evaluation of prime-boost anti-pneumococcal vaccination in patients with diffuse large b cell lymphoma treated with rituximab

Conditions: Pneumococcal Infections; Lymphoma, Large B-Cell, Diffuse

Summary: pneumococcal infections remain frequent and potentially fatal. to prevent them, two anti-pneumococcal vaccines exist: a 13-valent conjugate vaccine (prevenar®) and a 23-valent polysaccharide vaccine (pneumovax®). for their utilization, several studies approved a prime-boost strategy. it consist two administer pneumovax® at least two months later than prevenar®. patients with diffuse large b-cell lymphoma (dlbcl) have a higher-risk to develop a pneumococcal infection. the main reason is immunosuppression, induced by rituximab (b cell depletion), chemotherapy and lymphoma. patients are treated by immunochemotherapy, combining rituximab (anti-cd20 monoclonal antibody) and conventional chemotherapy (chop). however, those patients have a low rate of vaccination (about 15%).

pneumococcal infections remain frequent and potentially fatal. to prevent them, two anti-pneumococcal vaccines exist: a 13-valent conjugate vaccine (prevenar®) and a 23-valent polysaccharide vaccine (pneumovax®). for their utilization, several studies approved a prime-boost strategy. it consist two administer pneumovax® at least two months later than prevenar®. patients with diffuse large b-cell lymphoma (dlbcl) have a higher-risk to develop a pneumococcal infection. the main reason is immunosuppression, induced by rituximab (b cell depletion), chemotherapy and lymphoma. patients are treated by immunochemotherapy, combining rituximab (anti-cd20 monoclonal antibody) and conventional chemotherapy (chop). however, those patients have a low rate of vaccination (about 15%). also, in the current literature, rare studies investigated prime-boost immunogenicity in this relevant population. the investigators will evaluate vaccinal response of 10 serotype-specific immunoglobulin g (1, 3, 4, 6b, 7f, 9v, 14, 18c, 19f, 23f) at different time of treatment. the investigators search to compare efficiency of prime-boost anti-pneumococcal vaccination according to the time of prevenar administration (before or after immunochemotherapy) and to the dose of prevenar® (single or double-dose).

Eligibility criteria:
inclusion criteria: * de novo diffuse large b-cell lymphoma diagnostic (according 2016 world health organization (who) classification) * treatment decision by immunochemotherapy (r-chop) * age over 18 years old * negative pregnancy test at inclusion * active contraception at inclusion * free and informed consent procedure at inclusion * affiliation of the social security system exclusion criteria: * patient with prior treatment by immunotherapy or chemotherapy * patient with prior treatment by debulking chemotherapy (cop) * patient with prior treatment by high-dose of corticosteroids * patients with an autoimmune disease * patients with a diffuse large b-cell lymphoma from transformation (follicular lymphoma, chronic lymphoid leukemia) * immunosuppressed patient with : asplenia, hereditary immunodeficiency disorder, infection by hiv, hepatitis b or c viruses, transplanted patient, hematopoietic stem cell transplantation, nephrotic syndrome, meningeal breach, cochlear implants. * patients vaccinated in the last month before inclusion * patients with prior transfusion of blood-products or immunoglobulins in the last three months before inclusion * patient with bleeding disorders or thrombopenia contraindicating intramuscular injection * patient with prior pneumococcal documented infection * patient with current pregnancy and/or breastfeeding * patient under curatorship or guardianship

Keywords: lymphoma pneumococcal vaccination prime-boost rituximab