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Abstract
Highlights
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- Patients undergoing treatment for ovarian cancer are profoundly immunosuppressed and unable to mount an adequate immune response to seasonal influenza vaccine.
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- The B cell compartment was significantly functionally compromised.
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- Monoclonal B cell lymphocytosis was seen.
Objectives
To
examine the effect of chemotherapy for ovarian cancer on immunologic
function and to define the effect on the serologic response to the
influenza vaccine.
Methods
Under
IRB approved protocols, patients with ovarian cancer were administered
seasonal trivalent killed influenza vaccines. Peripheral blood was
collected for immunologic assessments. Serum was analyzed for
hemagglutination inhibition (HAI) antibody titers. Peripheral blood
mononuclear cells were isolated to characterize T and B cell populations
and function.
Results
Thirty-one
patients were recruited: 13 in remission receiving a dendritic cell
vaccine with or without a single dose of low-dose cyclophosphamide, 3 in
remission not receiving treatment, and 15 undergoing standard therapy.
Significant effects on T cell and B cell subset distributions were seen.
Functional effects were also seen. Few patients were able to mount a
4-fold HAI antibody response. A 4-fold response was observed for H1N1 in
20%, for H3N2 in 26%, and for influenza B in 6%. Pre-existing exposure
to influenza was predictive of responders.
Conclusions
Despite
CDC recommendations that patients undergoing chemotherapy receive
influenza vaccine, there is little evidence to support its serologic
effectiveness in this population. Patients with ovarian cancer are
almost uniformly unable to mount a meaningful antibody response. These
findings have serious implications for future resource allocation for
both seasonal and novel pandemic influenza outbreak and understanding
the immunologic deficits as a result of chemotherapy may improve patient
care.
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