Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group |
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| Institution: | 1. Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden;2. Department of Medicine, Section of Hematology, Örebro University Hospital, Örebro, Sweden;3. Department of Medicine, Falun Hospital, Falun, Sweden;4. Institution of Clinical Sciences, Faculty of Medicine, Lund University Hospital, Lund, Sweden;5. Department of Medicine, Section of Hematology, South Älvsborg Hospital, Borås, Sweden;6. Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden;7. Department of Medicine, Karlstad Hospital, Karlstad, Sweden;8. Department of Medicine, Unit of Hematology, Karolinska Institute and Karolinska University Hospital, Huddinge, Sweden;1. Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada;2. Division of Infectious Diseases, Moffitt Cancer Center, Tampa, FL, United States;1. Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Medical Oncology, Pitié Salpêtrière Hospital, Paris, France;2. Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Infectious Diseases, Pitié Salpêtrière Hospital, Paris, France;4. Sorbonne Université, INSERM, Pierre Louis Institute of Epidemiology and Public Health (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Virology, Pitié Salpêtrière Hospital, Paris, France;1. Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany;2. Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany;3. Department III of Internal Medicine, University Hospital Munich, Ludwig-Maximilians-University, Campus Großhadern, Munich, Germany;4. Gesundheitszentrum St Marien, Amberg, Germany;5. Stauferklinikum Schwäbisch-Gmünd, Mutlangen, Germany;6. Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany;7. Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany;8. Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany;1. Yale Cancer Center, New Haven, CT;2. Yale School of Medicine, New Haven, CT;3. Icahn School of Medicine at Mount Sinai, New York, NY;4. Yale School of Public Health, New Haven, CT;1. Department of Infectious Diseases, Belarusian State Medical University, Minsk, Belarus;2. Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Belarus;1. Department of Medical Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France;2. Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice, France;3. Department of Biology, Cerballiance, Cagnes-sur-Mer, France;4. Department of Radiation Oncology, Clinique Saint Jean, Cagnes-sur-Mer, France;5. Department of Infectious Disease, Centre Hospitalo-Universitaire de Nice, Nice, France |
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| Abstract: | AimTo determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response.BackgroundStreptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking.Methods128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA).ResultsPCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated.ConclusionsIn patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease. |
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| Keywords: | Chronic lymphocytic leukemia (CLL) Pneumococcal vaccine Polysaccharide vaccine Protein-conjugate vaccine Immunogenicity |
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