Predictive Markers for Humoral Influenza Vaccine Response in Patients With Common Variable Immunodeficiency Publisher Pubmed



Gardulf A^{1, 3} ; Abolhassani H^{1, 3, 7} ; Gustafson R⁵ ; Eriksson LE^{2, 4, 6} ; Hammarstrom L^{1, 3}
Source: Journal of Allergy and Clinical Immunology Published:2018

Abstract

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. © 2018