Elsevier

Vaccine

Volume 19, Issues 13–14, 8 February 2001, Pages 1671-1677
Vaccine

Antibody responses to pneumococcal and haemophilus vaccinations in patients with B-cell chronic lymphocytic leukaemia

https://doi.org/10.1016/S0264-410X(00)00409-6Get rights and content

Abstract

Although vaccination against Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae type b (Hib) is recommended for immunocompromised patients, such as patients with B-cell chronic lymphocytic leukaemia (B-CLL), its protective effect is questionable. We studied antibody responses to pneumococcal polysaccharide vaccine (Pneumovax-23®) and to conjugated H. influenzae type b-vaccine (Act-Hib®) in 25 patients with B-CLL. After vaccination, the number of patients with antibody levels in the protective range against pneumococcal serotypes and H. influenzae b increased from 9 (38%) to 12 (50%) of 24 patients and from 8 (35%) to 11 (48%) of 23 patients, respectively. The patients with adequate antibody response to Pneumovax-23® and Act-Hib® had significantly less advanced stages of B-CLL, higher gammaglobulin levels, total IgG-levels and IgG-subclasses 2 and 4 levels, and lower levels of soluble CD23. Consequently, vaccination with these vaccines should be given as soon as the diagnosis of B-CLL is made, early in the course of the disease with determination of post-vaccination antibody levels.

Introduction

Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia in Europe and the United States of America. The malignant clone is of B-cell lineage in more than 95% of the cases. Although CLL affects mainly elderly (>50 years), life expectancy is relatively high (about 150 months in patients with CLL Rai-0) [1], [2]. Respiratory infections are frequently observed in patients with B-CLL due to hypogammaglobulinaemia and defective specific antibody responses resulting in relatively high morbidity and mortality [3], [4], [5], [6]. Protection against serious and fatal infectious complications could be provided by active immunisation, but questions have been raised about the efficacy of vaccinations in patients with acquired immunodeficient states as in B-CLL [7], [8]. Previous studies on immunisation of patients with malignant diseases with or without chemotherapy have yielded large differences in both efficacy and immunogenicity [9], [10], [11], [12].

We studied antibody responses to pneumococcal polysaccharide capsular antigens (Pneumovax-23®) and conjugated Haemophilus influenzae type b-vaccine (Act-Hib®) in 25 patients with B-CLL, and tried to relate vaccine responses to disease progression for which sCD23 is considered a suitable marker [13].

Section snippets

Patients

Twenty-five patients (18 males and seven females) with immunophenotypically proven B-CLL were included; their mean age (±SD; range) was 70.4±7.9 years (range 50–84). The mean duration of disease (±SD; range) was 49.4±53.0 months (range: 6–240). The stage of B-CLL was expressed according to Rai [2]: 10 patients were classified as Rai-0, 5 patients as Rai-1, six patients as Rai-2, and 4 patients as Rai-4. Eight patients (32%) had been treated previously with chemotherapy, but no patient had

Antibody response to pneumococcal polysaccharide vaccine

One patient was excluded from the analysis because gammaglobulin therapy was started during the course of the study; a total of 24 patients were evaluable for analysis of specific antibody responses after pneumococcal polysaccharide vaccination.

Prior to vaccination, specific antibody titres considered to be in the protective range against S. pneumoniae were present in nine (38%) of the 24 patients. In two (22%) of these nine patients, an adequate response to vaccination was observed. In another

Discussion

Previous studies in patients with solid tumours and lymphoreticular neoplasms have lead to conflicting results with respect to the capacity to mount relevant antibody responses on vaccination with pneumococcal polysaccharide and conjugated H. influenzae type b vaccine. In immunocompetent individuals, seroconversion rates of 80% or more were obtained for Act-Hib® vaccination and for the pneumococcal serotypes responsible of bacteraemia, but response rates vary greatly with age [20], [22]. In

Acknowledgements

We thank Dr G. Veth, Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, for her assistance in this study.

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