Evaluation of Prime-boost Anti-pneumococcal Vaccination in Patients With Diffuse Large B Cell Lymphoma Treated With Rituximab

Pneumococcal infections remain frequent and potentially fatal. To prevent them, two anti-pneumococcal vaccines exist: a 13-valent conjugate vaccine (Prevenar®) and a 23-valent polysaccharide vaccine (Pneumovax®). For their utilization, several studies approved a prime-boost strategy. It consist two administer Pneumovax® at least two months later than Prevenar®. Patients with diffuse large B-cell Lymphoma (DLBCL) have a higher-risk to develop a pneumococcal infection. The main reason is immunosuppression, induced by rituximab (B cell depletion), chemotherapy and lymphoma. Patients are treated by immunochemotherapy, combining rituximab (anti-CD20 monoclonal antibody) and conventional chemotherapy (CHOP). However, those patients have a low rate of vaccination (about 15%). Also, in the current literature, rare studies investigated prime-boost immunogenicity in this relevant population. The investigators will evaluate vaccinal response of 10 serotype-specific immunoglobulin G (1, 3, 4, 6B, 7F, 9V, 14, 18C, 19F, 23F) at different time of treatment.

The investigators search to compare efficiency of prime-boost anti-pneumococcal vaccination according to the time of prevenar administration (before or after immunochemotherapy) and to the dose of Prevenar® (single or double-dose).

Inclusion criteria

• De novo Diffuse Large B-Cell Lymphoma diagnostic (according 2016 World Health Organization (WHO) classification)
• Treatment decision by immunochemotherapy (R-CHOP)
• Age over 18 years old
• Negative pregnancy test at inclusion
• Active contraception at inclusion
• Free and informed consent procedure at inclusion
• Affiliation of the social security system

Exclusion criteria

• Patient with prior treatment by immunotherapy or chemotherapy
• Patient with prior treatment by debulking chemotherapy (COP)
• Patient with prior treatment by high-dose of corticosteroids
• Patients with an autoimmune disease
• Patients with a diffuse large B-cell lymphoma from transformation (follicular lymphoma, chronic lymphoid leukemia)
• Immunosuppressed patient with : asplenia, hereditary immunodeficiency disorder, infection by HIV, hepatitis B or C viruses, transplanted patient, hematopoietic stem cell transplantation, nephrotic syndrome, meningeal breach, cochlear implants.
• Patients vaccinated in the last month before inclusion
• Patients with prior transfusion of blood-products or immunoglobulins in the last three months before inclusion
• Patient with bleeding disorders or thrombopenia contraindicating intramuscular injection
• Patient with prior pneumococcal documented infection
• Patient with current pregnancy and/or breastfeeding
• Patient under curatorship or guardianship