Antibody response of patients with Hodgkin's disease to protein and polysaccharide antigens.

We examined the antibody response of patients with Hodgkin's disease to a variety of vaccines to formulate guidelines for immunization. During and after treatment for Hodgkin's disease, both pre- and postimmunization levels of antibody to Streptococcus pneumoniae, Hemophilus influenzae type b, and tetanus toxoid antigens were significantly lower in patients than in controls. Impairments in the antibody response were most severe in intensively treated patients and improved as the interval between treatment and immunization increased. The primary, but not the secondary, antibody responses to the hemagglutinins of the influenza virus A/Victoria/75 and A/New Jersey/76 also were impaired in treated patients. Before treatment antibody responses to pneumococcal vaccine was normal regardless of the stage of disease unless treatment began within 10 days of immunization. Levels of antibody decreased during therapy in proportion to the intensity of treatment but remained higher than levels in comparably treated patients who were not immunized at diagnosis. We recommend that patients with Hodgkin's disease receive pneumococcal vaccine at diagnosis at least 10 days before initiation of treatment. Patients who are treated before immunization may be immunized several months after treatment, although the response of heavily treated individuals to vaccination may be marginal. More studies are needed to determine whether reimmunization of patients initially immunize at diagnosis is safe and effective.