Dept of Child Health, St George's, University of London, London, England.
Clin Infect Dis. 2010 Dec 15;51(12):e95-104. doi: 10.1086/657403. Epub 2010 Nov 10.
Children with cancer have an increased susceptibility to influenza infection. The objective of this study was to assess the immunogenicity of pandemic (H1N1) 2009 vaccine in children with cancer.
Children were recruited from the Royal Marsden Hospital, England, during November 2009. The vaccination schedule consisted of 2 doses of an AS03(B)-adjuvanted vaccine given at days 0 and 21. Serological analysis was performed on blood samples obtained at day 0 and day 42. The primary immunological end point was the seroconversion rate, which was defined as the proportion of subjects with an individual 4-fold increase in hemagglutination inhibition titer and a postvaccination hemagglutination inhibition titer ≥1:32.
Fifty-four children with a median age of 6.3 years (range, 1.4-16.6 years) were vaccinated and had samples taken for serological analysis. Twenty-four (44.4%) of 54 children demonstrated seroconversion. Seroconversion rates were 33.3% (9 of 27) among children with acute lymphoblastic leukemia, 36.4% (4 of 11) among those with lymphoma or other leukemias, 66.7% (6 of 9) among those with brain tumors, and 71.4% (5 of 7) among those with other solid tumors. Seroconversion occurred in 4 (28.6%) of 14 children receiving acute lymphoblastic leukemia maintenance therapy. Univariate analysis showed significantly higher responses among children with solid tumors, compared with those with hematological malignancies (11 [68.8%] of 16 vs 13 [34.2%] of 38; P = .03), and among those not receiving treatment, compared with those receiving treatment (7 [87.5%] of 8 vs 17 [37.0%] of 46; P = .02). Multivariable analysis showed that age, cancer type, and lymphopenia did not influence seroconversion rates.
These data suggest that this AS03(B)-adjuvanted pandemic (H1N1) 2009 vaccine can induce limited but useful protective immune responses in children with cancer.
癌症患儿对流感感染的易感性增加。本研究的目的是评估 2009 年大流行（H1N1）疫苗在癌症患儿中的免疫原性。
2009 年 11 月，从英国皇家马斯登医院招募患儿。疫苗接种方案包括在第 0 天和第 21 天接种 2 剂 AS03（B）佐剂疫苗。在第 0 天和第 42 天采集血样进行血清学分析。主要免疫学终点为血清转化率，定义为个体血凝抑制滴度增加 4 倍且接种后血凝抑制滴度≥1:32 的受试者比例。
54 例中位年龄为 6.3 岁（范围为 1.4-16.6 岁）的患儿接受了疫苗接种，并采集了血清学分析样本。54 例患儿中有 24 例（44.4%）发生血清转化率。血清转化率在急性淋巴细胞白血病患儿中为 33.3%（27 例中的 9 例），在淋巴瘤或其他白血病患儿中为 36.4%（11 例中的 4 例），在脑肿瘤患儿中为 66.7%（9 例中的 6 例），在其他实体瘤患儿中为 71.4%（7 例中的 5 例）。在接受急性淋巴细胞白血病维持治疗的 14 例患儿中，有 4 例（28.6%）发生血清转化率。单变量分析显示，与血液系统恶性肿瘤患儿相比，实体瘤患儿的反应显著更高（16 例中有 11 例[68.8%]，38 例中有 13 例[34.2%]；P=0.03），与接受治疗的患儿相比，未接受治疗的患儿的反应更高（8 例中有 7 例[87.5%]，46 例中有 17 例[37.0%]；P=0.02）。多变量分析显示，年龄、癌症类型和淋巴细胞减少症并未影响血清转化率。
这些数据表明，这种 AS03（B）佐剂的 2009 年大流行（H1N1）疫苗可以在癌症患儿中诱导有限但有用的保护性免疫反应。
