title: Severe, persistent, and fatal T-cell immunodeficiency following therapy for infantile leukemia.
abstract: We describe five cases of children who completed chemotherapy for infantile acute lymphoblastic leukemia (ALL) and soon after were diagnosed with severe T-cell, non-HIV immunodeficiency, with varying B-cell and NK-cell depletion. There was near absence of CD3(+) , CD4(+) , and CD8(+) cells. All patients developed multiple, primarily opportunistic infections. Unfortunately, four patients died, although one was successfully treated by hematopoietic stem cell transplantation. These immunodeficiencies appeared to be secondary to intensive infant ALL chemotherapy. Our report highlights the importance of the early consideration of this life-threatening immune complication in patients who received chemotherapy for infantile ALL.
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada. Ashley.geerlinks@iwk.nshealth.ca.
authors.forename: Ashley V
authors.initials: AV
authors.lastname: Geerlinks
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Issekutz
authors.affiliation: Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Wahlstrom
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, CA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Sullivan
authors.affiliation: Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Cowan
authors.affiliation: Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Dvorak
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Conrad V
authors.initials: CV
authors.lastname: Fernandez
mesh_terms: D002648:Child; D002675:Child, Preschool; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology*
keywords: ALL; death; immunocompromised host; immunodeficiency; infant leukemia; molecular diagnosis and therapy