Haggenburg Sabine, Garcia Garrido Hannah M, Kant Iris M J, Van der Straaten Hanneke M, De Boer Fransien, Kersting Sabina, Issa Djamila, Te Raa Doreen, Visser Hein P J, Kater Arnon P, Goorhuis Abraham, De Heer Koen
Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Vaccines (Basel). 2023 Jul 4;11(7):1201. doi: 10.3390/vaccines11071201.
Patients with Chronic Lymphocytic Leukemia (CLL) have a 29- to 36-fold increased risk of invasive pneumococcal disease (IPD) compared to healthy adults. Therefore, most guidelines recommend vaccination with the 13-valent pneumococcal conjugated vaccine (PCV13) followed 2 months later by the 23-valent polysaccharide vaccine (PPSV23). Because both CLL as well as immunosuppressive treatment have been identified as major determinants of immunogenicity, we aimed to assess the vaccination schedule in untreated and treated CLL patients. We quantified pneumococcal IgG concentrations against five serotypes shared across both vaccines, and against four serotypes unique to PPSV23, before and eight weeks after vaccination. In this retrospective cohort study, we included 143 CLL patients, either treated (n = 38) or naive to treatment (n = 105). While antibody concentrations increased significantly after vaccination, the overall serologic response was low (10.5%), defined as a ≥4-fold antibody increase against ≥70% of the measured serotypes, and significantly influenced by treatment status and prior lymphocyte number. The serologic protection rate, defined as an antibody concentration of ≥1.3 µg/mL for ≥70% of serotypes, was 13% in untreated and 3% in treated CLL patients. Future research should focus on vaccine regimens with a higher immunogenic potential, such as multi-dose schedules with higher-valent T cell dependent conjugated vaccines.
与健康成年人相比，慢性淋巴细胞白血病（CLL）患者发生侵袭性肺炎球菌疾病（IPD）的风险增加了29至36倍。因此，大多数指南建议接种13价肺炎球菌结合疫苗（PCV13），并在2个月后接种23价多糖疫苗（PPSV23）。由于CLL以及免疫抑制治疗均被确定为免疫原性的主要决定因素，我们旨在评估未治疗和已治疗的CLL患者的疫苗接种方案。我们在接种疫苗前和接种后8周，对两种疫苗共有的5种血清型以及PPSV23特有的4种血清型的肺炎球菌IgG浓度进行了定量。在这项回顾性队列研究中，我们纳入了143例CLL患者，其中38例接受过治疗，105例未接受过治疗。虽然接种疫苗后抗体浓度显著增加，但总体血清学反应较低（10.5%），血清学反应定义为针对≥70%的检测血清型抗体增加≥4倍，且受治疗状态和既往淋巴细胞数量的显著影响。血清学保护率定义为≥70%的血清型抗体浓度≥1.3µg/mL，未治疗的CLL患者中为13%，接受过治疗的CLL患者中为3%。未来的研究应聚焦于具有更高免疫原性潜力的疫苗方案，如使用更高价T细胞依赖性结合疫苗的多剂量方案。
