Strowd Roy E, Swett Katrina, Harmon Michele, Carter Annette F, Pop-Vicas Aurora, Chan Michael, Tatter Stephen B, Ellis Thomas, Blevins Maria, High Kevin, Lesser Glenn J
Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (R.E.S.); Department of Biostatistics, Wake Forest School of Public Health, Wake Forest University Health Sciences, Winston-Salem, North Carolina (K.S.); Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.H., A.F.C., G.J.L.); Division of Infectious Disease, Alpert Medical School at Brown University, Providence, Rhode Island (A.P.); Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.B.T.); Department of Internal Medicine, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina (M.B., K.H.).
Neuro Oncol. 2014 Dec;16(12):1639-44. doi: 10.1093/neuonc/nou051. Epub 2014 Apr 8.
Patients with central nervous system (CNS) malignancies represent an "at-risk" population for contracting influenza, particularly if they are receiving ongoing chemotherapy, radiation, and/or glucocorticoid treatment. The Centers for Disease Control endorses vaccination for these patients, although data are not available to indicate whether they mount an immunologic response adequate to achieve clinical protection.
A pilot prospective cohort study was designed to evaluate the immunogenicity of the standard-dose trivalent inactivated influenza vaccine in patients with malignant CNS tumors. Baseline data collection included diagnosis, chemotherapy, timing of chemotherapy or radiation relative to vaccination, and glucocorticoid dose. Serum samples were collected at baseline, day 14, day 28, and month 3 following vaccination. Samples were tested using hemagglutinin inhibition to determine seroconversion (4-fold rise in titer) and seroprotection (titer >1:40).
A total of 38 patients were enrolled (mean age, 54 years ±13.5 years, 60.5% male, 94.7% Caucasian, and 5.3% African American). CNS tumor diagnoses included glioblastoma multiforme (55.2%), other high-grade glioma (13.2%), low-grade glioma (15.8%), and primary CNS lymphoma (15.8%). At enrollment, 20 patients (52.6%) were taking glucocorticoids, 25 (65.8%) were on active chemotherapy, and 3 (7.9%) were undergoing radiation. Seroconversion rates at day 28 for the A/H1N1, A/H3N2, and B strains were 37%, 23% and 23%, respectively. Seroprotection was 80%, 69%, and 74%, respectively. All rates were significantly lower than published rates in healthy adults (P < .001).
Influenza vaccine immunogenicity is significantly reduced in patients with CNS malignancies. Future studies are needed to determine the causative etiologies and appropriate vaccination strategies.
中枢神经系统（CNS）恶性肿瘤患者是感染流感的“高危”人群，特别是那些正在接受化疗、放疗和/或糖皮质激素治疗的患者。疾病控制中心支持这些患者接种疫苗，尽管尚无数据表明他们是否能产生足以实现临床保护的免疫反应。
设计了一项前瞻性队列试验研究，以评估标准剂量三价灭活流感疫苗对恶性CNS肿瘤患者的免疫原性。基线数据收集包括诊断、化疗、化疗或放疗相对于疫苗接种的时间以及糖皮质激素剂量。在接种疫苗后的基线、第14天、第28天和第3个月采集血清样本。使用血凝抑制试验检测样本，以确定血清转化（滴度升高4倍）和血清保护（滴度>1:40）。
共纳入38例患者（平均年龄54岁±13.5岁，男性占60.5%，白种人占94.7%，非裔美国人占5.3%）。CNS肿瘤诊断包括多形性胶质母细胞瘤（55.2%）、其他高级别胶质瘤（13.2%）、低级别胶质瘤（15.8%）和原发性CNS淋巴瘤（15.8%）。入组时，20例患者（52.6%）正在服用糖皮质激素，25例（65.8%）正在接受积极化疗，3例（7.9%）正在接受放疗。A/H1N1、A/H3N2和B株在第28天的血清转化率分别为37%、23%和23%。血清保护率分别为80%、69%和74%。所有比率均显著低于健康成年人的公布比率（P<.001）。
CNS恶性肿瘤患者的流感疫苗免疫原性显著降低。需要进一步的研究来确定病因和合适的疫苗接种策略。
