Boost Vaccination Improves Humoral Immune Response Against Influenza Virus In Patients With Multiple Myeloma
Authors: Hahn Michael , Schnitzler Paul , Schweiger Brunhilde , Hollenbach Cathrin , Ho Anthony D. , Goldschmidt Hartmut , Schmitt Michael 
Published: October 2019

Abstract

Background
Immune response to viruses in patients with multiple myeloma can be hampered by both the disease and its treatment with chemotherapy and autologous transplantation. H1N1 or seasonal influenza in myeloma patients is often characterized by severe complications. Influenza vaccination is therefore generally recommended for these patients. Nevertheless, there is evidence that in these patients, the immune response to vaccination is frequently insufficient. Preliminary data suggest that the immune response may be increased by a boost vaccination.

Methods
Vaccination with a triple-antigen (H1N1, A, B) influenza vaccine (Optaflu(R) from Novartis Ltd.) was administered to patients with confirmed diagnosis of multiple myeloma at our outpatient clinic during the season 2012/13. Humoral response monitoring was performed employing hemagglutination inhibition assays. Titers above 40 U/l were considered as protective against the respective virus strain. Based on published data from smaller cohorts, patients not mounting sufficient immune responses to the first vaccination, but clinically well tolerating the vaccine, were offered a second vaccine. Blood samples were taken prior to immunization and four weeks after each vaccination for titer analysis.

Results
Forty-eight myeloma patients were vaccinated. None of them showed protective immunity against all of the three antigens Influenza H1N1, A and B before vaccination. Before the seasonal vaccination 2012/13 only 18% (9/48) of the patients had protective titers against H1N1, 10% (5/48) against A and 10% (5/48) against B. After the first vaccination a protective titer against all three antigens was achieved in 14% (7/48) of the patients, in 41% (20/48) against H1N1, in 33% (16/48) against A and 20% (10/48) against B.
Twenty-five patients received a second vaccine. After this boost vaccination 33% (8/25) of the patients had protective immunity against all three antigens, 75% (18/25) against H1N1, 58% (14/25) against A and 46% (11/25) against B.

Conclusions
Antibody protection against influenza virus is extremely poor in myeloma patients. The Federal Committee on Vaccination in Germany termed “Staendige Impfkommission (STIKO)” clearly recommends annual vaccination. In this pilot project we could demonstrate that in myeloma patients a single shot of seasonal influenza vaccine results only in 20-40% of the vaccinees in sufficient titers of neutralizing antibodies to a single antigen. The frequency of protective titers could be roughly doubled by a vaccine boost which is comparable to results reported for other groups of immunocompromised hosts like patients at hemodialysis or with HIV infection. We therefore recommend an influenza vaccine boost for myeloma patients in general. A prospective, randomized study would be highly appreciated to confirm this recommendation.

Disclosures:
No relevant conflicts of interest to declare.