Clinical Interventions in Aging (Oct 2019)
Immunogenicity And Safety Of The 13-Valent Pneumococcal Conjugate Vaccine In Patients With Monoclonal Gammopathy Of Undetermined Significance – Relationship With Selected Immune And Clinical Parameters
Abstract
Marcin Pasiarski,1,2 Barbara Sosnowska-Pasiarska,3 Ewelina Grywalska,4,5 Agnieszka Stelmach-Gołdyś,1 Artur Kowalik,6 Stanisław Góźdź,2,7 Jacek Roliński4,5 1Department of Hematology, Holycross Cancer Center, Kielce, Poland; 2Department of Immunology, Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland; 3Department of Oncocardiology, Holycross Cancer Center, Kielce, Poland; 4Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin, Poland; 5Clinical Immunology Department, St. John’s Cancer Center, Lublin, Poland; 6Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland; 7Department of Oncology, Holycross Cancer Center, Kielce, PolandCorrespondence: Ewelina GrywalskaDepartment of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, Lublin 20-093, PolandTel +48 81 448 6420Fax +48 81 448 6421Email [email protected]: Patients with monoclonal gammopathy of undetermined significance (MGUS) have an increased risk of developing infections. Streptococcus pneumoniae vaccinations are recommended for immunocompromised patients, including patients with lymphoproliferative disorders such as MGUS. The objective of the study was to assess the immune response to the 13-valent pneumococcal conjugate vaccine (PCV13) in treatment-naive MGUS patients versus healthy subjects. All study groups were evaluated for the levels of specific pneumococcal antibodies, the levels of IgG and IgG subclasses, and selected peripheral blood lymphocyte subpopulations, including the proportion of plasmablasts before and after immunization.Patients and methods: A total of 22 previously untreated patients with MGUS and 15 healthy age- and sex-matched volunteers were included in the study. All participants were immunized with PCV13 Prevenar13 (Pfizer). The following parameters were assessed: 1) serum-specific pneumococcal antibody titers before and 30 days after vaccination, 2) percentage of plasmablasts, defined as CD19+/IgD−/CD27++, before and 7 days after vaccination, 3) serum total IgG and IgG1, IgG2, IgG3, IgG4 levels before and 30 days after vaccination.Results and conclusion: PCV13 vaccination in MGUS patients is safe and effectively protects against S. pneumoniae infection. In unvaccinated individuals, vaccination should be carried out as soon as possible after diagnosis. It can protect patients against serious infectious complications, which can contribute to extending the time to progression and transformation into more aggressive diseases. PCV13 vaccination is more effective in MGUS patients with a lower concentration of M protein. Serum M protein concentration in patients diagnosed with MGUS may be a useful predictor of the effectiveness of vaccination.Keywords: 13-valent pneumococcal conjugate vaccine, immune response, monoclonal gammopathy of undetermined significance, M protein, plasmablasts, pneumococcal antibodies
