Influenza vaccines in immunosuppressed adults with cancer

Background This is an update of the Cochrane review published in 2013, Issue 10. Immunosuppressed cancer patients are at increased risk of serious influenza‐related complications. Guidelines, therefore, recommend influenza vaccination for these patients. However, data on vaccine effectiveness in this population are lacking, and the value of vaccination in this population remains unclear. Objectives To assess the effectiveness of influenza vaccine in immunosuppressed adults with malignancies. The primary review outcome is all‐cause mortality, preferably at the end of the influenza season. Influenza‐like illness (ILI, a clinical definition), confirmed influenza, pneumonia, any hospitalisations, influenza‐related mortality and immunogenicity were defined as secondary outcomes. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and LILACS databases up to May 2017. We searched the following conference proceedings: ICAAC, ECCMID, IDSA (infectious disease conferences), ASH, ASBMT, EBMT (haematological), and ASCO (oncological) between the years 2006 to 2017. In addition, we scanned the references of all identified studies and pertinent reviews. We searched the websites of the manufacturers of influenza vaccine. Finally, we searched for ongoing or unpublished trials in clinical trial registry databases. Selection criteria Randomised controlled trials (RCTs), prospective and retrospective cohort studies and case‐control studies were considered, comparing inactivated influenza vaccines versus placebo, no vaccination or a different vaccine, in adults (16 years and over) with cancer. We considered solid malignancies treated with chemotherapy, haematological cancer patients treated or not treated with chemotherapy, cancer patients post‐autologous (up to six months after transplantation) or allogeneic (at any time) haematopoietic stem cell transplantation (HSCT). Data collection and analysis Two review authors independently assessed the risk of bias and extracted data from included studies adhering to Cochrane methodology. Meta‐analysis could not be performed because of different outcome and denominator definitions in the included studies. Main results We identified six studies with a total of 2275 participants: five studies comparing vaccination with no vaccination, and one comparing adjuvanted vaccine with non‐adjuvanted vaccine. Three studies were RCTs, one was a prospective observational cohort study and two were