Immunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens

Brodtman, Daniel Heath; Rosenthal, David W.; Redner, Arlene; Lanzkowsky, Philip; Bonagura, Vincent R.

doi:10.1016/j.jpeds.2004.12.043

Cited by 65 publications

(52 citation statements)

References 42 publications

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“…8 Brodtman et al observed 52% positivity for measles and 76% for rubella among 99 children treated for ALL and off therapy for 1 year. 9 In our study we observed that 65% of the children had maintained adequate measles antibodies after completion of treatment, which is very similar to the results reported by the authors cited above. Nevertheless, positivity of 60-65% is well below the 95-99% seroconversion after the basic measles vaccination schedule expected for the healthy general population, 10 and means that more than 25% of our patients were vulnerable to measles.…”

Section: Resultssupporting

confidence: 92%

Avaliação da proteção vacinal contra sarampo e rubéola após o tratamento em crianças portadoras de leucemia linfóide aguda previamente imunizadas

Volc¹,

Almeida²,

Abadi³

et al. 2006

J. Pediatr. (Rio J.)

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Objective: To assess the vaccination history and the status of vaccine-induced protection from measles and rubella in children after treatment for acute lymphoblastic leukemia.Methods: Measles and rubella immunological status was assessed by the ELISA technique for 22 children previously treated for acute lymphoblastic leukemia.Results: From the total of 22 patients, 20 had been given two doses of measles vaccine and 18 had had one dose of rubella vaccine. The percentage of patients seropositive for measles and rubella were 65 and 88.9%, respectively, with no correlation with age of patient, aggression of treatment or the time passed between the end of treatment and sample collection. Conclusions:We detected that vaccination had failed against measles and rubella in 35 and 11.1% of cases, respectively. We recommend that a measles booster be given after the completion of treatment for acute lymphoblastic leukemia and that rubella immunity status should be assessed at this point, with revaccination performed when necessary.

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Section: Resultssupporting

confidence: 92%

Avaliação da proteção vacinal contra sarampo e rubéola após o tratamento em crianças portadoras de leucemia linfóide aguda previamente imunizadas

Volc¹,

Almeida²,

Abadi³

et al. 2006

J. Pediatr. (Rio J.)

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“…He reported protective anti-tetanus antibodies in 100% of the patients after chemotherapy. Brodtman et al [22] and Fioredda et al [23] also found post-chemotherapy protective antibodies in 69% and 83% of the patients, respectively. Ek et al [3] also used the same protective levels with Fioredda et al [23] and with us and found pre-chemotherapy protection in 81% of patients which decreased to 33% after-chemotherapy.…”

Section: Protective Antibody Levels Against Tetanusmentioning

confidence: 91%

Humoral immunity to diphtheria, tetanus, measles, and hemophilus influenzae type b in children with acute lymphoblastic leukemia and response to re‐vaccination

Zengin

Sarper

2009

Pediatric Blood & Cancer

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ObjectiveLoss of immunity to previous vaccination and timing of re‐vaccination in children receiving chemotherapy remains controversial. The aim of this study was to investigate the immunity to vaccine preventable diseases in children with acute lymphoblastic leukemia (ALL).ProcedureSixty‐one patients with ALL and 13 healthy siblings were enrolled. Three study groups included newly diagnosed patients (group 1), patients on maintenance chemotherapy (group 2), and patients that completed chemotherapy (group 3). Blood samples for baseline antibody titers were obtained from all the patients and controls. Patients in group 2 were vaccinated with diphtheria, tetanus, and hemophilus influenzae type b (Hib). Patients in group 3 and controls received the measles vaccine in addition to all the above vaccines. In groups 2 and 3, post‐vaccination antibody titers were also obtained.ResultsPatients and controls had no Hib vaccine during primary vaccination. After chemotherapy median antibody levels against diphtheria, tetanus, measles, and Hib were decreased but tetanus antibodies were still at the protective levels. Proportions of the patients with protective levels were 11.1%, 83.3%, 16.7%, and 16.7% for diphtheria, tetanus, Hib, and measles, respectively. Vaccination achieved protective antibody levels in 81%, 100%, 89.5%, and 70% of the patients for diphtheria, tetanus, Hib, and measles, respectively. Vaccine responses during maintenance were also satisfying.ConclusionWe recommend re‐vaccination after 3 months of cessation of chemotherapy. Administration of Hib vaccine may be beneficial after the first 3 months of maintenance chemotherapy especially in children with no primary vaccination followed by a second booster dose after cessation of therapy to increase immunity. Pediatr Blood Cancer 2009;53:967–972. © 2009 Wiley‐Liss, Inc.

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“…The study of Brodtman et al 41 mentioned a low protection rate, but failed to mention their definition of protective antibody level and vaccination status of the patients. In general, two different protective levels are used: 0.15 mg/ml for titer evaluation during follow-up but 4-6 weeks after vaccination with hemophilus influenzae type B (HiB) conjugate vaccine.…”

Section: Protective Antibody Levels Against Poliomyelitismentioning

confidence: 99%

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

et al. 2006

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Intensified chemotherapy regimens resulting in improved survival of children with acute lymphocytic leukemia (ALL) lead to concerns about therapy-induced immune damage reflected by the loss of protection of previous immunizations and the efficacy of (re-)vaccination. The severity of secondary immunodeficiency, however, is not clear and knowledge is based on a limited number of studies. We performed a systematic review on literature concerning vaccination data of children with ALL published since 1980. Eight studies fulfilled the inclusion criteria. Regarding antibody titers after treatment, the number of children who had preserved the defined protection level for antibodies differed widely, ranging from 17 to 98% for diphtheria, 27 to 82% for Bordetella pertussis, 20 to 98% for tetanus, 62 to 100% for poliomyelitis, 35 to 100% for Haemophilus influenzae type B (HiB), 29 to 92% for mumps, 29 to 60% for measles and 72 to 92% for rubella. Most patients however responded to revaccination, demonstrating immunological recovery. Although the designs and results of the included studies varied widely, it can be concluded that cytostatic therapy for ALL in children results in a temporarily reduction of specific antibody levels. Memory is preserved but revaccination may be warranted. This is the first systematic review and the best possible current approximation of chemotherapy-induced immune damage in children after ALL treatment.

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Immunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens

Cited by 65 publications

References 42 publications

Avaliação da proteção vacinal contra sarampo e rubéola após o tratamento em crianças portadoras de leucemia linfóide aguda previamente imunizadas

Avaliação da proteção vacinal contra sarampo e rubéola após o tratamento em crianças portadoras de leucemia linfóide aguda previamente imunizadas

Humoral immunity to diphtheria, tetanus, measles, and hemophilus influenzae type b in children with acute lymphoblastic leukemia and response to re‐vaccination

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

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