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Optimal timing of influenza vaccination during 3-week cytotoxic chemotherapy cycles

Authors

  • Bhumsuk Keam MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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    • The first 2 authors contributed equally to this article.

  • Min-Kyung Kim MD, MPH,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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    • The first 2 authors contributed equally to this article.

  • Yunhee Choi PhD,

    1. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
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  • Su-Jin Choi MSc,

    1. Laboratory of Infection and Immunity, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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  • Pyoeng Gyun Choe MD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Kyung-Hun Lee MD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Tae Min Kim MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Tae-Yong Kim MD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Do-Youn Oh MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Dong-Wan Kim MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Seock-Ah Im MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Nam-Joong Kim MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Laboratory of Infection and Immunity, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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  • Dae Seog Heo MD, PhD,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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  • Wan Beom Park MD, PhD,

    Corresponding author
    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Laboratory of Infection and Immunity, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
    • Corresponding author: Wan Beom Park, MD, PhD, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea; Fax: (011) 82-2-762-9662; wbpark1@snu.ac.kr

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  • Myoung-don Oh MD, PhD

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    2. Laboratory of Infection and Immunity, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Abstract

BACKGROUND

Cytopenia occurs frequently during cytotoxic chemotherapy. Little is known about the optimal timing of influenza vaccination for patients receiving chemotherapy. This study compared the immunogenicity of an influenza vaccine administered concurrently with chemotherapy (day 1) and within the cytopenic period (day 11) during 3-week cytotoxic chemotherapy cycles.

METHODS

Adult patients with solid cancer undergoing scheduled 3-week cytotoxic chemotherapy were randomly assigned to receive the 2014-2015 seasonal influenza vaccine on day 1 or 11 during the chemotherapy cycle. Patients were stratified by their age (<60 and ≥60 years) and previous influenza vaccination status. Antibody responses to influenza vaccine strains H1N1, H3N2, and B were measured before and 21 to 28 days after vaccination with a hemagglutination inhibition antibody assay.

RESULTS

Ninety-seven patients were randomized into a day 1 group (n = 43) or a day 11 group (n = 54). Eighty-three patients were included in the final analysis. The mean age was 54 (± 11) years. Cancer types included breast (61%) and lung cancer (30%). Baseline characteristics were not significantly different between the groups. Seroprotection rates after vaccination were also not significantly different for the day 1 and 11 groups (strain H1N1, 67% vs 75% [P = .403]; strain H3N2, 77% vs 80% [P = .772]; strain B, 21% vs 27% [P = .472]). Seroconversion rates and postvaccination geometric mean titers were also similar for the groups. Vaccine-related adverse events were more common in the day 11 group (13% vs. 32%; P = .040).

CONCLUSIONS

The antibody responses to influenza vaccination on days 1 and 11 during a 3-week cytotoxic chemotherapy cycle were comparable. Influenza vaccination can be performed concurrently with cytotoxic chemotherapy or during the cytopenic period. Cancer 2016. © 2016 American Cancer Society.

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