title: Loss of antibody titers and effectiveness of revaccination in post-chemotherapy pediatric sarcoma patients.
abstract: BACKGROUND
  Little is known about the effects of chemotherapy on patient antibody titers to vaccine-preventable infectious diseases; thus, there is no standard protocol for revaccinating post-chemotherapy patients.
  
  
  METHODS
  To assess losses of detectable antibody titers due to chemotherapy, we retrospectively examined antibody titers for tetanus, varicella, measles, mumps, rubella, hepatitis B, and polio in 109 pediatric sarcoma patients. We also evaluated revaccination data to determine current practices and efficacy of revaccination. We limited our sample to osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma patients to control for the chemotherapy regimen patients received.
  
  
  RESULTS
  Patients had pre-treatment detectable antibody titer that fell within the range of healthy children's antibody titers. However, 71% of patients had post-chemotherapy negative titers for at least one infectious disease. Patients most commonly had negative titers for hepatitis B (64%). Few patients had negative titers for measles (14%), mumps (9%), rubella (4%), polio 1 (0%), polio 2 (2.9%), polio 3 (4.8%), tetanus (5%), or varicella (11%). Revaccinations most frequently administered were hepatitis B and polio.
  
  
  CONCLUSIONS
  Our findings suggest that post-chemotherapy patients may need to be revaccinated against certain vaccine-preventable diseases including hepatitis B, tetanus, varicella, polio, measles, mumps, and rubella. Larger studies need to be performed to establish guidelines for revaccinating post-chemotherapy pediatric patients.
authors.affiliation: Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yu
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Chou
authors.forename: Alison
authors.initials: A
authors.lastname: Lennox
authors.forename: Phillip
authors.initials: P
authors.lastname: Kleiman
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Wexler
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Richard
authors.initials: R
authors.lastname: Gorlick
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000032:analysis / Q000187:drug effects*; D000970:Antineoplastic Agents / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000517:prevention & control*; D012516:Osteosarcoma; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma; D012509:Sarcoma / Q000150:complications / Q000628:therapy*; D012512:Sarcoma, Ewing; D014611:Vaccination / Q000592:standards*
chemical_list: D000906:Antibodies; D000970:Antineoplastic Agents