Impaired Antibody Response to Pneumococcal Vaccine after Treatment for Hodgkin's Disease

To determine if a normal antibody response can develop after therapy for Hodgkin's disease, we immunized 53 patients and 10 normal controls with dodecavalent pneumococcal vaccine. Antibody concentrations three weeks after immunization (geometric mean of 11 serotypes) were 1566 ng of protein nitrogen per milliliter in controls, 963 ng per milliliter after subtotal radiation (P<0.05 compared to controls), 658 ng per milliliter after chemotherapy (P<0.05), 377 ng per milliliter after subtotal radiation plus chemotherapy (P<0.01) and 283 ng per milliliter after total nodal radiation plus chemotherapy (P<0.001). Low levels of antibody before immunization correlated with a poor response (r = +0.73, P<0.001). The ability to respond to immunization improved significantly but did not return to normal as long as four years after combined therapy. The antibody response to pneumococcal vaccine is profoundly impaired in patients who have received intensive treatment for Hodgkin's disease: the ability of this vaccine to protect them from overwhelming postsplenectomy infections remains in doubt. (N Engl J Med 299:442–448, 1978) SPLENECTOMIZED patients are at increased risk from infections caused by encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae Type b and Neisseria meningitidis.^{1 2 3 4 5 6 7 8 9} The clinical course is frequently fulminant, leading to disseminated intravascular coagulation and death within hours.¹² The risk of splenectomy or splenic dysfunction is highest in young children,¹² in patients with disorders of reticuloendothelial function such as thalassemia major or sickle-cell anemia,³⁴ and in those who have received immunosuppressive therapy for hematologic cancer^{5 6 7 8} or renal transplantation.⁹ In patients with Hodgkin's disease the frequency of overwhelming post-splenectomy infections is related to the therapy.⁷ In as many as 20 per.