Active Immunization of Children with Leukemia and Other Malignancies

Abstract

Active immunization against measles, Haemophilus influenza B, tetanus, diphtheria, hepatitis B, influenza, poliomyelitis, and, when indicated varicella and pneumococcus induces long-lasting immunologic protection in most healthy pediatric vaccine recipients. Among children receiving immunosuppressive therapy for cancer, possible early loss of specific immunity acquired from prior vaccination or disease, and likely diminished responsiveness to initial or booster vaccination must be considered. In addition, the safety of vaccine administration requires separate study in this population. Published evidence demonstrates preservation of vaccine-induced antibody titers against tetanus, diphtheria, poliomyelitis and (in children treated for lymphoma) pneumococcus. In contrast, prior immunity to varicella, influenza, and hepatitis B (when naturally acquired), and measles (acquired by vaccination) is compromised during and/or after antineoplastic therapy. Studies of immunologic protection acquired by prior vaccination against hepatitis B, varicella, and H influenza have not been published. The safety of administering toxoids and inactivated vaccines in this population is well documented. In contrast, morbidity must be expected if live attenuated vaccines (oral polio vaccine, attenuated measles vaccine or attenuated varicella vaccine) are administered to children receiving anti-cancer therapy. The risks of using live vaccines should be measured against demonstrable benefits in any vaccine program. The response to initial or booster immunizations against tetanus and diphtheria are similar to those in healthy children. For all other immunizations reviewed, responsiveness is diminished during periods of chemotherapy, more strikingly in children treated for leukemia than for solid tumors. Antibody responses to these vaccines range from slightly blunted (in the case of H influenza B) to marginal (influenza) or completely useless (pneumococcus and hepatitis B in children treated for leukemia).

Profound abnormality of the B/T lymphocyte ratio during chemotherapy for pediatric acute lymphoblastic leukemia

“…[1][2][3][4][5][6][7][8][9] However, our data further show that T cell numbers are often normal. Thus, we demonstrate for the first time the profoundly low B/T ratios in ALL patients.…”

“…It is welldocumented that infection is a major complication of cancer therapy, [1][2][3][4] and poor vaccine responses hinder attempts to prevent infection among patients undergoing therapy for ALL. 5,6 Of note, primary immune responses in these patients are particularly impaired 7 and some reports suggest that such immunosuppression persists for years after cessation of therapy. 8,9 The immunodeficiencies of ALL patients have been attributed to abnormalities such as altered IL-2 production or loss of cell surface receptor expression by T cell subsets.…”

Loss of antibodies and response to (re-)vaccination in children after treatment for acute lymphocytic leukemia: a systematic review

“…Earlier reviews differ in their opinion about immune damage and recovery from secondary immunodeficiency. [42][43][44] As current tailored and intensive combination chemotherapy regimens probably have reached their optimal efficacy, long-term effects like immune damage will stabilize. Therefore, robust studies of sufficient size evaluating secondary immunodeficiency resulting from the current ALL chemotherapy regimens are required for optimal protection of patients against infectious diseases.…”

Measles, Mumps, Varicella Zoster, Diphtheria and Hepatitis B Surface Antibody Status in Pediatric Acute Leukemic Patients

“…Immuno-suppression state related to malignancy or its treatment is responsible for reduced serum antibodies levels attained from previous vaccination [2]. This immuno-compromised state renders host unprotected and subsequently predisposes to re-emergence of infections especially in younger patients [3,4]. Measles and Varicella zoster carry the risk of lethal encephalitis and pneumonia among the immune-compromised hosts [5] influenced by age and immunization status at time of diagnosis [6].…”