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Immune reconstitution after childhood acute lymphoblastic leukemia is most severely affected in the high risk group

Journal article
Authors Torben Ek
Lotta Mellander
B. Andersson
Jonas Abrahamsson
Published in Pediatr Blood Cancer
Volume 44
Issue 5
Pages 461-8
ISSN 1545-5009 (Print)
Publication year 2005
Published at Institute for the Health of Women and Children, Dept of Paediatrics
Pages 461-8
Language en
Keywords Adolescent, Adult, Antigens, CD/analysis, Antineoplastic Agents/adverse effects/therapeutic use, B-Lymphocytes/cytology/immunology, Case-Control Studies, Child, Child, Preschool, Cross-Sectional Studies, Humans, Immune System/cytology/*physiology, Immunoglobulins/blood, Immunosuppression/methods, Killer Cells, Natural/cytology/immunology, Leukemia, Lymphocytic, Acute, L1/*drug therapy, Lymphocyte Subsets/cytology, *Regeneration, T-Lymphocytes/cytology/immunology, Time Factors, *Vaccination
Subject categories Medical and Health Sciences


OBJECTIVE: The aim was to examine the immune reconstitution after current chemotherapy for childhood ALL, with a special focus on finding immunologic variables that predict a poor immune response to vaccinations. PROCEDURE: In a cross-sectional study of 31 children after treatment with the NOPHO ALL-1992 protocol peripheral blood lymphocyte subsets, T- and B-cell function in vitro and serum immunoglobulins (Ig) were measured. All patients were examined once, at 1 or at 6 months after cessation of chemotherapy, immediately before vaccination with DT and Hib. RESULTS: Lymphocytes, T-cells, and CD4+ T-cells were low at 6 months after treatment. Naive T-cell subsets were more reduced than memory subsets. In the high risk (HR) ALL group, CD8+ T-cells were reduced at 6 months. NK-cells were low at 1 month, but normal at 6 months; however, the CD3+CD56+ (NKT) subset was reduced at both time points. Total B-cell number was low at 1 month, but normal at 6 months. A relative increase of CD5+ B-cells (B-1 cells) was evident, particularly in the HR group. Antigen-independent T- and B-cell function in vitro were affected at 1 month, but virtually normalized at 6 months. Serum IgM level was decreased at 1 month and IgG3 level was increased at 1 and 6 months. CONCLUSIONS: This study shows that immune reconstitution after childhood ALL is slower than previously reported and emphasizes the influence of treatment intensity. The most intensively treated patients still have persistent abnormalities in T-, B-, and NK-cell subsets at 6 months post therapy and show a poor response to immunization with T-cell dependent antigens. In the HR group, routine re-immunizations before this time point are of limited benefit, and the effect of repeated vaccinations should be evaluated.

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