Longitudinal assessment of immunological status and rate of immune recovery following treatment in children with ALL.
BACKGROUND
We prospectively evaluated the immunological status, immune recovery and risk of infection in pediatric ALL patients treated on the BFM 95 protocol.


METHODS
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.


CONCLUSIONS
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.
Kosmidis
Sofia
S
Second Department of Radiotherapy of St. Savas Anticancer Hospital, Athens, Greece.
Baka
Margarita
M
Bouhoutsou
Despina
D
Doganis
Dimitrios
D
Kallergi
Constantina
C
Douladiris
Nikolaos
N
Pourtsidis
Apostolos
A
Varvoutsi
Maria
M
Saxoni-Papageorgiou
Fotini
F
Vasilatou-Kosmidis
Helen
H
D000293:Adolescent; D000361:Agammaglobulinemia / Q000139:chemically induced*; D000914:Antibodies, Viral / Q000097:blood; D000917:Antibody Formation / Q000187:drug effects; D015703:Antigens, CD / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D016867:Immunocompromised Host; D007223:Infant; D007239:Infections / Q000453:epidemiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy / Q000276:immunology* / Q000532:radiotherapy; D008297:Male; D009503:Neutropenia / Q000139:chemically induced*; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000276:immunology* / Q000532:radiotherapy; D011446:Prospective Studies; D012882:Skin Tests; D016176:T-Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology
D000914:Antibodies, Viral; D015703:Antigens, CD