Clinical Scorecard: Exploring T-Cell Responses Induced by Influenza Vaccination in Patients with Hematological Malignancies: A Commentary on Findings by Hall et al

At a Glance

Key Highlights

• Patients with hematological malignancies have up to 10-fold higher in-hospital mortality from seasonal influenza compared to the general population.
• Influenza-specific cellular immunity (IFN-γ–producing CD4⁺ and CD8⁺ T cells, mucosal-associated invariant T cells, natural killer cells) is preserved despite severely reduced humoral responses.
• Influenza vaccination is generally well tolerated and may provide robust cellular immune responses even in patients with prolonged B-cell depletion.

Guideline-Based Recommendations

Diagnosis

• Assess both humoral and cellular immune responses to influenza vaccination in patients with hematological malignancies to capture full vaccine-induced immunity.

Management

• Administer influenza vaccination before B-cell depleting treatments when possible.
• If vaccination prior to treatment is missed, vaccinate after treatment due to preserved T-cell responses despite B-cell depletion.
• Encourage influenza vaccination uptake in this high-risk population given the risk of severe infection and vaccine tolerability.

Monitoring & Follow-up

• Monitor T-cell and B-cell immune responses longitudinally, considering potential waning of antibody titers within 6 months post-vaccination.
• Include T-cell subpopulation analyses to better understand protection mechanisms against influenza infection and complications.

Risks

• High risk of severe influenza infection and mortality in patients with hematological malignancies, especially those with impaired humoral immunity.
• Suboptimal vaccination uptake increases vulnerability during active viral circulation.

Patient & Prescribing Data

Patients with hematological malignancies, including those receiving anti-CD20 therapies and CAR-T cell therapy

Despite blunted antibody responses, preserved cellular immunity supports influenza vaccination efficacy; vaccination timing should consider treatment schedules but should not be delayed due to prolonged B-cell depletion.

Clinical Best Practices

• Incorporate T-cell immunity assessments alongside antibody measurements in vaccine response evaluations.
• Prioritize influenza vaccination before initiating B-cell depleting therapies when feasible.
• Do not withhold influenza vaccination post-treatment due to expected preserved T-cell responses.
• Promote influenza vaccine uptake actively in hematological malignancy patients given their high risk and vaccine tolerability.
• Conduct larger cohort studies to strengthen evidence on immune responses and optimize vaccination strategies.

References

• Hall et al study on influenza vaccination immunogenicity
• Mortality risk in hematological malignancy patients with influenza
• T-cell responses predict influenza protection in older adults
• Impact of anti-CD20 treatments on humoral vaccine responses
• Humoral and cellular immunity after CAR-T therapy
• T-cell immunity to COVID-19 vaccines despite absent antibodies
• Antibody waning post-influenza vaccination in non-Hodgkin lymphoma
• Retention of immunity after CD19- and BCMA-directed CAR-T therapy
• Influenza vaccination uptake in hematological malignancy patients
• Safety and tolerability of influenza vaccines in hematological malignancies