A Phase 2 interventional study of Fluzone High Dose Vaccine and Fluzone Standard Dose Vaccine in HIV and Cancer, sponsored by St. Jude Children's Research Hospital. Completed at 1 site in United States. Open to participants aged 3 Years to 21 Years. Per ClinicalTrials.gov, last updated 2016-09-23.
Sponsored by St. Jude Children's Research Hospital · Phase 2, Interventional, and Treatment
This is an open label-study of Fluzone HD, a high-dose form of trivalent, inactivated influenza vaccine (TIV), vs. Fluzone, a standard-dose form of TIV. Subjects with cancer or HIV will be vaccinated twice with one of the two vaccines and evaluated for development of immune responses.
The primary objectives of this study are to compare the immune response of Fluzone HD, a high-dose, trivalent influenza vaccine (TIV), to Fluzone, a standard-dose TIV, in children with cancer and in children with HIV.
The secondary objectives of this study are to:
2,214 studies on the registry are indexed under Influenza, Human; 163 are open to participants now.
This study's enrollment of 85 is below the median of 238 across 1,853 interventional studies indexed under Influenza, Human.
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Exclusion Criteria
Subjects with a diagnosis of leukemia will be vaccinated twice with Fluzone High Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone High Dose Vaccine
Subjects with a diagnosis of leukemia will be vaccinated twice with Fluzone Standard Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone Standard Dose Vaccine
Subjects with a diagnosis of solid tumor will be vaccinated twice with Fluzone High Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone High Dose Vaccine
Subjects with a diagnosis of solid tumor will be vaccinated twice with Fluzone Standard Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone Standard Dose Vaccine
Subjects with a diagnosis of human immunodeficiency virus (HIV) will be vaccinated twice with Fluzone High Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone High Dose Vaccine
Subjects with a diagnosis of human immunodeficiency virus (HIV) will be vaccinated twice with Fluzone Standard Dose Vaccine and evaluated for development of immune responses.
Biological: Fluzone Standard Dose Vaccine
Two doses of Fluzone HD will be administered to children with leukemia, solid tumor, or HIV.
Also known as: Fluzone-HD
Two doses of Fluzone Standard Dose Vaccine will be administered to children with leukemia, solid tumor, or HIV.
Also known as: Fluzone-SD
Rate of Seroconversion After 1 Dose of Vaccine
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
Time frame: at least 21 days after first dose, which is given at the time of baseline evaluation visit, and prior to second dose
Rate of Seroprotection After 1 Dose of Vaccine
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroprotection was defined as a post-vaccine HAI titer ≥40.
Time frame: at least 21 days after first dose, which is given at the time of baseline evaluation visit, and prior to second dose
Number of Participants Achieving Seroprotection After Second Dose of Vaccine
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroprotection was defined as a post-vaccine HAI titer ≥40.
Time frame: 21 to 42 days after second dose
Number of Participants Reporting Grade 3 and Grade 4 Adverse Events Possibly, Probably, or Definitely Attributable to Fluzone or Fluzone HD
Number of participants reporting grade 3 and grade 4 adverse events possibly, probably, or definitely attributable to Fluzone or Fluzone HD.
Time frame: From initial vaccine administration through up to 8 months
Rate of Sero-conversion for 1 Dose vs. 2 Doses of Fluzone HD
The rate of seroconversion to the 3 antigens contained in the vaccine was determined by hemagglutination-inhibition test and was compared by disease. The immune response of 1 dose vs. 2 doses of Fluzone HD was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
Time frame: at least 21 days after each dose of vaccine
Rate of Sero-conversion for 1 Dose vs. 2 Doses of Fluzone SD
The rate of seroconversion to the 3 antigens contained in the vaccine was determined by hemagglutination-inhibition test and was compared by disease. The immune response of 1 dose vs. 2 doses of Fluzone SD was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
Time frame: at least 21 days after each dose of vaccine
Rate of Vaccine Response by Seroconversion Compared by Absolute Lymphocyte Count (ALC)
The relationship between baseline lymphocyte numbers/function and robustness of the immune response will be described through descriptive analysis of relationships between pre-defined variables.
Time frame: ALC at baseline and vaccine response at least 21 days after last dose of vaccine
Rate of Vaccine Response by Seroprotection Compared by Absolute Lymphocyte Count (ALC)
The relationship between baseline lymphocyte numbers/function and robustness of the immune response will be described through descriptive analysis of relationships between pre-defined variables.
Time frame: ALC at baseline and vaccine response at least 21 days after last dose of vaccine
Number of Local Reactogenicity Events After First Dose
Number of moderate or greater local reactogenicity events associated with the administration of Fluzone or FluzoneHD. Local reactions were defined as pain, redness, or induration.
Time frame: First 14 days after vaccination
Number of Local Reactogenicity Events After Second Dose
Number of moderate or greater local reactogenicity events associated with the administration of Fluzone or FluzoneHD. Local reactions were defined as pain, redness, or induration.
Time frame: First 14 days after vaccination
Number of Systemic Reactogenicity Events After First Dose
Number of moderate or greater systemic reactogenicity event associated with the administration of Fluzone or FluzoneHD. Systemic reactions were defined as muscle ache, fatigue, or fever.
Time frame: First 14 days after vaccination
Number of Systemic Reactogenicity Events After Second Dose
Number of moderate or greater systemic reactogenicity event associated with the administration of Fluzone or FluzoneHD. Systemic reactions were defined as muscle ache, fatigue, or fever.
Time frame: First 14 days after vaccination
Comparison of Geometric Mean Titer (GMT) by HAI
Serum antibody levels expressed as the reciprocal of the dilution needed to inhibit hemagglutination in vitro.
Time frame: Pre-vaccination, post-vaccination and 9 months after vaccination
Comparison of Geometric Mean Ratios (GMR) by HAI
GMTs compared to each other as a ratio of the pre- and post-vaccine titers and as the ratio post-last dose to 9 months later. GMRs were compared pre- to post-vaccination and post- vaccination to 9 months later.
Time frame: Pre-vaccination, post-vaccination and 9 months after vaccination
Participants were ≥3-21 yrs. at study entry with diagnosis of cancer or HIV. Those with cancer were receiving chemotherapy and/or radiotherapy or had received chemotherapy in the prior 12 weeks. One participant was enrolled but was lost to follow up prior to randomization. 84 participants were randomized between 9/2010 and 10/2011.
| Milestone | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| Started | 14 | 13 | 8 | 9 | 20 | 20 |
| Completed | 13 | 13 | 8 | 9 | 20 | 20 |
| Not completed | 1 | 0 | 0 | 0 | 0 | 0 |
| Withdrew: Withdrawal by subject | 1 | 0 | 0 | 0 | 0 | 0 |
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
| percentage of participants | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| H1 antigen | 31 | 0 | 50 | 22 | 61 | 65 |
| H3 antigen | 77 | 85 | 50 | 89 | 72 | 65 |
| B antigen | 38 | 46 | 63 | 44 | 67 | 35 |
Number of participants reporting grade 3 and grade 4 adverse events possibly, probably, or definitely attributable to Fluzone or Fluzone HD.
| participants | High-dose FluzoneHD | Standard Dose Fluzone |
|---|---|---|
| Number of Participants Reporting Grade 3 and Grade 4 Adverse Events Possibly, Probably, or Definitely Attributable to Fluzone or Fluzone HD | 1 | 0 |
The rate of seroconversion to the 3 antigens contained in the vaccine was determined by hemagglutination-inhibition test and was compared by disease. The immune response of 1 dose vs. 2 doses of Fluzone HD was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
| percentage of participants | Leukemia-1 Dose | Leukemia-2 Doses | Solid Tumor-1 Dose | Solid Tumor-2 Doses | HIV-1 Dose | HIV-2 Doses |
|---|---|---|---|---|---|---|
| H1 antigen | 31 | 54 | 50 | 88 | 61 | 72 |
| H3 antigen | 77 | 85 | 50 | 63 | 72 | 72 |
| B antigen | 38 | 85 | 63 | 75 | 67 | 78 |
The rate of seroconversion to the 3 antigens contained in the vaccine was determined by hemagglutination-inhibition test and was compared by disease. The immune response of 1 dose vs. 2 doses of Fluzone SD was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroconversion was defined as a post-vaccine HAI titer ≥40 if baseline was \<10, or a 4-fold rise in HAI titer if the baseline ≥10.
| percentrage of participants | Leukemia-1 Dose | Leukemia-2 Doses | Solid Tumor-1 Dose | Solid Tumor-2 Doses | HIV-1 Dose | HIV-2 Doses |
|---|---|---|---|---|---|---|
| H1 antigen | 0 | 54 | 22 | 67 | 65 | 70 |
| H3 antigen | 85 | 92 | 89 | 89 | 65 | 70 |
| B antigen | 46 | 85 | 44 | 89 | 35 | 75 |
The relationship between baseline lymphocyte numbers/function and robustness of the immune response will be described through descriptive analysis of relationships between pre-defined variables.
| percentagae of participants | ALC <1000 Cells/mm³ | ALC ≥1000 Cells/mm³ |
|---|---|---|
| Rate of Vaccine Response by Seroconversion Compared by Absolute Lymphocyte Count (ALC) | 62 | 68 |
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroprotection was defined as a post-vaccine HAI titer ≥40.
| Percentage of participants | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| H1 antigen | 77 | 85 | 75 | 78 | 100 | 100 |
| H3 antigen | 92 | 92 | 75 | 89 | 100 | 100 |
| B antigen | 62 | 85 | 63 | 89 | 100 | 90 |
The immune response of Fluzone HD to Fluzone was determined using the hemagglutination-inhibition (HAI) assay to each of the 3 antigens contained in the vaccine: H1, H3 and B. Seroprotection was defined as a post-vaccine HAI titer ≥40.
| number of participants | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| H1 antigen | 11 | 12 | 7 | 9 | 18 | 19 |
| H3 antigen | 8 | 8 | 7 | 7 | 18 | 19 |
| B antigen | 10 | 10 | 6 | 8 | 18 | 19 |
The relationship between baseline lymphocyte numbers/function and robustness of the immune response will be described through descriptive analysis of relationships between pre-defined variables.
| percentage of participants | ALC <1000 Cells/mm³ | ALC ≥1000 Cells/mm³ |
|---|---|---|
| Rate of Vaccine Response by Seroprotection Compared by Absolute Lymphocyte Count (ALC) | 96 | 100 |
Number of moderate or greater local reactogenicity events associated with the administration of Fluzone or FluzoneHD. Local reactions were defined as pain, redness, or induration.
| Events | High-dose FluzoneHD | Standard Dose Fluzone |
|---|---|---|
| Number of Local Reactogenicity Events After First Dose | 19 | 16 |
Number of moderate or greater local reactogenicity events associated with the administration of Fluzone or FluzoneHD. Local reactions were defined as pain, redness, or induration.
| Events | High-dose FluzoneHD | Standard Dose Fluzone |
|---|---|---|
| Number of Local Reactogenicity Events After Second Dose | 11 | 7 |
Number of moderate or greater systemic reactogenicity event associated with the administration of Fluzone or FluzoneHD. Systemic reactions were defined as muscle ache, fatigue, or fever.
| Events | High-dose FluzoneHD | Standard Dose Fluzone |
|---|---|---|
| Number of Systemic Reactogenicity Events After First Dose | 10 | 7 |
Number of moderate or greater systemic reactogenicity event associated with the administration of Fluzone or FluzoneHD. Systemic reactions were defined as muscle ache, fatigue, or fever.
| Events | High-dose FluzoneHD | Standard Dose Fluzone |
|---|---|---|
| Number of Systemic Reactogenicity Events After Second Dose | 8 | 3 |
Serum antibody levels expressed as the reciprocal of the dilution needed to inhibit hemagglutination in vitro.
| Titers | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| H1 Antigen/Pre-vaccination | 29 (17 to 49) | 50 (22 to 111) | 57 (16 to 203) | 40 (20 to 81) | 71 (37 to 137) | 67 (40 to 113) |
| H1 Antigen/Post-vaccination | 117 (62 to 221) | 161 (82 to 317) | 580 (157 to 2137) | 148 (84 to 260) | 373 (264 to 528) | 267 (188 to 378) |
| H1 Antigen/9 Months Post-vaccination | 30 (11 to 87) | 85 (14 to 533) | 403 (33 to 4940) | 80 (12 to 533) | 279 (145 to 535) | 174 (93 to 325) |
| H3 Antigen/Pre-vaccination | 26 (12 to 58) | 25 (10 to 61) | 20 (6 to 69) | 22 (9 to 53) | 42 (24 to 72) | 49 (31 to 78) |
| H3 Antigen/Post-vaccination | 139 (49 to 394) | 63 (21 to 188) | 215 (104 to 445) | 109 (31 to 381) | 154 (105 to 226) | 143 (97 to 212) |
| H3 Antigen/9 Months Post-vaccination | 49 (16 to 148) | 40 (13 to 123) | 101 (28 to 360) | 143 (49 to 416) | 70 (44 to 111) | 102 (52 to 199) |
| B Antigen/Pre-vaccination | 16 (8 to 31) | 29 (15 to 57) | 17 (8 to 35) | 23 (12 to 47) | 33 (23 to 48) | 34 (23 to 48) |
| B Antigen/Post-vaccination | 181 (89 to 371) | 113 (36 to 357) | 195 (33 to 1138) | 202 (83 to 488) | 160 (108 to 237) | 172 (100 to 297) |
| B Antigen/9 Months Post-vaccination | 9 (6 to 13) | 13 (6 to 28) | 16 (6 to 43) | 11 (5 to 23) | 13 (9 to 19) | 13 (9 to 19) |
GMTs compared to each other as a ratio of the pre- and post-vaccine titers and as the ratio post-last dose to 9 months later. GMRs were compared pre- to post-vaccination and post- vaccination to 9 months later.
| Ratio | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| H1 post- over pre-vaccination | 4.0 | 3.2 | 10.2 | 3.7 | 5.2 | 4.0 |
| H1 post-vaccination over 9 months | 3.9 | 1.9 | 1.4 | 1.9 | 1.3 | 1.5 |
| H3 post- over pre-vaccination | 5.3 | 2.6 | 10.8 | 5.0 | 3.7 | 2.9 |
| H3 post-vaccination over 9 months | 2.8 | 1.6 | 2.1 | 0.8 | 2.2 | 1.4 |
| B post- over pre-vaccination | 11.2 | 3.9 | 11.6 | 8.6 | 4.8 | 5.1 |
| B post-vaccination over 9 months | 20.6 | 8.8 | 12.3 | 18.0 | 12.1 | 12.9 |
Collected over Adverse events were collected for 21 days after each dose of vaccine. No "other" adverse events were observed.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Leukemia-HD | — | 0/13 (0%) | 0/13 (0%) |
| Leukemia-SD | — | 0/13 (0%) | 0/13 (0%) |
| Solid Tumor-HD | — | 1/8 (12.5%) | 0/8 (0%) |
| Solid Tumor-SD | — | 0/9 (0%) | 0/9 (0%) |
| HIV-HD | — | 0/20 (0%) | 0/20 (0%) |
| HIV-SD | — | 0/20 (0%) | 0/20 (0%) |
| Event | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD |
|---|---|---|---|---|---|---|
| SomnolenceNervous system disorders | 0/13 | 0/13 | 1/8 | 0/9 | 0/20 | 0/20 |
This was an open-label study where participants were randomized at a 1:1 ratio into Fluzone high-dose (HD) and Fluzone standard dose (SD) groups by disease group with the use of a computer-generated randomization schedule.
| Age, Continuous(years) | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD | Total |
|---|---|---|---|---|---|---|---|
| Mean | 10.8 ± 5.7 | 11.8 ± 5.1 | 12.4 ± 4.2 | 11.7 ± 4.5 | 16.7 ± 5.6 | 19.9 ± 1.8 | 14.6 ± 5.9 |
| Sex: Female, Male(Participants) | Leukemia-HD | Leukemia-SD | Solid Tumor-HD | Solid Tumor-SD | HIV-HD | HIV-SD | Total |
|---|---|---|---|---|---|---|---|
| Female | 4 | 5 | 4 | 4 | 7 | 4 | 28 |
| Male | 9 | 8 | 4 | 5 | 13 | 16 | 55 |
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St. Jude Children's Research Hospital