Kosmidis Sofia, Baka Margarita, Bouhoutsou Despina, Doganis Dimitrios, Kallergi Constantina, Douladiris Nikolaos, Pourtsidis Apostolos, Varvoutsi Maria, Saxoni-Papageorgiou Fotini, Vasilatou-Kosmidis Helen
Second Department of Radiotherapy of St. Savas Anticancer Hospital, Athens, Greece.
Pediatr Blood Cancer. 2008 Mar;50(3):528-32. doi: 10.1002/pbc.21327.
We prospectively evaluated the immunological status, immune recovery and risk of infection in pediatric ALL patients treated on the BFM 95 protocol.
Humoral and cellular immunity were evaluated in 72 children with ALL at the end of intensive therapy and values were compared to those at the completion of therapy and 6-monthly. Parameters investigated included lymphocyte subpopulation by flow cytometry, immunoglobulin levels by nephelometry, antibody titers to previous immunizations and delayed hypersensitivity with skin testing. Immune responses were correlated to duration of therapy, CNS radiotherapy, age and sex.
Humoral immunity was severely depressed by the end of intensive therapy with low immunoglobulin levels and CD19, improved after therapy cessation. Cellular immune responses were normal at the end of intensive treatment but declined significantly by the end of therapy and both CD4 and CD8 remained low at later evaluation points whereas CD4/CD8 ratio was increasing. Duration of therapy and CNS radiotherapy did not affect the rate of immune recovery whereas female had higher CD19, CD45RO, and IgM and children >7 years had higher CD19 and lower CD16 and CD3DR. Among immunized children, 86.7% maintained protective antibodies to MMR and 63% to polio. Despite impairment of immunity, infections outside the neutropenic periods were common viral illnesses.
Humoral immunity was depressed in children with ALL at the end of intensive therapy but began to recover after cessation of therapy. In contrast, cellular immunity declined significantly by the end of therapy and remained abnormal for at least 1 year post-therapy.
我们前瞻性评估了采用BFM 95方案治疗的儿童急性淋巴细胞白血病（ALL）患者的免疫状态、免疫恢复情况及感染风险。
对72例ALL患儿在强化治疗结束时进行体液免疫和细胞免疫评估，并将这些值与治疗结束时及每6个月时的值进行比较。研究的参数包括通过流式细胞术检测淋巴细胞亚群、通过散射比浊法检测免疫球蛋白水平、检测对既往免疫接种的抗体滴度以及通过皮肤试验检测迟发型超敏反应。免疫反应与治疗持续时间、中枢神经系统放疗、年龄和性别相关。
强化治疗结束时体液免疫严重受抑，免疫球蛋白水平和CD19降低，治疗停止后有所改善。强化治疗结束时细胞免疫反应正常，但治疗结束时显著下降，在后续评估点CD4和CD8均维持在低水平，而CD4/CD8比值在升高。治疗持续时间和中枢神经系统放疗不影响免疫恢复速度，而女性的CD19、CD45RO和IgM较高，7岁以上儿童的CD19较高，CD16和CD3DR较低。在已接种疫苗的儿童中，86.7%维持对麻疹、腮腺炎和风疹（MMR）的保护性抗体，63%维持对脊髓灰质炎的保护性抗体。尽管免疫功能受损，但中性粒细胞减少期以外的感染多为常见病毒疾病。
ALL患儿在强化治疗结束时体液免疫受抑，但治疗停止后开始恢复。相比之下，细胞免疫在治疗结束时显著下降，且在治疗后至少1年内仍保持异常。
