The influence of chemotherapy on response of patients with hematologic malignancies to influenza vaccine.

Bivalent influenza vaccine (containing antigens A/Victoria and A/New Jersey) was administered to 52 patients with hematologic malignancies, and pre- and postvaccination antibody titers to both antigens were determined by hemagglutination-inhibition. In comparison to healthy controls, mean antibody titer elevations were lower for both antigens in all disease groups, being significant (p less than 0.05) for A/Victoria in patients with non-Hodgkin's lymphoma, acute leukemia and lymphoproliferative diseases, and for A/New Jersey in patients with Hodgkin's and non-Hodgkin's lymphomas. In comparison to controls, significant depression of antibody response to both antigens was seen in patients on combination chemotherapy (p less than 0.0005), to a lesser extent in patients on daily single alkylating agent chemotherapy (p less than 0.05), while untreated patients did not differ significantly. Lymphopenia and depressed immunoglobulin levels were associated with a higher failure rate in eliciting "protective" greater than or equal to fourfold antibody titer increases. The findings suggest that patients with hematologic malignancies who are receiving chemotherapy at the time of vaccination are unlikely to attain seroconversion to protective antibody levels with influenza vaccine.