title: Differential loss of humoral immunity against measles, mumps, rubella and varicella-zoster virus in children treated for cancer.
abstract: BACKGROUND
  Intensive chemotherapy in children with cancer results in long-term impairment of humoral immunity. Whereas most studies to date focused on children with acute lymphoblastic leukemia (ALL), little data have been published on patients suffering from Hodgkin disease or from solid tumors. We therefore analyzed the loss of protective immunity (defined as immunity at the time of diagnosis and lack of immunity after completion of therapy) against vaccine-preventable diseases in children treated for various malignancies.
  
  
  METHODS
  Children and adolescents <21 years of age at diagnosis and treated between 2001 and 2010 for various malignancies in the Department of Pediatric Hematology and Oncology, University of Frankfurt, were included in the retrospective chart review. Antibody levels against measles, mumps, rubella and varicella-zoster-virus (VZV) were routinely assessed at the time of diagnosis and within 12 months after completion of therapy.
  
  
  RESULTS
  The study population consisted of 195 children (122 male); 80 patients had ALL, 15 acute myelogenous leukemia (AML), 18 non-Hodgkin lymphoma (NHL), 22 Hodgkin disease, and 60 various solid tumors. Overall, 27%, 47%, 19%, and 17% of the patients lost their humoral immunity against measles, mumps, rubella, and VZV, respectively. The risk of losing protective antibody titers depended on age with a higher risk in younger children. The loss of protective humoral immunity occurred significantly more often in patients with ALL compared to patients with any other underlying malignant disease (hematological malignancies such AML and NHL, Hodgkin disease or solid tumors).
  
  
  CONCLUSIONS
  Our data demonstrate that a significant number of children lose pre-existing humoral immunity against measles, mumps, rubella, and VZV after completion of chemotherapy. This loss occurs more often in children with ALL than in children with AML, solid tumors and Hodgkin disease. Our results underline the need for post-chemotherapy revaccination of childhood cancer survivors.
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Bochennek
authors.affiliation: Institute of Medical Virology, University of Frankfurt, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Allwinn
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Langer
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Becker
authors.affiliation: Institute of Medical Virology, University of Frankfurt, Germany.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Keppler
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klingebiel
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany. Electronic address: thomas.lehrnbecher@kgu.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehrnbecher
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002644:Chickenpox / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D056724:Immunity, Humoral; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008457:Measles / Q000276:immunology; D009107:Mumps / Q000276:immunology; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology*; D012189:Retrospective Studies; D012409:Rubella / Q000276:immunology; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000970:Antineoplastic Agents
keywords: Cancer; Child; Measles; Mumps; Rubella; Vaccination; Varicella