Immunodeficiency in long-term survivors of acute lymphoblastic leukemia treated with Berlin-Frankfurt-Münster therapy.
OBJECTIVE
To determine whether the immune systems of long-term survivors of acute lymphoblastic leukemia (ALL) have persistent immune defects after Berlin-Frankfurt-Münster (BFM) treatment.


METHODS
We evaluated the cellular and humoral immune responses of 13 children with ALL in complete remission and off modified protocol treatment for 2 or more years. All patients had received complete immunizations for measles, mumps, rubella, and poliovirus before ALL developed. They were challenged with Haemophilus influenzae type B (Hib) and Pneumococcus vaccines after baseline serum samples were obtained. We also determined in vivo humoral immune responses to bacteria and viruses that cause common pediatric diseases.


RESULTS
Compared with age-matched control subjects, the long-term survivors of ALL had a significant difference in the presence of protective antibodies to measles (p < 0.0001) and polioviruses (p < 0.0001) in their baseline sera; more than half had no protective antibodies to one or more previously administered vaccines or related infections. Most produced protective concentrations of specific antibody after reimmunization, but some were repeatedly unable to make protective antibodies, or mount a normal antibody response, despite natural disease and/or revaccination. Four children had significant infections.


CONCLUSIONS
Long-term survivors of ALL who had BFM treatment may have persistent immune defects with respect to common childhood bacterial and viral diseases they previously had, or vaccines they received.
Smith
S
S
Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Schiffman
G
G
Karayalcin
G
G
Bonagura
V
V
D000293:Adolescent; D000917:Antibody Formation / Q000187:drug effects; D015703:Antigens, CD; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000276:immunology / Q000517:prevention & control; D018073:Haemophilus Vaccines; D006193:Haemophilus influenzae / Q000276:immunology; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced; D007111:Immunity, Cellular; D007136:Immunoglobulins / Q000097:blood*; D008297:Male; D008934:Mitogens; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
D015703:Antigens, CD; D018073:Haemophilus Vaccines; D007136:Immunoglobulins; D008934:Mitogens