One of the many reasons public health officials recommend the flu shot for everyone is that those with a lower risk of catching the flu also have a lower likelihood of passing it on to more vulnerable populations, such as children, senior adults and cancer patients.
Now a new study has found a way to reduce the risk of flu to myeloma cancer patients even further, by giving them two doses of the high-dose flu vaccine designed for older adults.
“This has been an unmet need for quite some time across many cancers,” said senior study author Dr. Madhav Dhodapkar, chief of the section of hematology at Yale Cancer Center. Most cancer patients are already recommended to receive the flu vaccine, but it’s not often very effective for them.
“People with cancer in general, including myeloma, have a poor responses to vaccinations,” Dhodapkar said. The problem is even more exaggerated in patients with plasma cell disorders because those are the cells responsible for making antibodies in the first place. When cancerous cells crowd out healthy plasma cells, patients’ immune systems cannot mount a defense in response to the vaccine and the patients have an even greater risk of infection because their antibody production is suppressed.
In fact, these patients are about 10 times more likely to catch influenza, with about one in five getting sick from the flu every year. Although the vaccine’s effectiveness in these patients ranges from only 5%-19%, clinicians continue to routinely recommend it because it was the only option for some protection. Until now.
In research presented at the annual meeting of the American Society of Hematology in Orlando, Florida, Dhodapkar and his colleagues showed that only 4% of 51 patients with plasma cell disorders developed lab-confirmed influenza during a season when they received two doses, a month apart, of the Fluzone high-dose vaccine, manufactured by
Because the trial was small and did not include a comparison (control) group, what we can conclude from it is limited, and there’s no guarantee that it was the vaccine that led the flu infection ate to be so low for a change. However, the researchers also collected data on 30 multiple myeloma patients’ immune response that suggests this strategy really does result in better protection against the flu. After one dose of the high-dose vaccine, a third of the patients tested positive for titers (antibody levels) for all three vaccine strains. This seroprotection rate of 33% is considerably higher than the 5% to 19% typically seen after the standard flu vaccine in these patients.
“To us, this is interesting because it’s a relatively simple intervention which could have a major impact on patients,” Dhodapkar said. “We give flu vaccines all the time to our patients every year and we tell them we recommend it because it’s what recommended by every health organization, but we also warn them that this doesn’t mean you won’t get the flu.”
Of course, getting a double dose of the high-dose Fluzone doesn’t guarantee they won’t get the flu either, but their chances seem considerably diminished. The researchers are planning a randomized, controlled trial for the 2015-2016 season that compares the two-dose high-dose regime to standard care with a regular flu vaccine to find out.
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