title: Immunologic consequences of chemotherapy for ovarian cancer: impaired responses to the influenza vaccine.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania, Perelman School of Medicine, United States.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Chu
authors.forename: Jean D
authors.initials: JD
authors.lastname: Boyer
authors.forename: Abbas
authors.initials: A
authors.lastname: Jawad
authors.forename: Kenyetta
authors.initials: K
authors.lastname: McDonald
authors.forename: Wade T
authors.initials: WT
authors.lastname: Rogers
authors.forename: Eline T
authors.initials: ET
authors.lastname: Luning Prak
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Sullivan
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D000970:Antineoplastic Agents; D007252:Influenza Vaccines; D015164:Vaccines, Inactivated
keywords: Antibody; Cyclophosphamide; DC vaccine; ELISpot; Immune compromised; Monoclonal B cell lymphocytosis; Treg
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