglou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Despina Bouhoutsou
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Varvoutsi
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Helen Kosmidis
- a Oncology Department , P & A Kyriakou Children's Hospital , Athens , Greece
| | - Maria Tsolia
- c Second Department of Paediatrics , National and Kapodistrian University of Athens (NKUA), School of Medicine, P. and A. Kyriakou Children's hospital , Athens , Greece
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26
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Abstract
Infection is a major complication of patients with hematological malignancies. Prophylaxis is a key element in the management of these patients, and is composed by two main components: infection control measures and antimicrobial chemoprophylaxis. Infection control measures are safe, but not always effective. Antimicrobial prophylaxis is usually effective but may increase resistance rates, toxicity, and cost. Therefore, a careful evaluation of the actual risk for infection, the pathogens that predominate in a particular setting, and the periods at risk are important in order to define the most appropriate strategy. In this chapter we review the most important parameters to assess the risk on an individual basis, and the evidences and recommendations supporting infection control measures and antimicrobial prophylaxis against bacteria, fungi, viruses, and parasites.
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27
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Grivas PD, Devata S, Khoriaty R, Boonstra PS, Ruch J, McDonnell K, Hernandez-Aya L, Wilfong J, Smerage J, Ison MG, Eisenberg JNS, Silveira M, Cooney KA, Worden FP. Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:871-877. [PMID: 27055536 DOI: 10.1007/s13187-016-1017-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011-2012) and 9.4 % (2012-2013) compared to an average 6.9 % during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35-40.3 %) and 56.1 % (95 % CI 40.9-73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.
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Affiliation(s)
- Petros D Grivas
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Sumana Devata
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Rami Khoriaty
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Ruch
- Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA
| | - Kevin McDonnell
- Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA
| | - Leonel Hernandez-Aya
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Wilfong
- Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA
| | - Jeffrey Smerage
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Maria Silveira
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A Cooney
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Francis P Worden
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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28
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Abstract
Annual administration of the seasonal influenza vaccine is strongly recommended to reduce the burden of disease, particularly for persons at the highest risk for the viral infection. Even during years when there is a good match between the vaccine and circulating strains, host-related factors such as age, preexisting immunity, genetic polymorphisms, and the presence of chronic underlying conditions may compromise influenza vaccine responsiveness. The application of new methodologies and large-scale profiling technologies are improving the ability to measure vaccine immunogenicity and our understanding of the immune mechanisms by which vaccines induce protective immunity. This review attempts to summarize the general concepts of how host factors can contribute to the heterogeneity of immune responses induced by influenza vaccines.
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Affiliation(s)
- Maria R Castrucci
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
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29
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Criado I, Muñoz-Criado S, Rodríguez-Caballero A, Nieto WG, Romero A, Fernández-Navarro P, Alcoceba M, Contreras T, González M, Orfao A, Almeida J. Host virus and pneumococcus-specific immune responses in high-count monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia: implications for disease progression. Haematologica 2017; 102:1238-1246. [PMID: 28385786 PMCID: PMC5566034 DOI: 10.3324/haematol.2016.159012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/05/2017] [Indexed: 11/29/2022] Open
Abstract
Patients diagnosed with chronic lymphocytic leukemia (CLL) display a high incidence of infections due to an associated immunodeficiency that includes hypogammaglobulinemia. A higher risk of infections has also been recently reported for high-count monoclonal B-cell lymphocytosis, while no information is available in low-count monoclonal B-cell lymphocytosis. Here, we evaluated the status of the humoral immune system in patients with chronic lymphocytic leukemia (n=58), as well as in low- (n=71) and high- (n=29) count monoclonal B-cell lymphocytosis versus healthy donors (n=91). Total free plasma immunoglobulin titers and specific levels of antibodies against cytomegalovirus, Epstein-Barr virus, influenza and S.pneumoniae were measured by nephelometry and ELISA-based techniques, respectively. Overall, our results show that both CLL and high-count monoclonal B-cell lymphocytosis patients, but not low-count monoclonal B-cell lymphocytosis subjects, present with relatively high levels of antibodies specific for the latent viruses investigated, associated with progressively lower levels of S.pneumoniae-specific immunoglobulins. These findings probably reflect asymptomatic chronic reactivation of humoral immune responses against host viruses associated with expanded virus-specific antibody levels and progressively decreased protection against other micro-organisms, denoting a severe humoral immunodeficiency state not reflected by the overall plasma immunoglobulin levels. Alternatively, these results could reflect a potential role of ubiquitous viruses in the pathogenesis of the disease. Further analyses are necessary to establish the relevance of such asymptomatic humoral immune responses against host viruses in the expansion of the tumor B-cell clone and progression from monoclonal B-cell lymphocytosis to CLL.
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Affiliation(s)
- Ignacio Criado
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca and IBSAL, Salamanca, Spain
| | | | - Arancha Rodríguez-Caballero
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca and IBSAL, Salamanca, Spain
| | - Wendy G Nieto
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca and IBSAL, Salamanca, Spain
| | - Alfonso Romero
- Gerencia de Atención Primaria de Salud, Centro de Atención Primaria de Salud Miguel Armijo, Salamanca, Sanidad de Castilla y León (SACYL), Spain
| | - Paulino Fernández-Navarro
- Centro de Atención Primaria de Salud de Ledesma, Salamanca, Sanidad de Castilla y León (SACYL), Spain
| | - Miguel Alcoceba
- Hematology Service, University Hospital of Salamanca, IBMCC, IBSAL and Department of Medicine, University of Salamanca, Spain
| | | | - Marcos González
- Hematology Service, University Hospital of Salamanca, IBMCC, IBSAL and Department of Medicine, University of Salamanca, Spain
| | - Alberto Orfao
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca and IBSAL, Salamanca, Spain.
| | - Julia Almeida
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca and IBSAL, Salamanca, Spain
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30
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Influenza vaccination in adult patients with solid tumours treated with chemotherapy. Eur J Cancer 2017; 76:134-143. [PMID: 28324748 DOI: 10.1016/j.ejca.2017.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 01/04/2023]
Abstract
Patients with solid tumours receiving chemotherapy are at risk for influenza complications. Yearly influenza vaccination is recommended to patients treated with chemotherapy. However, adherence to vaccination is low, most likely due to lack of data on efficacy, optimal timing and safety of vaccination. There is scarce evidence for the effectiveness of the influenza vaccine in adult patients with solid tumours and chemotherapy on reduction of pneumonia, decreased mortality and fewer interruptions of oncological treatment. A review of 20 non-randomised serological studies in adult patients with different cancer types and chemotherapy provides insight in general trends of response to vaccination. Overall, the magnitude of the antibody response after influenza vaccination (i.e. seroconversion) can be lower than in healthy controls, but the majority of patients with solid tumours is able to mount a timely, protective immunological response (i.e. seroprotection) regardless of chemotherapy schedule, similar to healthy controls. Small sample sizes, patient heterogeneity and lack of comparable study designs limit more specific recommendations related to cancer type and optimal timing of vaccination. The inactivated influenza vaccine is safe to administer to immunosuppressed patients; side-effects are similar to those in healthy individuals. Although vaccination before start of chemotherapy is preferred to ensure optimal protection in adults with solid tumours, also vaccination during chemotherapy can reduce influenza-related complications considering the overall trends in serological response. Given the increased morbidity and mortality of influenza, influenza vaccination should be advocated as an inexpensive and safe preventive measure in patients with solid tumours receiving chemotherapy.
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31
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Wumkes ML, van der Velden AMT, de Bruin E, Meerveld-Eggink A, Koopmans MPG, Rimmelzwaan GF, Rijkers GT, Biesma DH. Microarray profile of the humoral immune response to influenza vaccination in breast cancer patients treated with chemotherapy. Vaccine 2017; 35:1299-1305. [PMID: 28169075 DOI: 10.1016/j.vaccine.2017.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients treated with chemotherapy have an impaired response to influenza virus vaccination compared to healthy controls. Little is known about the broadness of the antibody response in these patients. METHODS Breast cancer patients on FEC (5-fluorouracil, epirubicin and cyclophosphamide) chemotherapy regimens were vaccinated with influenza virus vaccine. Sera were obtained before and three weeks after vaccination. In addition to the determination of virus-specific antibody titres by hemagglutination inhibition assay, the broadness of the response was assessed by the use of a protein microarray and baseline titres were compared with an age-matched reference group. RESULTS We included 38 breast cancer patients and found a wide variety in serum antibody response after vaccination. Patients with a history of influenza vaccination had higher pre-vaccination titres, which were comparable to the reference group. Increasing number of cycles of chemotherapy did not have a negative effect on influenza array antibody levels, nor on the HI antibody response. CONCLUSIONS Overall there was a broad serum antibody response to the influenza virus vaccine in patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- M L Wumkes
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands; Department of Internal Medicine, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - A M T van der Velden
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands.
| | - E de Bruin
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - A Meerveld-Eggink
- Department of Medical Oncology, Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, The Netherlands; Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
| | - M P G Koopmans
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G F Rimmelzwaan
- Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G T Rijkers
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Science Department, University College Roosevelt, PO Box 94, 4330 AB Middelburg, The Netherlands.
| | - D H Biesma
- Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Influenza Vaccination Coverage Among Polish Patients with Chronic Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 968:19-34. [PMID: 28315129 DOI: 10.1007/5584_2016_193] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients at a high-risk of severe influenza, because of their underlying health disorders, are recommended to receive a seasonal influenza vaccination. In Poland, influenza coverage rate in the general population is very low (3.4 %). However, there is little known about the coverage rate among high-risk patients. The aim of this study was to describe a general knowledge, perception, and influenza vaccination coverage rate among Polish patients with enhanced risk for influenza. We conducted a self-reported survey among 500 patients with chronic disorders: 120 pulmonary, 80 hemodialyzed, 100 thyroid cancer, and 200 cardiovascular patients. We found the following influenza vaccination coverage in the respective groups of patients: 58 % in pulmonary, 34 % in hemodialyzed, 32 % in cardiovascular, and 9 % in thyroid cancer patients. The difference between the coverage rate in pulmonary patients compared with the other risk groups was significant (p < 0.05). In pulmonary patients, the most important barrier for influenza vaccination was a lack of recommendations from healthcare workers, while a high awareness of influenza was the most powerful driver for vaccination (p < 0.05). We conclude that although the influenza vaccination coverage in Polish patients with chronic diseases is higher than that reported in the general population, this rate remains much below the recommended level and should be improved.
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Keam B, Kim MK, Choi Y, Choi SJ, Choe PG, Lee KH, Kim TM, Kim TY, Oh DY, Kim DW, Im SA, Kim NJ, Heo DS, Park WB, Oh MD. Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles. Cancer 2016; 123:841-848. [DOI: 10.1002/cncr.30468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Bhumsuk Keam
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Min-Kyung Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Yunhee Choi
- Medical Research Collaborating Center; Seoul National University Hospital; Seoul Republic of Korea
| | - Su-Jin Choi
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Do-Youn Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Nam-Joong Kim
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
| | - Myoung-don Oh
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Republic of Korea
- Laboratory of Infection and Immunity, Biomedical Research Institute; Seoul National University Hospital; Seoul Republic of Korea
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Dulek DE, Halasa NB. Timing isn't everything: Influenza vaccination in cancer patients. Cancer 2016; 123:731-733. [DOI: 10.1002/cncr.30467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel E. Dulek
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
| | - Natasha B. Halasa
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville Tennessee
- Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee
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Choi DK, Fuleihan RL, Walterhouse DO. Serologic response and clinical efficacy of influenza vaccination in children and young adults on chemotherapy for cancer. Pediatr Blood Cancer 2016; 63:2011-8. [PMID: 27327360 DOI: 10.1002/pbc.26110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm(3) has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. PROCEDURE We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). RESULTS Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62% (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm(3) versus 602 cells/mm(3) , respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm(3) at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95% CI: 1.1-5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26% (8/31) required hospitalization, and 81% (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. CONCLUSIONS Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.
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Affiliation(s)
- Daniel K Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
| | - Ramsay L Fuleihan
- Division of Allergy/Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David O Walterhouse
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sánchez-Ramón S, Dhalla F, Chapel H. Challenges in the Role of Gammaglobulin Replacement Therapy and Vaccination Strategies for Hematological Malignancy. Front Immunol 2016; 7:317. [PMID: 27597852 PMCID: PMC4993076 DOI: 10.3389/fimmu.2016.00317] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/05/2016] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are prone to present with antibody production deficits associated with recurrent or severe bacterial infections that might benefit from human immunoglobulin (Ig) (IVIg/SCIg) replacement therapy. However, the original IVIg trial data were done before modern therapies were available, and the current indications do not take into account the shift in the immune situation of current treatment combinations and changes in the spectrum of infections. Besides, patients affected by other B cell malignancies present with similar immunodeficiency and manifestations while they are not covered by the current IVIg indications. A potential beneficial strategy could be to vaccinate patients at monoclonal B lymphocytosis and monoclonal gammopathy of undetermined significance stages (for CLL and MM, respectively) or at B-cell malignancy diagnosis, when better antibody responses are attained. We have to re-emphasize the need for assessing and monitoring specific antibody responses; these are warranted to select adequately those patients for whom early intervention with prophylactic anti-infective therapy and/or IVIg is preferred. This review provides an overview of the current scenario, with a focus on prevention of infection in patients with hematological malignancies and the role of Ig replacement therapy.
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Affiliation(s)
- Silvia Sánchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Microbiology I, Complutense University School of Medicine, Madrid, Spain
| | - Fatima Dhalla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Clinical Immunology, John Radcliffe Hospital, Headington, Oxford, UK
| | - Helen Chapel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Clinical Immunology, John Radcliffe Hospital, Headington, Oxford, UK
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Sanada Y, Yakushijin K, Nomura T, Chayahara N, Toyoda M, Minami Y, Kiyota N, Mukohara T, Kawamoto S, Ito M, Matsuoka H, Minami H. A prospective study on the efficacy of two-dose influenza vaccinations in cancer patients receiving chemotherapy. Jpn J Clin Oncol 2016; 46:448-52. [DOI: 10.1093/jjco/hyw020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/03/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yukinari Sanada
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Kimikazu Yakushijin
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Tetsuhiko Nomura
- Hyogo Prefectural AWAJI Medical Center, Sumoto City, Hyogo Prefecture
| | - Naoko Chayahara
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Masanori Toyoda
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Yosuke Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Naomi Kiyota
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Toru Mukohara
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Shinichiro Kawamoto
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Mitsuhiro Ito
- Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe City, Hyogo Prefecture, Japan
| | - Hiroshi Matsuoka
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe City, Hyogo Prefecture
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Prinsen H, van Laarhoven HWM, Pots JM, Duiveman-de Boer T, Mulder SF, van Herpen CML, Jacobs JFM, Leer JWH, Bleijenberg G, Stelma FF, Torensma R, de Vries IJM. Humoral and cellular immune responses after influenza vaccination in patients with postcancer fatigue. Hum Vaccin Immunother 2016; 11:1634-40. [PMID: 25996472 PMCID: PMC4514289 DOI: 10.1080/21645515.2015.1040207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to compare humoral and cellular immune responses to influenza vaccination in cancer survivors with and without severe symptoms of fatigue. Severely fatigued (n = 15) and non-fatigued (n = 12) disease-free cancer survivors were vaccinated against seasonal influenza. Humoral immunity was evaluated at baseline and post-vaccination by a hemagglutination inhibition assay. Cellular immunity was evaluated at baseline and post-vaccination by lymphocyte proliferation and activation assays. Regulatory T cells were measured at baseline by flow cytometry and heat-shock protein 90 alpha levels by ELISA. Comparable humoral immune responses were observed in fatigued and non-fatigued patients, both pre- and post-vaccination. At baseline, fatigued patients showed a significantly diminished cellular proliferation upon virus stimulation with strain H3N2 (1414 ± 1201 counts), and a trend in a similar direction with strain H1N1 (3025 ± 2339 counts), compared to non-fatigued patients (3099 ± 2401 and 5877 ± 4604 counts, respectively). The percentage of regulatory T lymphocytes was significantly increased (4.4 ± 2.1% versus 2.4 ± 0.8%) and significantly lower amounts of interleukin 2 were detected prior to vaccination in fatigued compared to non-fatigued patients (36.3 ± 44.3 pg/ml vs. 94.0 ± 45.4 pg/ml with strain H3N2 and 28.4 ± 44.0 pg/ml versus 74.5 ± 56.1 pg/ml with strain H1N1). Pre-vaccination heat-shock protein 90 alpha concentrations, post-vaccination cellular proliferation, and post-vaccination cytokine concentrations did not differ between both groups. In conclusion, influenza vaccination is favorable for severely fatigued cancer survivors and should be recommended when indicated. However, compared to non-fatigued cancer survivors, fatigued cancer survivors showed several significant differences in immunological reactivity at baseline, which warrants further investigation.
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Key Words
- CBT, cognitive behavior therapy
- CIS-fatigue, Checklist Individual Strength fatigue subscale
- HI, hemagglutination-inhibition
- HSP90α, human heat shock protein 90 alpha
- IFN- γ, interferon gamma
- IL-10, interleukin 10
- IL-2, interleukin 2
- IL-4, interleukin 4
- IL-5, interleukin 5
- PBMC, peripheral blood mononuclear cells
- PHA, phytohemagglutinin
- Radboudumc, Radboud University Medical Center
- Treg, regulatory T lymphocytes
- cancer
- fatigue
- immunity
- influenza
- vaccination
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Affiliation(s)
- Hetty Prinsen
- a Department of Medical Oncology; Radboud University Medical Center ; Nijmegen , the Netherlands
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Toleman MS, Herbert K, McCarthy N, Church DN. Vaccination of chemotherapy patients--effect of guideline implementation. Support Care Cancer 2016; 24:2317-2321. [PMID: 26610767 DOI: 10.1007/s00520-015-3037-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Despite substantial morbidity and mortality of influenza and pneumococcal infections in cancer patients treated with chemotherapy, vaccination against both illnesses is infrequent. We evaluated the impact of implementation of clinical guidelines on vaccination of chemotherapy patients treated in our institute. METHODS We performed a prospective audit before (2012) and after (2013-2014) the introduction of immunisation guidelines for chemotherapy patients in a UK tertiary cancer centre. RESULTS Guideline implementation was associated with a significant increase in the rate of pneumococcal vaccination compared to the 2012 baseline (47 vs. 25 %, P = 0.0018), though this was not sustained the following year (34 %, P = 0.13, vs. baseline). Influenza vaccine coverage was high (∼ 70 %) throughout. There was a marked disparity between patients aged ≤ 65 and those >65 years in the rate of pneumococcal vaccination in both 2013 and 2014 (38 vs. 68 % and 17 vs. 53 %, respectively, both P < 0.001), and, to a lesser extent, in the rate of influenza vaccination in the same period (64 vs. 82 %, P < 0.1, and 63 vs. 85 %, P = 0.009, respectively). CONCLUSIONS The implementation of clinical vaccine guidelines was associated with a significant increase in pneumococcal vaccination, though continued effort appears required to deliver persistent improvement. Initiatives to increase vaccination uptake in patients aged ≤ 65 are merited.
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Affiliation(s)
- Michelle S Toleman
- Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Katharine Herbert
- Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Noel McCarthy
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - David N Church
- Oxford Cancer Centre, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford, OX3 7LE, UK.
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN, UK.
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Jamshed S, Walsh EE, Dimitroff LJ, Santelli JS, Falsey AR. Improved immunogenicity of high-dose influenza vaccine compared to standard-dose influenza vaccine in adult oncology patients younger than 65 years receiving chemotherapy: A pilot randomized clinical trial. Vaccine 2015; 34:630-635. [PMID: 26721330 DOI: 10.1016/j.vaccine.2015.12.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/18/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients undergoing chemotherapy often fail to develop robust responses to influenza vaccination. Compared to standard-dose influenza vaccine (SD), high-dose influenza vaccine (HD) has shown improved immunogenicity and protection against influenza illness in adults 65 years and older. This study compared the immunogenicity and tolerability of HD to SD in adults younger than 65 years of age receiving chemotherapy. METHODS This double-blind study randomized patients receiving chemotherapy to vaccination with either SD or HD influenza vaccine. Hemagglutination inhibition assays (HAI) were performed prior to and 4 weeks after vaccination. HAI were summarized as geometric mean titers (GMT), seroconversion rates, and seroprotection rates. RESULTS A total of 105 subjects were enrolled in the trial (51 received SD and 54 received HD). Subjects were well matched for demographic and medical conditions. Both vaccines were well tolerated with no SAEs. Of the 100 subjects with evaluable data, seroconversion rates for all 3 influenza antigens & post-vaccination GMTs for H3N2 & B strains were significantly improved with HD compared to SD. Seroprotection was excellent and equivalent in both groups. CONCLUSIONS Trivalent high-dose influenza vaccine can be safely administered to patients receiving chemotherapy with improved immunogenicity and seroconversion compared to standard-dose vaccine. Post-vaccination seroprotection rates were similar in both groups. A larger study is needed to show clinical benefits with HD in this population. This study was registered at ClinicalTrials.gov as NCT01666782.
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Affiliation(s)
- Saad Jamshed
- Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA.
| | - Edward E Walsh
- Department of Medicine University of Rochester School of Medicine and Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA.
| | - Lynda J Dimitroff
- Nazareth College, Department of Nursing, 4245 East Avenue, Rochester, NY 14618, USA.
| | | | - Ann R Falsey
- Department of Medicine University of Rochester School of Medicine and Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA.
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A Population-Based, Nationwide Cross-Sectional Study on Influenza Vaccination Status among Cancer Survivors in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10133-49. [PMID: 26308031 PMCID: PMC4555334 DOI: 10.3390/ijerph120810133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022]
Abstract
Cancer survivors are at increased risk of developing influenza-related complications. The purpose of this study was to investigate the vaccination coverage among cancer survivors in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES). Adult cancer survivors were selected from fourth (2007–2009) and fifth (2010–2012) KNHANES (n = 1156) datasets. General characteristics, cancer-related data, and influenza vaccination status were collected using self-report questionnaires. Chi-square tests and multiple logistic regression analyses were performed to investigate the association between influenza vaccination coverage and associated factors. Overall, 51% of survivors were vaccinated. Vaccine prevalence exceeded 75% in those more than 65 years but was only 26% in survivors aged 19–44. Increasing age, low frequency of alcohol consumption, having poor self-rated health, and having a shorter duration since cancer diagnosis were significant predictors of vaccination status among cancer survivors under 65 years of age. Influenza vaccine coverage remains much lower than recommended among cancer survivors, particularly in the younger age groups. Further study is needed to determine the factors that contribute to the lack of vaccination in cancer survivors, despite their increased risk for influenza.
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Eibl MM, Wolf HM. Vaccination in patients with primary immune deficiency, secondary immune deficiency and autoimmunity with immune regulatory abnormalities. Immunotherapy 2015; 7:1273-92. [PMID: 26289364 DOI: 10.2217/imt.15.74] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Vaccination has been an important healthcare measure in preventing infectious diseases. The response to vaccination is reduced in immunocompromised patients, primary immune deficiency (PID) and secondary immune deficiency (SID), but vaccination studies still demonstrated a protective effect resulting in reducing complications, hospitalization, treatment costs and even mortality. The primary physician and the specialist directing patient care are responsible for vaccination. Live vaccines are contraindicated in patients with severe immune impairment, killed vaccines are highly recommended in PID and SID. Criteria have been defined to distinguish high- or low-level immune impairment in the different disease entities among PID and SID patients. For patients who do not respond to diagnostic vaccination as characterized by antibody failure immunoglobulin replacement is the mainstay of therapy.
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Affiliation(s)
- Martha M Eibl
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
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Antiviral prophylaxis in patients with solid tumours and haematological malignancies--update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol 2015; 94:1441-50. [PMID: 26193852 PMCID: PMC4525190 DOI: 10.1007/s00277-015-2447-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 01/17/2023]
Abstract
Reactivation of viral infections is common in patients with solid tumour or haematological malignancy. Incidence and severity depend on the extent of cellular immunosuppression. Antiviral prophylaxis may be effective to prevent viral reactivation. In 2006, the Infectious Diseases Working Party of German Society for Hematology and Medical Oncology (DGHO) published guidelines for antiviral prophylaxis in these patient populations. Here, we present an update of these guidelines for patients with solid and haematological malignancies undergoing antineoplastic treatment but not allogeneic stem cell transplantation. Relevant literature for reactivation of different viruses (herpes simplex virus (HSV), varicella zoster virus (VZV), hepatitis B virus (HBV) and respiratory viruses) is discussed to provide evidence-based recommendations for clinicians taking care of this patient population. We recommend a risk-adapted approach with (val)acyclovir against HSV and VZV in patients treated with alemtuzumab, bortezomib or purine analogues. Seasonal vaccination against influenza is recommended for all patients with solid or haematological malignancies regardless of antineoplastic therapy. Hepatitis B screening is recommended in lymphoproliferative disorders, acute leukaemia, and breast cancer, and during treatment with monoclonal anti-B-cell antibodies, anthracyclines, steroids and in autologous stem cell transplantation. In those with a history of hepatitis B prophylactic lamivudine, entecavir or nucleotide analogues as adefovir are recommended to prevent reactivation.
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Ide Y, Imamura Y, Ohfuji S, Fukushima W, Ide S, Tsutsumi C, Koga M, Maeda K, Hirota Y. Immunogenicity of a monovalent influenza A(H1N1)pdm09 vaccine in patients with hematological malignancies. Hum Vaccin Immunother 2015; 10:2387-94. [PMID: 25424946 DOI: 10.4161/hv.29094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Patients with hematological malignancies have high risk for morbidity and mortality from influenza. This study was conducted to evaluate the immunogenicity and reactogenicity of an influenza A(H1N1)pdm09 vaccine among such subjects. Fifty subjects were vaccinated twice during the 2009-2010 season. The antibody response was expressed in terms of mean fold rise (MFR) of geometric mean titer, seroresponse proportion (sR), and seroprotection proportion (sP). The first vaccination induced only a small response, and additional antibody was acquired after the second dose (MFR 2.3 and 3.9, sR 32% and 54%, and sP 30% and 48% after the first and the second vaccination, respectively). Rituximab treatment showed an especially inhibitory effect (MFR 1.3, sR 9% and sP 0%). When analyzed using logistic regression models, only rituximab was found to have an independent effect; the adjusted odds ratio for sR was 0.09 (P = 0.05). Influenza vaccination of patients with hematological malignancies resulted in adepuate response, and the second vaccination induced additional antibody. It is therefore recommended to vaccinate this group twice.
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Affiliation(s)
- Yuichiro Ide
- a Department of Public Health; Osaka City University Graduate School of Medicine; Osaka, Japan
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Koinis F, Nintos G, Georgoulias V, Kotsakis A. Therapeutic strategies for chemotherapy-induced neutropenia in patients with solid tumors. Expert Opin Pharmacother 2015; 16:1505-19. [DOI: 10.1517/14656566.2015.1055248] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Freedman JL, Reilly AF, Powell SC, Bailey LC. Quality improvement initiative to increase influenza vaccination in pediatric cancer patients. Pediatrics 2015; 135:e540-6. [PMID: 25583919 DOI: 10.1542/peds.2014-0943] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric patients with cancer face more severe complications of influenza than healthy children. Although Centers for Disease Control and Prevention guidelines recommend yearly vaccination in these patients, in our large academic center, <60% of oncology patients receiving chemotherapy were immunized at baseline. Our objective was to increase this rate through a multifaceted quality improvement initiative. METHODS Eligible patients were >6 months old, within 1 year of receiving chemotherapy, >100 days from stem cell transplant, and had ≥ 1 outpatient oncology visit between September 1, 2012, and March 31, 2013. Five interventions were instituted concomitantly: (1) family education: influenza/vaccine handouts were provided to families in clinic waiting rooms; (2) health informatics: daily lists of outpatients due for immunization were generated from the electronic medical record and sent automatically to triage staff and nurses; (3) outpatient clinic: patients due for vaccination were given colored wristbands during triage to alert providers; (4) inpatient: vaccine order was built into admission order set; and (5) provider education: staff education was provided at conferences on screening of patients, vaccine ordering, and documentation of refusals/contraindications. RESULTS The complete influenza immunization rate increased by 20.1% to 64.5%, and the proportion of patients receiving ≥ 1 dose of vaccination increased by 22.9% to 77.7%. Similar changes were noted across all cancer types, with highest rates of immunization in leukemia/lymphoma patients (86.8%) and lowest in patients after stem cell transplant (66.7%). CONCLUSIONS Technology, education, and multidisciplinary clinical process changes increased influenza vaccination rates. Ongoing efforts are targeting subgroups with lowest rates of immunization.
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Affiliation(s)
| | - Anne F Reilly
- Division of Oncology, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie C Powell
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - L Charles Bailey
- Division of Oncology, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Pasiarski M, Rolinski J, Grywalska E, Stelmach-Goldys A, Korona-Glowniak I, Gozdz S, Hus I, Malm A. Antibody and plasmablast response to 13-valent pneumococcal conjugate vaccine in chronic lymphocytic leukemia patients--preliminary report. PLoS One 2014; 9:e114966. [PMID: 25506837 PMCID: PMC4266633 DOI: 10.1371/journal.pone.0114966] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) leads to significant immune system dysfunction. The predominant clinical presentation in 50% of patients involves recurrent, often severe, infections. Infections are also the most common (60-80%) cause of deaths in CLL patients. The scope of infections varies with the clinical stage of the disease. Treatment-naive patients typically present with respiratory tract infections caused by encapsulated bacteria Streptococcus pneumoniae and Haemophilus influenzae. Since 2012, the 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended in the United States and some EU countries for pneumococcal infection prevention in patients with CLL (besides the long-standing standard, 23-valent pneumococcal polysaccharide vaccine, PPV23). The aim of this study was to compare the immune response to PCV13 in 24 previously untreated CLL patients and healthy subjects. METHODS Both groups were evaluated for: the levels of specific pneumococcal antibodies, the levels of IgG and IgG subclasses and selected peripheral blood lymphocyte subpopulations including the frequency of plasmablasts before and after immunization. RESULTS Adequate response to vaccination, defined as an at least two-fold increase in specific pneumococcal antibody titers versus pre-vaccination baseline titers, was found in 58.3% of CLL patients and 100% of healthy subjects. Both the CLL group and the control group demonstrated a statistically significant increase in the IgG2 subclass levels following vaccination (P = 0.0301). After vaccination, the frequency of plasmablasts was significantly lower (P<0.0001) in CLL patients in comparison to that in controls. Patients who responded to vaccination had lower clinical stage of CLL as well as higher total IgG, and IgG2 subclass levels. No significant vaccine-related side effects were observed. CONCLUSIONS PCV13 vaccination in CLL patients is safe and induces an effective immune response in a considerable proportion of patients. To achieve an optimal vaccination response, the administration of PCV13 is recommended as soon as possible following CLL diagnosis.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Female
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Pneumococcal Infections/blood
- Pneumococcal Infections/complications
- Pneumococcal Infections/immunology
- Pneumococcal Infections/prevention & control
- Pneumococcal Vaccines/immunology
- Pneumococcal Vaccines/therapeutic use
- Streptococcus pneumoniae/immunology
- Vaccines, Conjugate/immunology
- Vaccines, Conjugate/therapeutic use
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Affiliation(s)
- Marcin Pasiarski
- Department of Hematology, Holycross Cancer Center, Kielce, Poland
| | - Jacek Rolinski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland
- St. John’s Cancer Center, Lublin, Poland
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland
- St. John’s Cancer Center, Lublin, Poland
| | | | | | - Stanislaw Gozdz
- Department of Chemotherapy and Clinical Oncology, Holycross Cancer Center, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
| | - Anna Malm
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Lublin, Poland
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Abstract
BACKGROUND Our aim was to determine the clinical and epidemiological features of pandemic influenza A/H1N1 in immunocompromised children with solid tumors and hematological malignancies. PATIENTS AND METHODS A prospective study was conducted during the H1N1 pandemic between August 2009 and February 2010 in a pediatric hematology-oncology unit. Demographic and clinical data were obtained from all children with suspected H1N1 infection (high fever with or without respiratory symptoms). Laboratory diagnosis of influenza A/H1N1 was performed by means of polymerase chain reaction analysis of nasopharyngeal wash specimens. RESULTS We identified 57 episodes of suspected influenza A/H1N1 infection in 40 children. In all episodes, children were treated with oseltamivir and antibiotics until influenza A/H1N1 results were received. Of all episodes, 13 (22.8%) tested positive for influenza A/H1N1. Two of the H1N1-positive children (15.4%) had been previously immunized against influenza A/H1N1. No differences between H1N1-positive and H1N1-negative children were noted in terms of demographic features, clinical presentation, laboratory findings, and underlying disease.Three polymerase chain reaction-positive (23.0%) children and 1 H1N1-negative (2.3%) child were admitted to the pediatric intensive care unit and were mechanically ventilated (P=0.03). One (7.7%) H1N1-positive patient died versus none of the H1N1-negative patients (P=0.2). The condition of all other children in both the groups improved rapidly during hospitalization. CONCLUSIONS Febrile hospitalized pediatric oncology patients, with and without pandemic influenza A/H1N1, had a similar demographic and clinical presentation with a relatively good outcome. This was probably because of early antiviral treatment and possibly because of the relatively low virulence of the virus. Immunization should be encouraged in these patients.
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Abstract
Febrile neutropenia (FN) can occur at any time during the course of a malignancy, especially hematologic malignancies, from diagnosis to end-stage disease. The majority of FN episodes are typically confined to the period of initial diagnosis and active treatment. Because of suppressed inflammatory responses, fever is often the sole sign of infection. As FN is a true medical emergency, prompt identification of and intervention in FN can prolong survival and improve quality of life. This article reviews FN in the setting of hematologic malignancies, specifically myelodysplastic syndromes and acute leukemias, providing an overview of the definition of fever and neutropenia, diagnostic approach, categories of risk/risk assessment, management in patients at low and high risk, and prophylaxis of infections.
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Shehata MA, Karim NA. Influenza vaccination in cancer patients undergoing systemic therapy. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2014; 8:57-64. [PMID: 24855405 PMCID: PMC4011725 DOI: 10.4137/cmo.s13774] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer patients often experience preventable infections, including influenza A and B. These infections can be a cause of significant morbidity and mortality. The increased risk of infection may be because of either cancer itself or treatment-induced immunosuppression.1 Influenza immunization has been shown to decrease the risk of influenza infection in patients with intact immunity.2 In cancer patients, active immunization has been shown to confer protective immunity against several infections at similar rates to healthy individuals, which has translated into decreased duration and severity of infection and potentially improved morbidity and mortality.3 OBJECTIVES SEARCH METHODS We searched MEDLINE/PubMed database for articles published from 1964 to 2013 using the search terms “cancer,” “adult,” “influenza vaccination,” and “chemotherapy.” SELECTION CRITERIA We included studies based on systematic sampling with defined clinical criteria irrespective of the vaccination status of cancer patients. Studies measure the serological response or clinical response to compare between the study group and the control group. Studies assessed the inactivated influenza vaccines and live attenuated influenza vaccine (LAIV) protective serological reaction and the clinical outcomes after vaccination. DATA COLLECTION AND ANALYSIS Two independent authors assessed the methodological quality of included studies and extracted data. MAIN RESULTS We included 16 studies (total number of participants = 1,076). None of the included studies reported clinical outcomes. All included studies reported on influenza immunity and adverse reaction on vaccination. We included 6 solid tumor studies and 10 hematological studies. In 12 studies, the serological response to influenza vaccine was compared in patients receiving chemotherapy (n = 425) versus those not receiving chemotherapy (n = 376). In three studies, the serological responses to influenza vaccination in patients receiving chemotherapy are compared to that in healthy adult. Measures used to assess the serological responses included a four-fold rise increase in antibody titer development of hemagglutination inhibition (HI) titer >40, and pre- and post-vaccination geometric mean titers (GMTs). Immune responses in patients receiving chemotherapy were consistently weaker (four-fold rise of 17–52%) than in those who had completed chemotherapy (50–83%) and healthy patients (67–100%). Concerning adverse effects, oncology patients received influenza vaccine, and the side effects described were mild local reactions and low-grade fever. No life-threatening or persistent adverse effects were reported. AUTHORS’ CONCLUSION Patients with solid and some of hematological tumors are able to mount a serological response to influenza vaccine, but it remains unclear how much this response protects them from influenza infection or its complications. Meanwhile, influenza vaccine appears to be safe in these patients. While waiting results of randomized controlled trials to give us more details about the clinical benefits of the influenza vaccination, the clinicians should consider the currently proved benefits of influenza vaccination on management of the cancer patients undergoing systematic chemotherapy such as decrease in the duration and severity of the of the disease, and significant decrease in influenza-associated morbidity and mortality in these high-risk patients.3
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Affiliation(s)
- Mahmoud A Shehata
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nagla Abdel Karim
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
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