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Intensive treatment for childhood acute lymphoblastic leukemia reduces immune responses to diphtheria, tetanus, and Haemophilus influenzae type b

Artikel i vetenskaplig tidskrift
Författare Torben Ek
Lotta Mellander
M. Hahn-Zoric
Jonas Abrahamsson
Publicerad i J Pediatr Hematol Oncol
Volym 26
Nummer/häfte 11
Sidor 727-34
ISSN 1077-4114 (Print)
Publiceringsår 2004
Publicerad vid Institutionen för kvinnors och barns hälsa, Avdelningen för pediatrik
Sidor 727-34
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adolescent, Antibodies/blood, Antibody Formation/*drug effects, Antineoplastic Combined Chemotherapy Protocols/*adverse, effects/therapeutic use, B-Lymphocytes/immunology, Case-Control Studies, Child, Child, Preschool, Diphtheria-Tetanus Vaccine/administration & dosage/*immunology, Female, Haemophilus Vaccines/administration & dosage/*immunology, Humans, Immunization, Immunologic Memory, Leukemia, Lymphocytic, Acute, L1/drug therapy/*immunology, Male, Tetanus Toxoid/administration & dosage/*immunology, Time Factors
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

OBJECTIVES: Immunity to diphtheria toxoid (D), tetanus toxoid (T), and Haemophilus influenzae type b (Hib) is affected in children with acute lymphoblastic leukemia (ALL). The aims were to examine immunity and to compare the response to immunization at 1 or 6 months after treatment. METHODS: Thirty-one patients were immunized with DT and conjugated Hib vaccine (ActHib) at 1 month or 6 months after treatment of ALL with the NOPHO 92 protocol. Antibody levels were determined before and 3 weeks after vaccination. Specific T and Hib antibody-secreting cells of IgG/IgA/IgM isotypes were analyzed in peripheral blood using an ELISPOT technique. RESULTS: All specific antibody levels decreased during ALL treatment, and protective levels after treatment were noted for 17% against D, 33% against T, and 100% against Hib. No high-risk patient had full D or T protection after treatment. After vaccination all the standard- and intermediate-risk patients achieved full protection against D, T, and Hib. The high-risk group showed insufficient immune response (full protection after vaccination: D 56%, T 22%, Hib 78%). No difference was found between vaccination at 1 month or 6 months after treatment. The poor antibody production in the high-risk group correlated to low numbers of antibody-secreting cells. CONCLUSIONS: Nonprotective antibody levels against D, T, and Hib after childhood ALL are more common than previously thought. Insufficient immune response was restricted to the high-risk group and was related to a low number of memory B cells in this study. Immunizations should be included in follow-up after childhood ALL, and the policy should be adapted to treatment intensity.

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