title: Antibody and plasmablast response to 13-valent pneumococcal conjugate vaccine in chronic lymphocytic leukemia patients--preliminary report.
abstract: BACKGROUND
  Chronic lymphocytic leukemia (CLL) leads to significant immune system dysfunction. The predominant clinical presentation in 50% of patients involves recurrent, often severe, infections. Infections are also the most common (60-80%) cause of deaths in CLL patients. The scope of infections varies with the clinical stage of the disease. Treatment-naive patients typically present with respiratory tract infections caused by encapsulated bacteria Streptococcus pneumoniae and Haemophilus influenzae. Since 2012, the 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended in the United States and some EU countries for pneumococcal infection prevention in patients with CLL (besides the long-standing standard, 23-valent pneumococcal polysaccharide vaccine, PPV23). The aim of this study was to compare the immune response to PCV13 in 24 previously untreated CLL patients and healthy subjects.
  
  
  METHODS
  Both groups were evaluated for: the levels of specific pneumococcal antibodies, the levels of IgG and IgG subclasses and selected peripheral blood lymphocyte subpopulations including the frequency of plasmablasts before and after immunization.
  
  
  RESULTS
  Adequate response to vaccination, defined as an at least two-fold increase in specific pneumococcal antibody titers versus pre-vaccination baseline titers, was found in 58.3% of CLL patients and 100% of healthy subjects. Both the CLL group and the control group demonstrated a statistically significant increase in the IgG2 subclass levels following vaccination (P = 0.0301). After vaccination, the frequency of plasmablasts was significantly lower (P<0.0001) in CLL patients in comparison to that in controls. Patients who responded to vaccination had lower clinical stage of CLL as well as higher total IgG, and IgG2 subclass levels. No significant vaccine-related side effects were observed.
  
  
  CONCLUSIONS
  PCV13 vaccination in CLL patients is safe and induces an effective immune response in a considerable proportion of patients. To achieve an optimal vaccination response, the administration of PCV13 is recommended as soon as possible following CLL diagnosis.
authors.affiliation: Department of Hematology, Holycross Cancer Center, Kielce, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Pasiarski
authors.affiliation: Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland; St. John's Cancer Center, Lublin, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Rolinski
authors.affiliation: Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland; St. John's Cancer Center, Lublin, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Grywalska
authors.affiliation: Department of Hematology, Holycross Cancer Center, Kielce, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Stelmach-Goldys
authors.affiliation: Department of Pharmaceutical Microbiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Izabela
authors.initials: I
authors.lastname: Korona-Glowniak
authors.affiliation: Department of Chemotherapy and Clinical Oncology, Holycross Cancer Center, Kielce, Poland; Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Gozdz
authors.affiliation: Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Hus
authors.affiliation: Department of Pharmaceutical Microbiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Malm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use*; D013296:Streptococcus pneumoniae / Q000276:immunology; D018074:Vaccines, Conjugate / Q000276:immunology / Q000627:therapeutic use*
chemical_list: C538862:13-valent pneumococcal vaccine; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate