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Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group.
Vaccine. 2018 06 14; 36(25):3701-3707.V

Abstract

AIM

To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response.

BACKGROUND

Streptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking.

METHODS

128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA).

RESULTS

PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated.

CONCLUSIONS

In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease.

Authors+Show Affiliations

Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden. Electronic address: tobias.svensson@akademiska.se.Department of Medicine, Section of Hematology, Örebro University Hospital, Örebro, Sweden.Department of Medicine, Falun Hospital, Falun, Sweden.Institution of Clinical Sciences, Faculty of Medicine, Lund University Hospital, Lund, Sweden.Department of Medicine, Section of Hematology, South Älvsborg Hospital, Borås, Sweden.Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden.Department of Medicine, Karlstad Hospital, Karlstad, Sweden.Department of Medicine, Eskilstuna Hospital, Eskilstuna, Sweden.Department of Medical Sciences, Section of Hematology, Uppsala University, Uppsala, Sweden.Department of Medicine, Unit of Hematology, Karolinska Institute and Karolinska University Hospital, Huddinge, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29748028

Citation

Svensson, Tobias, et al. "Pneumococcal Conjugate Vaccine Triggers a Better Immune Response Than Pneumococcal Polysaccharide Vaccine in Patients With Chronic Lymphocytic Leukemia a Randomized Study By the Swedish CLL Group." Vaccine, vol. 36, no. 25, 2018, pp. 3701-3707.
Svensson T, Kättström M, Hammarlund Y, et al. Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Vaccine. 2018;36(25):3701-3707.
Svensson, T., Kättström, M., Hammarlund, Y., Roth, D., Andersson, P. O., Svensson, M., Nilsson, I., Rombo, L., Cherif, H., & Kimby, E. (2018). Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Vaccine, 36(25), 3701-3707. https://doi.org/10.1016/j.vaccine.2018.05.012
Svensson T, et al. Pneumococcal Conjugate Vaccine Triggers a Better Immune Response Than Pneumococcal Polysaccharide Vaccine in Patients With Chronic Lymphocytic Leukemia a Randomized Study By the Swedish CLL Group. Vaccine. 2018 06 14;36(25):3701-3707. PubMed PMID: 29748028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. AU - Svensson,Tobias, AU - Kättström,Magdalena, AU - Hammarlund,Ylva, AU - Roth,Daniel, AU - Andersson,P-O, AU - Svensson,Magnus, AU - Nilsson,Ingmar, AU - Rombo,Lars, AU - Cherif,Honar, AU - Kimby,Eva, Y1 - 2018/05/07/ PY - 2017/11/10/received PY - 2018/05/01/revised PY - 2018/05/02/accepted PY - 2018/5/12/pubmed PY - 2018/9/27/medline PY - 2018/5/12/entrez KW - Chronic lymphocytic leukemia (CLL) KW - Immunogenicity KW - Pneumococcal vaccine KW - Polysaccharide vaccine KW - Protein-conjugate vaccine SP - 3701 EP - 3707 JF - Vaccine JO - Vaccine VL - 36 IS - 25 N2 - AIM: To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response. BACKGROUND: Streptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking. METHODS: 128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA). RESULTS: PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated. CONCLUSIONS: In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/29748028/Pneumococcal_conjugate_vaccine_triggers_a_better_immune_response_than_pneumococcal_polysaccharide_vaccine_in_patients_with_chronic_lymphocytic_leukemia_A_randomized_study_by_the_Swedish_CLL_group_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(18)30619-4 DB - PRIME DP - Unbound Medicine ER -