title: Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin's lymphoma patients treated with rituximab-containing regimens.
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.
authors.affiliation: Department of Oncology, Biology, and Genetics, University of Genoa, 16132 Genoa, Italy. davide.bedognetti@nih.gov
authors.forename: Davide
authors.initials: D
authors.lastname: Bedognetti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Zoppoli
authors.forename: Carlotta
authors.initials: C
authors.lastname: Massucco
authors.forename: Elisa
authors.initials: E
authors.lastname: Zanardi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Zupo
authors.forename: Andrea
authors.initials: A
authors.lastname: Bruzzone
authors.forename: Mario Roberto
authors.initials: MR
authors.lastname: Sertoli
authors.forename: Enrico
authors.initials: E
authors.lastname: Balleari
authors.forename: Omar
authors.initials: O
authors.lastname: Racchi
authors.forename: Marco
authors.initials: M
authors.lastname: Messina
authors.forename: Graziano
authors.initials: G
authors.lastname: Caltabiano
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Icardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Durando
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Marincola
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.forename: Manlio
authors.initials: M
authors.lastname: Ferrarini
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Maria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000276:immunology / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007156:Immunologic Memory; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology; D009981:Influenza B virus / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009975:Orthomyxoviridae / Q000276:immunology*; D000069283:Rituximab; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7 / Q000276:immunology; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000914:Antibodies, Viral; D007075:Immunoglobulin M; D007252:Influenza Vaccines; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine