title: Humoral and cellular immunity to primary H1N1 infection in patients with hematologic malignancies following stem cell transplantation.
abstract: Limited data are available on immunologic responses to primary H1N1 infection in patients with hematologic malignancies. We present a prospective, case-surveillance study of such patients with real-time polymerase chain reaction (RT-PCR) confirmed H1N1-influenza who presented to our institution between September 2009 and January 2010. Ninety-two patients presented with influenza-like symptoms, and 13 had H1N1 infection confirmed by RT-PCR, including 4 allogeneic stem cell transplant recipients (1 with acute myelogenous leukemia, 1 with chronic lymphoblastic leukemia [CLL], 1 with non-Hodgkin lymphoma, and 1 with chronic myelogenous leukemia), 5 patients with multiple myeloma following autologous stem cell transplantation, 1 patient with multiple myeloma perimobilization, 2 patients with NHL post chemotherapy, and 1 patient with CLL. All 13 patients required hospitalization. Six (43%) were admitted to the intensive care unit (ICU), of whom 4 (67%) died. We evaluated B cell and T cell responses to H1N1 infection prospectively in these patients compared with those in 4 otherwise healthy controls. Within 12 weeks of diagnosis, only 6 of 11 patients developed seropositive antibody titers as measured by hemagglutination-inhibition or microneutralization assays, compared with 4 of 4 controls. H1N1-specific T cells were detected in only 2 of 8 evaluable patients compared with 4 of 4 controls. H1N1-specific T cells were functional, capable of producing interferon γ, tumor necrosis factor α, and CD107a mobilization. Furthermore, CD154 was up-regulated on CD4(+) T cells in 3 of 4 controls and 2 of 2 patients who had both B cell and T cell responses to H1N1. Post-H1N1 infection, 5 of 8 patients developed seasonal influenza-specific T cells, suggesting cross-reactivity induced by H1N1 infection. These data offer novel insights into humoral and cell-mediated immunologic responses to primary H1N1 infection.
authors: Department of Hematology, Imperial College London, London, UK.
authors: Paula
authors: P
authors: Garland
authors: Hugues
authors: H
authors: de Lavallade
authors: Takuya
authors: T
authors: Sekine
authors: Katja
authors: K
authors: Hoschler
authors: Shiranee
authors: S
authors: Sriskandan
authors: Parind
authors: P
authors: Patel
authors: Stephen
authors: S
authors: Brett
authors: Kate
authors: K
authors: Stringaris
authors: Eva
authors: E
authors: Loucaides
authors: Katherine
authors: K
authors: Howe
authors: David
authors: D
authors: Marin
authors: Ed
authors: E
authors: Kanfer
authors: Nichola
authors: N
authors: Cooper
authors: Donald
authors: D
authors: Macdonald
authors: Amin
authors: A
authors: Rahemtulla
authors: Mark
authors: M
authors: Atkins
authors: Akila
authors: A
authors: Danga
authors: Dragana
authors: D
authors: Milojkovic
authors: Ian
authors: I
authors: Gabriel
authors: Ahmad
authors: A
authors: Khoder
authors: Abdullah
authors: A
authors: Alsuliman
authors: Jane
authors: J
authors: Apperley
authors: Katayoun
authors: K
authors: Rezvani
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis / Q000276:immunology; D023201:CD40 Ligand / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D006385:Hemagglutination Inhibition Tests; D019337:Hematologic Neoplasms / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007251:Influenza, Human / Q000276:immunology* / Q000517:prevention & control; D007371:Interferon-gamma / Q000032:analysis / Q000096:biosynthesis; D052118:Lysosomal-Associated Membrane Protein 1 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D052118:Lysosomal-Associated Membrane Protein 1; D023201:CD40 Ligand; D007371:Interferon-gamma