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Efficacy of the Influenza Vaccine in Patients with Malignant Lymphoma

Joseph J. Mazza, MD, Department of Hematology/Oncology, Marshfield Clinic, Marshfield, Wisconsin
Steven H. Yale, MD, FACP, Department of Internal Medicine, Marshfield Clinic, and Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
Jodi R. Arrowood, RPh, Pharmacy, St. Joseph’s Hospital, Marshfield, Wisconsin
Cory E. Reynolds, MS, Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
Ingrid Glurich, PhD, Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
Po-Huang Chyou, PhD, Biostatistics and Bioinformatics Core, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
James G. Linneman, MS, Biostatistics and Bioinformatics Core, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
Kurt D. Reed, MD, Department of Pathology, Marshfield Clinic and Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin

Reprint Requests: Joseph J. Mazza, MD, Department of Hematology/Oncology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield,WI 54449,Tel: 715-387-5426, Fax: 715-389-3808, Email: mazza.joseph{at}marshfieldclinic.org

Background: The benefits and efficacy of the influenza vaccine have been controversial and have had mixed reviews in the recent literature. Immunosuppressed patients and those receiving chemotherapy are particularly at risk for infectious complications and are therefore given high priority to receiving prophylactic vaccines.

Method: We administered the influenza vaccine to 29 patients with malignant lymphoma who were receiving chemotherapy or had recently completed therapy during the flu season of 2003–2004. An aged-matched control group received the same vaccine during the same period. The ability of both groups to mount a protective titer of antibodies to the antigens in the vaccine was measured.

Results: Three of 29 patients (10%) in the lymphoma group were able to mount a 4-fold titer to at least one of the influenza A antigens. One patient developed a protective titer to both influenza A and B antigens and 3 of 29 responded to the influenza B antigen. In the control group 13 of 29 (45%) responded to an influenza A antigen and 14 of 29 (48%) had a 4-fold response to the B antigen. Seven of 29 controls (24%) had a 4-fold increase in their titers to both the A and B antigens.

Conclusions: This study confirmed the low incidence of response or efficacy to the influenza vaccine reported in previous studies. Only a small percentage (10%) of immunosuppressed patients with malignant lymphoma responded with a 4-fold increase in their antibody titer to the major antigens of the 2003 influenza vaccine. Most interestingly, less than 50% of the aged-matched control population studied responded with a 4-fold increase in their antibody titer. Additional studies are needed to determine methods for improving the efficacy of the vaccine and the effectiveness of the influenza vaccination program in preventing influenza infections in the United States.

Key Words: Antigens • Influenza • Lymphoma • Titer • Vaccine

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