Immunodeficiency in long-term survivors of acute lymphoblastic leukemia treated with Berlin-Frankfurt-Münster therapy

Smith, Steven J.; Schiffman, Gerald; Karayalcin, Gungor; Bonagura, Vincent R.

doi:10.1016/s0022-3476(95)70259-8

Cited by 59 publications

(39 citation statements)

References 17 publications

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“…[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.…”

Section: Resultsmentioning

confidence: 78%

“…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. 10 Other groups have noted deficiencies involving both B and T cells such as decreased absolute lymphocyte counts and hypogammaglobulinemia.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1998

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The fluorescence-activated cell sorter (FACS) was utilized to phenotype lymphocyte compartments in children receiving intensive chemotherapy for acute lymphoblastic leukemia (ALL). Sixteen patients (eight males and eight females) of diverse ages, risks of relapse, and within weeks 7-53 of maintenance/continuation chemotherapy treatment were arbitrarily selected for study. All 16 patients had profound B cell lymphopenia. In contrast, T cell numbers were often normal or marginally low, and accounted for up to 98% of the lymphocyte populations. No abnormality in T cell phenotypes could be demonstrated. Due to the highly skewed B/T lymphocyte ratios in these ALL patients, the absolute white blood cell counts and lymphocyte percentages were not predictive of the underlying B cell lymphopenia. Patients were also tested for serum immunoglobulin levels and most had abnormally low IgG and IgM. None of four patients immunized with the 1996-1997 influenza virus vaccine seroconverted to at least two vaccine antigens as compared to 10 of 10 healthy, age-matched controls. In total, these data highlight for the first time the profound abnormality of the B/T lymphocyte ratio in patients during treatment for ALL, and argue for consideration of B cell-targeted immunotherapy.

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“…[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.…”

Section: Resultsmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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

et al. 1998

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“…Again, overall protection rates were high (above 70%) in most studies, with the exception of a small study of Smith et al, 40 who showed a lower protection rate. No (re-)vaccination data were reported.…”

Section: Protective Antibody Levels Against Poliomyelitismentioning

confidence: 86%

“…Moreover, HiB conjugate vaccinations started only in the early 1990s of the last century in most countries. Smith et al 40 did not mention the HiB conjugate vaccination status, whereas Ek et al 16 reported 50% of their patients to be vaccinated and 50% naturally exposed. Remarkably, (re-)vaccination did not seem to improve the protection rate in these studies in contrast with the previously mentioned vaccines against tetanus, diphtheria and B. pertussis.…”

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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“…1 The underlying disease and the treatment itself both result in significant immunosuppression, which can remain even after white blood cell counts have returned to normal. 2 Assessment of the immune status of these patients with reference to common childhood diseases, after completion of their treatment, is a subject that, while relevant, has received little study.…”

Section: Introductionmentioning

confidence: 99%

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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Immunodeficiency in long-term survivors of acute lymphoblastic leukemia treated with Berlin-Frankfurt-Münster therapy

Cited by 59 publications

References 17 publications

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

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

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

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

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