Use of Live Attenuated Vaccines in Teenagers Treated With Imatinib for CML
Posted: Wednesday, May 27, 2020
Vaccination with live attenuated vaccines may be a safe option for some teenagers with chronic myeloid leukemia (CML) being treated with imatinib, according to a small observational study published in Frontiers in Immunology. “As long as herd immunity against dangerous diseases like measles is not established in many countries, patients with CML require protection,” explained Meinolf Suttorp, MD, PhD, of Technical University Dresden, Germany, and colleagues. “However, in line with observations that memory B cells are lost under exposure to imatinib, revaccination may become necessary.”
The vaccination status of youngsters with CML enrolled in the CML-paed II study was investigated during a measles outbreak in the surrounding area. The researchers identified a cohort of four adolescents (between the ages of 12 and 15) who were seronegative to one or more diseases with a live virus vaccine—measles, mumps, rubella, or varicella—and offered vaccination after detailing the risks and benefits to each patient’s family.
After vaccination, two patients reacted with stable long-term seroconversion. Another patient lost protective titers against measles when assessed 10 months after vaccination, but revaccination resulted in stable seroprotective titers over 12 months after the last vaccination. The final patient did not achieve serum titer conversion against measles and varicella after either the first vaccination or revaccination 3 years later. Live vaccination was well tolerated without acute or long-term side effects in all four patients.
The authors suggested offering live vaccines to patients receiving imatinib if the following prerequisites are met: 1) The patient is in an area with poor herd immunity; 2) the patient is in a stable phase of CML; 3) prior vaccination with an inactivated vaccine resulted in an adequate immune response; and 4) the benefits and risks are discussed in depth with the patient and legal guardians.
Disclosure: The study authors reported no conflicts of interest.