Two, High-Dose Flu Shots Help High-Risk Patients Avoid Infection

LAUREN M. GREEN @OncNurseEditor
Monday, December 07, 2015
Although patients with multiple myeloma and other plasma cell disorders (PCDs) are routinely vaccinated against influenza, studies show that a one-time flu shot does not confer an adequate immune response in these high-risk patients. A new pilot study by researchers at the Yale Cancer Center suggests that two, higher-dose vaccinations administered 1 month apart may help.

The findings, presented at the 2015 Annual Meeting of the American Society of Hematology (ASH), showed that when a high-dose flu shot was followed by a second high-dose booster, the flu infection rate was 6%, comparing favorably with the expected rate of 20%.1

The strategy also improved protection against all flu strains covered by the vaccine in about two-thirds of patients, according to the study’s first author, Andrew Branagan, MD.

"Using an approved flu vaccine in a novel dosing schedule yielded promising results for a group of patients at high risk for infection,” Branagan said in a statement. “We hope to confirm these results in a larger, prospective, randomized trial that is under way now at Yale during the 2015-2016 flu season. We suspect this strategy could benefit other cancer patient populations.”

Patients with cancers of the immune system such as multiple myeloma are especially susceptible to common infections, and a bout of the flu can lead to serious illness and even death. Studies have shown that influenza risk may be tenfold higher among patients with PCDs.

Recent research demonstrated that use of a standard-dose flu shot booster improved seroprotection in patients with multiple myeloma.2 The study reported at ASH, however, evaluated using the high-dose Fluzone vaccine, which was approved by the FDA in 2009 for adults aged ≥65 years.

Fifty-one patients with PCDs were enrolled to receive the two-dose Fluzone. Median age of the participants was 75 years. The regimen was well tolerated, and no grade 2 or higher adverse events were attributed to the vaccine. After close clinical follow-up, just 2 of the 51 patients developed confirmed influenza.

Additionally, in the subset of 30 patients with multiple myeloma, only 7% had protective hemaglutination antibody inhibition titers to three seasonal influence vaccine strains at baseline, but after one dose of Fluzone, the seroprotective rate increased to 33% (10 patients)—about double the historically observed rate of 5% to 19%. Analyses of the rate of seroconversion after the second dose are under way, the researchers noted.

1. Branagan AR, Duffy E, Boddupall CS, et al. 3058 Fluzone high-dose influenza vaccine with booster is associated with low rates of influenza infection in patients with plasma cell disorders.
2. Hahn M, Schnitzler P, Schweiger B, et al. Efficacy of single versus boost vaccination against influenza virus in patients with multiple myeloma. Haematologica. 2015;100(7):e285-e288.

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