Flu Shot

Interesting discussion in the support group today: should Follicular NHL patients get a flu shot?

We had some mixed responses, with some saying they were encouraged to get one, some saying they were discouraged, and some saying they were told not to, but were encouraged to tell everyone around them to get one.

For the record, I was told to get one when I was first diagnosed and visited the lymphoma specialist. It was January, at the height of flu season, and I hadn't had one yet.

But someone posted a link to a very recent article (published about a week ago) in the Journal of Clinical Immunology called "Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination." The authors of the article seem to be specialists in Rheumatology, and Rituxan is used to treat disorders other than NHL, including rheumatoid arthritis. The authors examined 17 patients with rheumatology issues that had been given Rituxan and then a flu shot, and found that, as the title suggests, the response to the shot was poor. Only 16% had a four-fold increase in titer; this means that not many had a build up of the antibodies that are necessary to fight of influenza. This is the whole point of a flu shot: the body learns to recognize an invader and begins to develop antibodies that will fight it off when the real flu bug invades it.

The problem? Rituxan kills off the B cells that do all that fighting.

So it makes sense: give Rituxan; it kills bad B cells; it kills off good B cells; those cells can't do their job.

There was some speculation in the support group that maybe doctors were advising against a flu shot because those patients had been given Rituxan within the last 6 months, which is about how long it continues to work after the final dose. The authors of this study did find that there is some correlation between B cell recovery after Rituxan and success of the vaccine.

More time since Rituxan = more B cells = greater chance of success.

It all makes sense, but it's nice to have some evidence to back it up.

The takeaway? Get a flu shot. Unless you received Rituxan very recently, there's at least a chance that it will do some good. At the very least, it can't hurt.

And tell your loved ones to get flu shots, too.