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Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination

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Abstract

The efficacy of influenza vaccination in patients treated with rituximab is a clinically important question. Rheumatology clinics are populated with patients receiving rituximab for a broad array of disorders. Although several studies have explored the efficacy of other vaccines in rituximab-treated populations, results have been conflicting. We wished to define influenza vaccine efficacy in a rituximab-treated cohort. We examined 17 evaluable subjects treated with rituximab for rheumatologic conditions. T cell subsets, B cells subsets, T cell function, and B cell function were evaluated at specific time points along with hemagglutinination inhibition titers after receiving the standard inactivated influenza vaccine. T cell subset counts were significantly different than controls but did not change with rituximab. B cells depleted in all patients but were in various stages of recovery at the time of vaccination. Influenza vaccine responsiveness was poor overall, with only 16 % of subjects having a four-fold increase in titer. Pre-existing titers were retained throughout the study, however. The ability to respond to the influenza vaccine appeared to be related to the degree of B cell recovery at the time of vaccination. This study emphasizes that antibody responses to vaccine are impaired in subjects treated with rituximab and supports the concept that B cell recovery influences influenza vaccine responsiveness.

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Acknowledgements

The authors would like to thank the patients and the physicians who contributed to this study. The skills of Dr. Yang-Zhu Du, Lytia Fisher and Kristal Dow are gratefully acknowledged. Supported in part by NIH grant NO1-AI-50024, the Arthritis Foundation, the American Autoimmunity Related Disease Association, and R01 AR34156 and R01 AI063626. The authors declare no conflict of interest.

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The authors declare that have no conflict of interest.

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Authors and Affiliations

  1. Division of Rheumatology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Robert A. Eisenberg

  2. Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Abbas F. Jawad

  3. Abramson Cancer Center, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jean Boyer

  4. Division of Allergy Immunology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Kelly Maurer, Kenyetta McDonald & Kathleen E Sullivan

  5. Department of Pathology and Laboratory Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Eline T. Luning Prak

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  1. Robert A. Eisenberg
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  7. Kathleen E Sullivan
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Correspondence to Kathleen E Sullivan.

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Eisenberg, R.A., Jawad, A.F., Boyer, J. et al. Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination. J Clin Immunol 33, 388–396 (2013). https://doi.org/10.1007/s10875-012-9813-x

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