Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin's lymphoma patients treated with rituximab-containing regimens

J Immunol. 2011 May 15;186(10):6044-55. doi: 10.4049/jimmunol.1004095. Epub 2011 Apr 15.

Abstract

Influenza vaccination is generally recommended for non-Hodgkin's lymphoma (NHL) patients, but no data are available about the activity of this vaccine after treatment with rituximab-containing regimens. We evaluated the humoral response to the trivalent seasonal influenza vaccine in a group of NHL patients in complete remission for ≥6 mo (median, 29 mo) after treatment with rituximab-containing regimens (n = 31) compared with age-matched healthy subjects (n = 34). B cell populations and incidence of influenza-like illness were also evaluated. For each viral strain, the response was significantly lower in patients compared with controls and was particularly poor in patients treated with fludarabine-based regimens. In the patient group, the response to vaccination did not fulfill the immunogenic criteria based on the European Committee for Medicinal Products for Human Use requirements. Among the patients, CD27(+) memory B cells were significantly reduced, and their reduction correlated with serum IgM levels and vaccine response. Episodes of influenza-like illness were recorded only in patients. These results showed that NHL patients treated with rituximab-containing regimens have persisting perturbations of B cell compartments and Ig synthesis and may be at particular risk for infection, even in long-standing complete remission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived / immunology
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antibodies, Viral / blood*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • B-Lymphocytes / immunology*
  • Case-Control Studies
  • Female
  • Humans
  • Immunoglobulin M / blood
  • Immunologic Memory
  • Influenza A Virus, H1N1 Subtype / immunology
  • Influenza A Virus, H3N2 Subtype / immunology
  • Influenza B virus / immunology
  • Influenza Vaccines / administration & dosage
  • Influenza Vaccines / immunology*
  • Influenza, Human / immunology
  • Influenza, Human / prevention & control*
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / immunology*
  • Male
  • Middle Aged
  • Orthomyxoviridae / immunology*
  • Rituximab
  • Tumor Necrosis Factor Receptor Superfamily, Member 7 / immunology
  • Vidarabine / analogs & derivatives
  • Vidarabine / therapeutic use

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antibodies, Viral
  • Immunoglobulin M
  • Influenza Vaccines
  • Tumor Necrosis Factor Receptor Superfamily, Member 7
  • Rituximab
  • Vidarabine
  • fludarabine