Evaluation of Human Immune Responses Vaccination in Patients With Lymphoma

This clinical trial evaluates the influenza virus vaccination in evaluating human immune response in patients with lymphoma. Evaluating immune response may increase the understanding of how the immune system changes when patients receive treatment for lymphomas by looking at the antibody levels and the level of the different cells that make up the immune system over time compared to those without lymphoma.

Study Overview

• Status: Recruiting
• Conditions: Follicular Lymphoma; Diffuse Large B-Cell Lymphoma; Mantle Cell Lymphoma; Chronic Lymphocytic Leukemia; Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma
• Intervention / Treatment: Biological: Inactivated Influenza Vaccine

Detailed Description

PRIMARY OBJECTIVE:

I. To determine the seroprotection and seroconversion rates after influenza or SARS-CoV2 vaccination in patients with lymphoma receiving active treatment or in follow up observation.

SECONDARY OBJECTIVES:

I. To characterize virus-specific plasmablasts and memory B cells after vaccination in patients with lymphoma receiving active treatment or in follow up observation.

II. To investigate the longevity of viral-specific humoral immunity to influenza virus in patients with lymphoma receiving active treatment or in follow up observation.

III. To assess the timing and strength of the peak immune response to vaccination.

IV. To assess the effect of different lymphomas and treatment modalities in the immune response to vaccination.

OUTLINE:

Patients receive seasonal inactivated influenza vaccine intramuscularly (IM) at day 0.

After completion of study treatment, patients are followed up at days 7, 28, 90, 180, and 365.

• Study Type: Observational
• Enrollment (Estimated): 200

Contacts and Locations

• Study Contact: Name: Andres Chang, MD, PhD; Phone Number: 404-778-3942; Email: andres.chang@emory.edu

Study Locations

• United States
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Recruiting
      • Emory University Hospital/Winship Cancer Institute
      • Contact: Mike Churnetski; Phone Number: 404-778-3703; Email: michael.c.churnetski@emory.edu
      • Contact: Vanessa Smith; Phone Number: 404-778-2419; Email: vanessa.smith@emory.edu
    • Atlanta, Georgia, United States, 30308
      • Recruiting
      • Emory University Hospital Midtown
      • Contact: Michael Churnetski; Phone Number: 404-778-3703; Email: michael.c.churnetski@emory.edu
      • Principal Investigator: Andres Chang, MD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

20 patients per observation group

Description

Inclusion Criteria:

• Subjects with a diagnosis of lymphoma falling into the following categories:

  • B-NHL who have received 1 cycle of chemotherapy
  • B-NHL in complete remission and within 12 months after completion of chemotherapy
  • Chronic lymphocytic leukemia (CLL) or mantle cell lymphoma (MCL) receiving ibrutinib for at least 1 month
  • B-NHL in complete remission for over 12 months
  • Aggressive peripheral T-cell lymphoma (PTCL) who have received 1 cycle of chemotherapy

• Subject capable of providing written or electronic informed consent prior to initiation of any study procedures; subjects able to understand and comply with planned study procedures and be available for all study visits.

  • Screening labs must be within the following ranges or considered to be not clinically significant by the investigator:

Hematology:

• Hemoglobin: 7.0-16.1 gm/dL
• Platelet count: 10-600/µL

• Subjects who have not received the seasonal influenza vaccine in the current flu season and are not suspected to have had an influenza infection in the current flu season *- Platelet count: 10-600/uL

  • For cohort 1: Subjects who have not received the seasonal influenza vaccine in the current flu season and are not suspected to have had an influenza infection in the current flu season.
  • For cohort 3: Subjects must have previously received at least 1 dose of SARS-CoV2 vaccine. Patients who have not receive a prior SARS-CoV2 vaccine will be eligible to enroll in cohort.

Exclusion Criteria:

• Known infection with human immunodeficiency virus (HIV). This information will be obtained verbally from the patient
• Have any medical disease or condition that, in the opinion of the site principal investigator is a contraindication to study participation; this includes any chronic medical condition, defined as persisting 3 months (defined as 90 days) or longer, that would place the subject at an unacceptable risk of injury, render the subject unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or the subject?s successful completion of this study
• Have an acute illness, as determined by the site principal investigator within 72 hours prior to study vaccination; an acute illness which is nearly resolved with only minor residual symptoms remaining is allowable if, in the opinion of the site principal investigator, the residual symptoms will not interfere with the ability to assess safety parameters as required by the protocol and was not due to an influenza infection
• Subjects taking long-term systemic steroids defined as greater than 3 months in the past 12 months
• Have known hypersensitivity or allergy to eggs, egg or chicken protein, or other components of the study vaccine
• Have a history of Guillain-Barre syndrome (GBS)
• Subjects who had or are suspected to have had an influenza infection in the current influenza season
• Subjects who, at screening, have abnormal vital signs and/or physical exam, including a temperature ≥ 38.0 C, systolic blood pressure ≤ 90 or > 180 mmHg, pulse ≤ 60 or > 130 beats per minute, new rash, signs of infection
• Subjects who have already received the seasonal influenza vaccine in the current influenza vaccination season
• Subjects enrolled in hospice or whose life expectancy is less than 6 months

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Inactivated Influenza Vaccine; Patients will be vaccinated with an FDA approved seasonal inactivated influenza vaccine	Biological: Inactivated Influenza Vaccine; Given seasonal inactivated influenza vaccine IM; Other Names: Fluzone Quadrivalent; Quadrivalent Influenza Vaccine; Flu Vaccine; Fluzone Quadrivalent Influenza Vaccine; Quadrivalent Inactivated Influenza Vaccine
Qualifying subjects to receive a SARS-CoV2 vaccine.; Patients receive a SARS-CoV2 vaccine.
Clinical Group Receiving SARS-CoV2 Booster Vaccines; Patients receive a SARS-CoV2 vaccine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cohort 1: Percentage of subjects achieving seroprotection, defined as the percentage of subjects with a post-vaccination HI titer > 1:40	Rates of seroprotection will be calculated for each patient group, and 95% exact binomial confidence intervals will be estimated using the Clopper-Pearson method.	Up to 180 days after immunization
Percentage of subjects achieving seroconversion	Seroconversion is defined as the percentage of subjects with either a pre-vaccination HI titer < 1:10 and a post-vaccination HI titer > 1:40 or a pre-vaccination HI titer > 1:10 and a minimum four-fold rise in post-vaccination HI antibody titer (day 0, 28). Rates of seroconversion will be calculated for each patient group, and 95% exact binomial confidence intervals will be estimated using the Clopper-Pearson method.	Up to 180 days after immunization
Cohort 2: Efficacy (immune response of COVID vaccines at least 7 days after the second dose.	Assessments will be performed at baseline (time of enrollment), day 7 after first dose of SARS-CoV2 vaccine, day of second dose of vaccine, day 8 after second dose of vaccine, and days 90, 180, and 365.	Up to 365 days after immunization
Cohort 3: Efficacy (immune response) of COVID vaccines at least 7 days after each booster vaccine dose.	Assessments will be performed after each dose of SARS-CoV2 booster vaccine.	From baseline up to 365 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measurement of virus-specific serum antibody levels after vaccination	For serum antibody responses directed against the vaccine epitopes, endpoint IgG titers after vaccination at each time point will be determined.	Up to 180 days after immunization
Measurement of virus-specific plasmablasts (PBs) after influenza vaccination	PBs responses against influenza or SARS-CoV2 will be determined by direct ex vivo enzyme-linked immunospot (ELISPOT). Changes in the PB population will be measured to assess the timing and strength of the peak immune response to vaccination.	Up to 180 days after immunization
Measurement of virus-specific memory B-cells (MBCs) after vaccination	The frequency of hemagglutinin (HA)-specific immunoglobulin G (IgG)-secreting MBCs per total IgG-secreting cells after vaccination will be determined. Changes in the MBC population will be measured to assess the timing and strength of the peak immune response to vaccination.	Up to 180 days after immunization
Maximum fold rise in antibody titer	Hemagglutination inhibition assays will be used to assess the timing and strength of the peak immune response to vaccination.	Up to 180 days after immunization

Collaborators and Investigators

• Sponsor: Emory University
• Investigators: Principal Investigator: Andres Chang, MD, PhD, Emory University

Study record dates

Study Major Dates

• Study Start (Actual): April 6, 2018
• Primary Completion (Estimated): October 22, 2024
• Study Completion (Estimated): October 22, 2024

Study Registration Dates

• First Submitted: April 10, 2018
• First Submitted That Met QC Criteria: April 16, 2018
• First Posted (Actual): April 18, 2018

Study Record Updates

• Last Update Posted (Actual): February 23, 2024
• Last Update Submitted That Met QC Criteria: February 22, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Disease Attributes; Leukemia, Lymphoid; Leukemia; Leukemia, B-Cell; Lymphoma, B-Cell; Chronic Disease; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Mantle-Cell; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, T-Cell; Physiological Effects of Drugs; Immunologic Factors; Vaccines
• Other Study ID Numbers: IRB00101067; NCI-2017-02313 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); Winship4236-17 (Other Identifier: Winship Cancer Institute)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes