Predictive markers for humoral influenza vaccine response in patients with common variable immunodeficiency - 06/12/18
, Hassan Abolhassani, MD, PhD a, b, g, Rolf Gustafson, MD, PhD c, Lars E. Eriksson, RN, MSc, PhD d, e, f, Lennart Hammarström, MD, PhD a, bAbstract |
Background |
A subgroup of patients with common variable immunodeficiencies (CVIDs) responds to vaccination. The aim of this study was to try to identify predictive markers for those with a humoral immune response after influenza vaccination.
Methods |
Forty-eight patients with CVID (29 female and 19 male patients; mean age, 57.7 years) were vaccinated with the A(H1N1) influenza vaccine Pandemrix (GlaxoSmithKline, Wavre, Belgium) and boosted after 1 month. Blood samples were collected before each vaccination and 2 months later. Patients with a 4-fold titer increase in results on the hemagglutinin inhibition test (≥1:40) were considered responders and compared with nonresponders for clinical, immunologic, and genetic markers.
Results |
Eight (16.7%) patients responded to the vaccination. A significantly higher proportion of the responders, who showed a EUROclass SmB−Trnorm21norm profile (P = .03) with a post–germinal center B-cell pattern (P = .04) in blood, experienced enteropathies (P = .04) compared with nonresponders. On the other hand, bronchiectasis was found exclusively among nonresponders (n = 7), as was autoimmune cytopenia (n = 5). Nonresponders with a EUROclass SmB−Trnorm21low profile (P = .02) had a significantly greater prevalence of progressive antibody deficiency (P = .048) and, at diagnosis, a higher mean serum IgM level (P = .03), lower mean serum IgG1 level (P = .007), expansion of absolute counts of cytotoxic CD8+ T cells (P = .033), and increased proportion of memory CD8+ T cells (P = .044) in blood. CVID-associated HLA markers were not detected in responders (P = .03).
Conclusion |
About one fifth of the patients with CVIDs achieved protective antibody levels after A(H1N1) vaccination and selected clinical, and immunologic markers were identified that might predict a positive outcome of influenza vaccination. Patients with CVID should be offered vaccination also against seasonal influenza because of the potential severity of the infection and risk for bacterial complications.
Le texte complet de cet article est disponible en PDF.Key words : Common variable immunodeficiency, specific antibody deficiency, vaccination, influenza, pandemic influenza, immune response, A(H1N1), Pandemrix
Abbreviations used : CVID, HA, PID, TACI
Plan
| Supported by the Jeffrey Modell Foundation, New York, NY, and the Swedish Research Council, Stockholm, Sweden. |
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| Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
Vol 142 - N° 6
P. 1922 - décembre 2018 Retour au numéro
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