The humoral immune response to high-dose influenza vaccine in persons with monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL).

Background: Limited data are available regarding the immunogenicity of high-dose influenza vaccine among persons with chronic lymphocytic leukemia (CLL) and monoclonal B cell lymphocytosis (MBL).
Methods: A prospective pilot study of humoral immune responses to 2013-2014 and 2014-2015 high-dose trivalent influenza vaccine (HD IIV; Fluzone® High-Dose; Sanofi Pasteur) was conducted among individuals with MBL and previously untreated CLL. Serum hemagglutination inhibition (HAI) antibody titers were measured at baseline and Day 28 after vaccination; seroprotection and seroconversion rates were determined. Memory B cell responses were assessed by B-cell enzyme-linked immune absorbent spotassays.
Results: Thirty subjects (17 CLL and 13 MBL) were included. Median age was 69.5 years. Day 28 seroprotection rates for the cohort were 19/30 (63.3%) for A/H1N1; 21/23 (91.3%) for A/H3N2; and 13/30 (43.3%) for influenza B. Those with MBL achieved higher day 28 HAI geometric mean titers (54.1 [4.9, 600.1] vs. 12.1 [1.3, 110.1]; p = 0.01) and higher Day 28 seroprotection rates (76.9% vs. 17.6%; p = 0.002) against the influenza B-vaccine strain virus than those with CLL.
Conclusions: Immunogenicity of the HD IIV3 in patients with CLL and MBL is lower than reported in healthy adults. Immunogenicity to influenza B was greater in those with MBL than CLL.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JAW, DEG, KMG, and TGC have no conflicts of interest to disclose. SAP: Research funding has been provided to the institution from Pharmacyclics, MorphoSys, Janssen, AstraZeneca, TG Therapeutics, Bristol Myers Squibb, AbbVie, and Ascentage Pharma for clinical studies in which Sameer A. Parikh is a principal investigator. Sameer A. Parikh has also participated in Advisory Board meetings of Pharmacyclics, AstraZeneca, Genentech, Gilead, GlaxoSmithKline, Verastem Oncology, and AbbVie. (He was not personally compensated for his participation.) TDS: Research funding has been provided to the institution from Genentech, Pharmacyclics, Abbvie, GlaxoSmithKline, and Merck. NEK: Research funding from: Acerta Pharma, Bristol Meyer Squib, Celgene, Pharmacyclics, Tolero Pharmaceuticals, MEI Pharma, Sunesis,and Abbvie. DSMC (Data Safety Monitoring Committee) for Agios Pharm, AstraZeneca, Celgene, Cytomx Therapeutics, Morpho-sys and Rigel. Advisory Board for: Cytomx Therapy, Pharmacyclics, Dava oncology, Juno Theraputics, Astra Zeneca and Oncotracker. RBK has received research funding from Merck Research Laboratories to study waning immune responses to mumps vaccine. GAP and RBK hold a patent related to vaccinia peptide vaccines. WD: research funding from Merck, DTRM pharma, Astrazenica, Abbvie and Mundi Pharma in which WD is a PI for these research studies. WD has participated Advisory board of Alexion, Merck, Octapharma and MEI pharma (no personal compensation for participation). SSK is inventor on patents in the field of CART cell therapy that are licensed to Novartis, Humanigen, and Mettefoge. SSK has received research funding from Novartis, Kite, Gilead, Juno, Celgene, Tolero, Humanigen, Sunesis, Morphosys, and Lentigen. SSK has participated on advisory boards for Humanigen, Kite, and Calibr. GAP is the chair of a Safety Evaluation Committee for novel investigational vaccine trials being conducted by Merck Research Laboratories. GAP offers consultative advice on vaccine development to Merck & Co. Inc., Avianax, Adjuvance, Valneva, Medicago, Sanofi Pasteur, GlaxoSmithKline, Dynavax, and Emergent Biosolutions. GAP and RBK hold a patent related to vaccinia peptide vaccines. These activities have been reviewed by the Mayo Clinic Conflict of Interest Review Board and are conducted in compliance with Mayo Clinic Conflict of Interest policies.
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