Immunity to childhood vaccines following high dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) for germ cell tumors (GCT) with comparison to Hodgkin lymphoma (HL).

Authors

null

Darren R. Feldman

Memorial Sloan Kettering Cancer Center, New York, NY

Darren R. Feldman , Akeem Ronell Lewis , Andrea Knezevic , David Ali , Maria Bromberg , Julia Aronson , Samuel Aaron Funt , Deaglan Joseph McHugh , Robert J. Motzer , Dean F. Bajorin , Sujata Patil , Gunjan L. Shah , Monika Shah , Susan Seo , Mini Kamboj , Miguel-Angel Perales , Genofeva Papanicolaou

Organizations

Memorial Sloan Kettering Cancer Center, New York, NY, Mayo Clinic, Rochester, MN, Robert Wood Johnson Medical School, New Brunswick, NJ, Mount Sinai West, New York, NY

Research Funding

Other Foundation
Craig D. Tifford Fund and the The Louise B. Blackman Foundation

Background: HDCT/ASCT represents a curative salvage treatment for patients with GCT but is rarely used for other solid tumors. Patients undergoing HDCT/ASCT for hematologic neoplasms require revaccination for their childhood immunizations. Whether this is necessary in patients with GCT is unknown. Methods: In this prospective longitudinal study, patients with GCT undergoing HDCT-ASCT from 11/2010 to 5/2018 had serologies for Measles, Mumps, Rubella, Diphtheria, Tetanus, Polio, and Varicella Zoster measured before HDCT and at 3, 6, and in a subset, 12+ months after the last HDCT with results at these timepoints compared using descriptive statistics. In addition, titer levels at ≥6 months post-transplant were matched 1:1 for age and gender with HL patients who underwent HDCT/ASCT during the same time period. Immunity was compared between cohorts using the Cochran-Mantel-Haenszel test. Results: Of 80 patients with GCT (median age 30, 84% nonseminoma), 91% received 3 sequential transplants and 68 had repeat titers at ≥6 months. Immunity at baseline was >95% for Diphtheria, Tetanus and Polio and 89% for Varicella Zoster but lower for Measles (74%), Mumps (85%), and Rubella (83%) (Table). Compared to baseline, proportional immunity for all infections was similar at 3, 6, and 12 months post-transplant in the GCT population (≥6 months shown in Table). Matching resulted in 58 GCT-HL pairs. One-year immunity was numerically lower for most infections in the HL vs. GCT patients and significantly decreased for Measles and Rubella (Table). Conclusions: To our knowledge, this is the first study to assess vaccine titers following HDCT/ASCT for GCT. We demonstrate that HDCT/ASCT does not result in loss of immunity to childhood vaccines and that GCT patients retain protective titers more frequently than those with HL. However, 15-31% of GCT patients lack MMR immunity at baseline and at 1-year post-ASCT. Therefore, we recommend checking MMR titers at 1-year post-ASCT with revaccination of those lacking immunity. Titer evaluation and revaccination is not necessary for other childhood immunizations.

Proportion of patients with immunity to childhood vaccines.

Disease/Vaccine
GCT Cohort
Matched GCT/HL Cohorts at ≥ 6 months
Baseline
≥ 6 months
GCT
HL
P
N
N (%)
N
N (%)
N
N (%)
N
N (%)
Diphtheria7878 (100)6868 (100)5858 (100)5857 (98)0.32
Tetanus8078 (98)6766 (99)5857 (98)5754 (95)0.30
Polio 17975 (95)6864 (94)5855 (95)5852 (90)0.29
Polio 37977 (98)6868 (100)5858 (100)5858 (100)-
Measles8059 (74)6547 (69)5842 (72)5828 (48)0.03
Mumps7967 (85)6856 (82)5849 (85)5843 (74)0.37
Rubella8080 (83)6852 (77)5848 (83)5837 (64)0.05
Var. zoster8071 (89)6858 (87)5850 (86)5545 (82)0.57

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Germ Cell/Testicular Cancer

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 5017)

DOI

10.1200/JCO.2021.39.15_suppl.5017

Abstract #

5017

Abstract Disclosures