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Antibody Responses to Polysaccharide and Polysaccharide-Conjugate Vaccines after Treatment of Hodgkin Disease

Deborah C. Molrine, MD; Suzanne George, MD; Nancy Tarbell, MD; Peter Mauch, MD; Lisa Diller, MD; Donna Neuberg, PhD; Robert C. Shamberger, MD; Edwin L. Anderson, MD; Nichole R. Phillips, BA; Karalyn Kinsella, BA; and Donna M. Ambrosino, MD
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From the Dana-Farber Cancer Institute, The Joint Center for Radiation Therapy, and Children's Hospital, Boston, Massachusetts; and Saint Louis University Health Science Center, St. Louis, Missouri. Acknowledgments: Tritiated polyribosylribitol phosphate and human albumin were provided by Dr. Porter Anderson, University of Rochester, Rochester, New York. Dr. George M. Carlone, Centers for Disease Control and Prevention, Atlanta, Georgia, provided the N. meningitidis group A polysaccharide solution. Grant Support: In part by grants A129623 and CA01730 from the National Institutes of Health; Friends of Dana-Farber Cancer Institute; and the David B. Perini, Jr., Quality of Life Program. Dr. Molrine received a Pediatric Infectious Disease Society Fellowship Award funded by Lederle Laboratories. Dr. George received an American Heart Association medical school research fellowship. All vaccines were donated by their manufacturers. Requests for Reprints: Dr. Deborah C. Molrine, Laboratory of Infectious Diseases, Dana-Farber Cancer Institute, JFB Room 410, 44 Binney Street, Boston, MA 02115. Current Author Addresses: Dr. Molrine: Dana-Farber Cancer Institute, JFB Room 410, 44 Binney Street, Boston, MA 02115.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(11):828-834. doi:10.7326/0003-4819-123-11-199512010-00003
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Objective: To compare the immunogenicity of polysaccharide-conjugate vaccines with that of polysaccharide vaccines in patients previously treated for Hodgkin disease.

Design: All patients were immunized with Haemophilus influenzae type b (HIB)-conjugate and 4-valent meningococcal polysaccharide vaccines. Subgroups of patients were randomly assigned to receive either 23-valent pneumococcal polysaccharide vaccine or a 7-valent pneumococcal-conjugate vaccine that links seven pneumococcal serotypes to the outer membrane protein complex of Neisseria meningitidis.

Patients: 144 patients who had completed treatment for Hodgkin disease, which had been diagnosed at least 2 years before the study.

Measurements: Antigen-specific antibody concentrations before and 3 to 6 weeks after immunization; number of persons who achieved anti-HIB antibody concentrations considered to be in the protective range.

Results: The geometric mean anti-HIB antibody concentration increased from 1.79 µg/mL before immunization to 54.1 µg/mL after; the percentage of persons with antibody concentrations in the protective range increased from 62% before immunization to 99% after. Patients immunized with 23-valent pneumococcal vaccine had a geometric mean pneumococcal antibody concentration after immunization (9.15 µg/mL) that was similar to that of healthy controls (10.0 µg/mL) for the seven serotypes measured. In contrast, patients who received 7-valent pneumococcal-conjugate vaccine had a significantly lower mean response compared with patients who received 23-valent vaccine; their geometric mean antibody concentration after immunization was 4.95 µg/mL (P = 0.005).

Conclusion: A single dose of HIB-conjugate vaccine was immunogenic in patients who had completed treatment for Hodgkin disease diagnosed at least 2 years before immunization. In addition, responses to the 23-valent pneumococcal and 4-valent meningococcal vaccines were equivalent to those seen in healthy controls. Finally, patients had a significantly lower response to a single dose of 7-valent pneumococcal-conjugate vaccine than to 23-valent vaccine.


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Figure 1.
Total anti-Haemophilus influenzae type b antibody concentrations in patients with Hodgkin disease, displayed by time since diagnosis. Top.Bottom.

Before immunization. After immunization. Closed circles represent patients who had received HIB vaccine before diagnosis; the solid lines represent the estimated long-term protective level (1.00 µg/mL); and the dashed lines represent the estimated short-term protective level (0.150 µg/mL), as measured by radioimmunoassay.

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