title: A prospective study of chemotherapy immunologic effects and predictors of humoral influenza vaccine responses in a pediatric oncology cohort.
abstract: BACKGROUND
  Pediatric oncology patients represent a cohort of individuals uniquely at risk of complications from influenza, yet less likely to respond to the vaccine. It is not yet clear how to best protect this vulnerable population.
  
  
  METHODS
  We performed a prospective analysis of 177 pediatric oncology patients to define the predictors of influenza vaccine responses. Each variable was examined over three time points and a repeated measure analysis was performed.
  
  
  RESULTS
  Patients with ALL vaccinated during induction phase had superior influenza vaccine responses than those subjects vaccinated during post-induction or maintenance phases (P=0·0237). Higher aggregate HAI titer responses were associated with a higher baseline B-cell count (P=0·0240), and higher CD4 and CD8 influenza-specific T-cell responses, suggesting prior antigen exposure is a significant contributor. The solid tumor cohort had equivalent responses during all time frames of chemotherapy.
  
  
  CONCLUSIONS
  The optimal protection from influenza of pediatric patients on chemotherapy should include vaccination, but it is clear that not all patients produce high titers of antibodies after vaccination. This study identified biomarkers that could be used to individualize vaccine approaches. Immunologic predictors might have a role in targeting resources, as B-cell counts predicted of vaccine responses among the patients with ALL.
authors.affiliation: Division of Oncology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Kersun
authors.forename: Anne
authors.initials: A
authors.lastname: Reilly
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: Jean
authors.initials: J
authors.lastname: Boyer
authors.forename: Eline T
authors.initials: ET
authors.lastname: Luning Prak
authors.forename: Kenyetta
authors.initials: K
authors.lastname: McDonald
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Hou
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Jawad
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D011446:Prospective Studies
chemical_list: D000914:Antibodies, Viral; D000970:Antineoplastic Agents; D007252:Influenza Vaccines