Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors
BackgroundInfluenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious...
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-03-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/7/1/53.full |
| _version_ | 1831775873084162048 |
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| author | Justine V. Cohen Doll Lauren Alexandra Golden Syed S. Mahmood Raza M. Alvi Nathaniel D. Mercaldo Malek Z. O. Hassan Adam Rokicki Connor Mulligan Sean P. T. Murphy Maeve Jones-O’Connor Lucie M. Heinzerling Rongras Damrongwatanasuk Carol L. Chen Michael C. Kirchberger Sachin P. Shah Muhammad A. Rizvi Carlo G. Tocchetti Valentina Mercurio Donald P. Lawrence John D. Groarke Michael G. Fradley Kerry L. Reynolds Tomas G. Neilan |
| author_facet | Justine V. Cohen Doll Lauren Alexandra Golden Syed S. Mahmood Raza M. Alvi Nathaniel D. Mercaldo Malek Z. O. Hassan Adam Rokicki Connor Mulligan Sean P. T. Murphy Maeve Jones-O’Connor Lucie M. Heinzerling Rongras Damrongwatanasuk Carol L. Chen Michael C. Kirchberger Sachin P. Shah Muhammad A. Rizvi Carlo G. Tocchetti Valentina Mercurio Donald P. Lawrence John D. Groarke Michael G. Fradley Kerry L. Reynolds Tomas G. Neilan |
| author_sort | Justine V. Cohen |
| collection | DOAJ |
| description | BackgroundInfluenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs.MethodsPatients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death.ResultsThe FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002).ConclusionThe rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV. |
| first_indexed | 2024-12-22T09:22:46Z |
| format | Article |
| id | doaj.art-23d13b13f69045c4aed81f89294aab8e |
| institution | Directory Open Access Journal |
| issn | 2051-1426 |
| language | English |
| last_indexed | 2024-12-22T09:22:46Z |
| publishDate | 2019-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj.art-23d13b13f69045c4aed81f89294aab8e2022-12-21T18:31:09ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262019-03-017110.1186/s40425-019-0535-yInfluenza vaccination and myocarditis among patients receiving immune checkpoint inhibitorsJustine V. Cohen0Doll Lauren Alexandra Golden1Syed S. Mahmood2Raza M. Alvi3Nathaniel D. Mercaldo4Malek Z. O. Hassan5Adam Rokicki6Connor Mulligan7Sean P. T. Murphy8Maeve Jones-O’Connor9Lucie M. Heinzerling10Rongras Damrongwatanasuk11Carol L. Chen12Michael C. Kirchberger13Sachin P. Shah14Muhammad A. Rizvi15Carlo G. Tocchetti16Valentina Mercurio17Donald P. Lawrence18John D. Groarke19Michael G. Fradley20Kerry L. Reynolds21Tomas G. Neilan22Aff2 000000041936754Xgrid.38142.3cHarvard Medical School 02115 Boston MA USA Aff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff2 0000 0000 8499 1112grid.413734.6Cardiology DivisionNew York-Presbyterian Hospital, Weill Cornell Medical Center New York NY USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USAAff4 Department of DermatologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) Erlangen GermanyAff5 Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine Tampa FL USAAff6 0000 0001 2171 9952grid.51462.34Cardiology DivisionMemorial Sloan Kettering Cancer Center, Weill Cornell Medical College New York NY USAAff4 Department of DermatologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU) Erlangen GermanyAff8 grid.419182.7Cardiology DivisionLahey Hospital & Medical Center Burlington MA USAAff10 0000 0004 0443 0913grid.413625.7Division of Oncology and Hematology, Department of MedicineLehigh Valley Hospital Allentown PA USAAff13 0000 0001 0790 385Xgrid.4691.aDepartment of Translational Medical SciencesFederico II University Naples ItalyAff13 0000 0001 0790 385Xgrid.4691.aDepartment of Translational Medical SciencesFederico II University Naples ItalyAff3 0000 0004 0386 9924grid.32224.35Division of Oncology and Hematology, Department of MedicineMassachusetts General Hospital Boston MA USAAff17 0000 0004 0378 8294grid.62560.37Cardio-Oncology Program, Division of Cardiology, Department of MedicineBrigham and Women’s Hospital Boston MA USAAff5 Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine Tampa FL USAAff3 0000 0004 0386 9924grid.32224.35Division of Oncology and Hematology, Department of MedicineMassachusetts General Hospital Boston MA USAAff1 0000 0004 0386 9924grid.32224.35Cardiac MR PET CT Program, Department of RadiologyMassachusetts General Hospital 165 Cambridge Street, Suite 400 02114 Boston MA USA BackgroundInfluenza vaccination (FV) is recommended for patients with cancer. Recent data suggested that the administration of the FV was associated with an increase in immune-related adverse events (irAEs) among patients on immune checkpoint inhibitors (ICIs). Myocarditis is an uncommon but serious complication of ICIs and may also result from infection with influenza. There are no data testing the relationship between FV and the development of myocarditis on ICIs.MethodsPatients on ICIs who developed myocarditis (n = 101) (cases) were compared to ICI-treated patients (n = 201) without myocarditis (controls). A patient was defined as having the FV if they were administered the FV from 6 months prior to start of ICI to anytime during ICI therapy. Alternate thresholds for FV status were also tested. The primary comparison of interest was the rate of FV between cases and controls. Patients with myocarditis were followed for major adverse cardiac events (MACE), defined as the composite of cardiogenic shock, cardiac arrest, hemodynamically significant complete heart block and cardiovascular death.ResultsThe FV was administered to 25% of the myocarditis cases compared to 40% of the non-myocarditis ICI-treated controls (p = 0.01). Similar findings of lower rates of FV administration were noted among myocarditis cases when alternate thresholds were tested. Among the myocarditis cases, those who were vaccinated had 3-fold lower troponin levels when compared to unvaccinated cases (FV vs. No FV: 0.12 [0.02, 0.47] vs. 0.40 [0.11, 1.26] ng/ml, p = 0.02). Within myocarditis cases, those administered the FV also had a lower rate of other irAEs when compared to unvaccinated cases (36 vs. 55% p = 0.10) including lower rates of pneumonitis (12 vs. 36%, p = 0.03). During follow-up (175 [IQR 89, 363] days), 47% of myocarditis cases experienced a MACE. Myocarditis cases who received the FV were at a lower risk of cumulative MACE when compared to unvaccinated cases (24 vs. 59%, p = 0.002).ConclusionThe rate of FV among ICI-related myocarditis cases was lower than controls on ICIs who did not develop myocarditis. In those who developed myocarditis related to an ICI, there was less myocardial injury and a lower risk of MACE among those who were administered the FV.https://jitc.bmj.com/content/7/1/53.full |
| spellingShingle | Justine V. Cohen Doll Lauren Alexandra Golden Syed S. Mahmood Raza M. Alvi Nathaniel D. Mercaldo Malek Z. O. Hassan Adam Rokicki Connor Mulligan Sean P. T. Murphy Maeve Jones-O’Connor Lucie M. Heinzerling Rongras Damrongwatanasuk Carol L. Chen Michael C. Kirchberger Sachin P. Shah Muhammad A. Rizvi Carlo G. Tocchetti Valentina Mercurio Donald P. Lawrence John D. Groarke Michael G. Fradley Kerry L. Reynolds Tomas G. Neilan Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors Journal for ImmunoTherapy of Cancer |
| title | Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| title_full | Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| title_fullStr | Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| title_full_unstemmed | Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| title_short | Influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| title_sort | influenza vaccination and myocarditis among patients receiving immune checkpoint inhibitors |
| url | https://jitc.bmj.com/content/7/1/53.full |
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