ASCO 2021: Immunity to Childhood Vaccines Following High Dose Chemotherapy and Autologous Stem Cell Transplantation for Germ Cell Tumors With Comparison to Hodgkin Lymphoma

(UroToday.com) High dose chemotherapy/autologous stem cell transplantation represents a curative salvage treatment for patients with germ cell tumors but is rarely used for other solid tumors. Patients undergoing high dose chemotherapy/autologous stem cell transplantation for hematologic neoplasms require revaccination for their childhood immunizations. Whether this is necessary for patients with germ cell tumor patients is unknown. At the 2021 ASCO annual meeting, Dr. Darren Feldman and colleagues presented the results of their study assessing immunity to childhood vaccines following high dose chemotherapy and autologous stem cell transplantation for germ cell tumors with comparison to Hodgkin lymphoma.

In this prospective longitudinal study, patients with germ cell tumors undergoing high dose chemotherapy/autologous stem cell transplantation from November 2010 to May 2018 had serologies for Measles, Mumps, Rubella, Diphtheria, Tetanus, Polio, and Varicella Zoster measured before high dose chemotherapy and at 3, 6, and in a subset, 12+ months after the last high dose chemotherapy with results at these time points compared using descriptive statistics. There were 80 germ cell tumor patients treated with high dose chemotherapy/autologous stem cell transplantation during the study period that met inclusion criteria, in addition to 148 Hodgkin lymphoma patients undergoing high dose chemotherapy/autologous stem cell transplantation during the same time period. Titer levels at ≥6 months post-transplant were matched 1:1 for age and gender with Hodgkin lymphoma patients. Immunity was compared between cohorts using the Cochran-Mantel-Haenszel test.

Among 80 patients with germ cell tumor (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%):

Feldman_ASCO_1.png

Compared to baseline, proportional immunity for all infections was similar at 3, 6, and 12 months post-transplant in the germ cell tumor population. Matching resulted in 58 germ cell tumor-Hodgkin lymphoma pairs. One-year immunity was numerically lower for most infections in the Hodgkin lymphoma versus germ cell tumor patients and significantly decreased for Measles and Rubella:

Feldman_ASCO_2.png

Dr. Feldman concluded his presentation with the following take-home messages:

  • This is the first study to assess vaccine titers following high dose chemotherapy/autologous stem cell transplantation for germ cell tumor patients
  • This study demonstrates that high dose chemotherapy/autologous stem cell transplantation does not result in loss of immunity to childhood vaccines and that germ cell tumor patients retain protective titers more frequently than those with Hodgkin lymphoma
  • However, 15-31% of germ cell tumor patients lack MMR immunity at baseline and at 1-year autologous stem cell transplantation. Therefore, re-checking MMR titers at 1-year post-autologous stem cell transplantation should be done with revaccination of those lacking immunity
  • Titer evaluation and revaccination is not necessary for other childhood immunizations

Presented by: Darren R. Feldman, MD, Medical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY

Co-Authors: 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; 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

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, Virtual Annual Meeting #ASCO21, June, 4-8, 2021

email news signup