Journal of Clinical Immunology

, Volume 33, Issue 2, pp 388–396 | Cite as

Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination

  • Robert A. Eisenberg
  • Abbas F. Jawad
  • Jean Boyer
  • Kelly Maurer
  • Kenyetta McDonald
  • Eline T. Luning Prak
  • Kathleen E SullivanEmail author
Original Research


The efficacy of influenza vaccination in patients treated with rituximab is a clinically important question. Rheumatology clinics are populated with patients receiving rituximab for a broad array of disorders. Although several studies have explored the efficacy of other vaccines in rituximab-treated populations, results have been conflicting. We wished to define influenza vaccine efficacy in a rituximab-treated cohort. We examined 17 evaluable subjects treated with rituximab for rheumatologic conditions. T cell subsets, B cells subsets, T cell function, and B cell function were evaluated at specific time points along with hemagglutinination inhibition titers after receiving the standard inactivated influenza vaccine. T cell subset counts were significantly different than controls but did not change with rituximab. B cells depleted in all patients but were in various stages of recovery at the time of vaccination. Influenza vaccine responsiveness was poor overall, with only 16 % of subjects having a four-fold increase in titer. Pre-existing titers were retained throughout the study, however. The ability to respond to the influenza vaccine appeared to be related to the degree of B cell recovery at the time of vaccination. This study emphasizes that antibody responses to vaccine are impaired in subjects treated with rituximab and supports the concept that B cell recovery influences influenza vaccine responsiveness.


Rituxmab influenza antibody HAI titer B cell 



The authors would like to thank the patients and the physicians who contributed to this study. The skills of Dr. Yang-Zhu Du, Lytia Fisher and Kristal Dow are gratefully acknowledged. Supported in part by NIH grant NO1-AI-50024, the Arthritis Foundation, the American Autoimmunity Related Disease Association, and R01 AR34156 and R01 AI063626. The authors declare no conflict of interest.

Conflict of Interest

The authors declare that have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Robert A. Eisenberg
    • 1
  • Abbas F. Jawad
    • 2
  • Jean Boyer
    • 3
  • Kelly Maurer
    • 4
  • Kenyetta McDonald
    • 4
  • Eline T. Luning Prak
    • 5
  • Kathleen E Sullivan
    • 4
    Email author
  1. 1.Division of RheumatologyThe Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Abramson Cancer CenterThe Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Division of Allergy ImmunologyThe Children’s Hospital of Philadelphia, University of Pennsylvania School of MedicinePhiladelphiaUSA
  5. 5.Department of Pathology and Laboratory MedicineThe Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA

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