Longitudinal assessment of immunological status and rate of immune recovery following treatment in children with ALL

• Published in: Pediatric Blood & Cancer Vol. 50; no. 3; pp. 528 - 532
• Main Authors: Kosmidis, Sofia, Baka, Margarita, Bouhoutsou, Despina, Doganis, Dimitrios, Kallergi, Constantina, Douladiris, Nikolaos, Pourtsidis, Apostolos, Varvoutsi, Maria, Saxoni-Papageorgiou, Fotini, Vasilatou-Kosmidis, Helen
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2008
• Subjects: Adolescent; Agammaglobulinemia - chemically induced; ALL; Antibodies, Viral - blood; Antibody Formation - drug effects; Antigens, CD - analysis; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation - adverse effects; Disease Susceptibility; Female; Humans; immunity; Immunity, Cellular - drug effects; Immunocompromised Host; Infant; Infection - epidemiology; infections; Leukemia-Lymphoma, Adult T-Cell - drug therapy; Leukemia-Lymphoma, Adult T-Cell - immunology; Leukemia-Lymphoma, Adult T-Cell - radiotherapy; Male; Neutropenia - chemically induced; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy; Prospective Studies; Skin Tests; T-Lymphocyte Subsets - drug effects; T-Lymphocyte Subsets - immunology
• ISSN: 1545-5009; 1545-5017; 1096-911X
• DOI: 10.1002/pbc.21327

Background We prospectively evaluated the immunological status, immune recovery and risk of infection in pediatric ALL patients treated on the BFM 95 protocol. Procedure Humoral and cellular immunity were evaluated in 72 children with ALL at the end of intensive therapy and values were compared to those at the completion of therapy and 6‐monthly. Parameters investigated included lymphocyte subpopulation by flow cytometry, immunoglobulin levels by nephelometry, antibody titers to previous immunizations and delayed hypersensitivity with skin testing. Immune responses were correlated to duration of therapy, CNS radiotherapy, age and sex. Results Humoral immunity was severely depressed by the end of intensive therapy with low immunoglobulin levels and CD19, improved after therapy cessation. Cellular immune responses were normal at the end of intensive treatment but declined significantly by the end of therapy and both CD4 and CD8 remained low at later evaluation points whereas CD4/CD8 ratio was increasing. Duration of therapy and CNS radiotherapy did not affect the rate of immune recovery whereas female had higher CD19, CD45RO, and IgM and children >7 years had higher CD19 and lower CD16 and CD3DR. Among immunized children, 86.7% maintained protective antibodies to MMR and 63% to polio. Despite impairment of immunity, infections outside the neutropenic periods were common viral illnesses. Conclusion Humoral immunity was depressed in children with ALL at the end of intensive therapy but began to recover after cessation of therapy. In contrast, cellular immunity declined significantly by the end of therapy and remained abnormal for at least 1 year post‐therapy. Pediatr Blood Cancer 2008;50:528–532. © 2007 Wiley‐Liss, Inc.