LESS Centre, University Hospital for Children and Adolescents, Department for Paediatric Oncology and Immunology, Loschgestrasse 15, 91054 Erlangen, Germany.
Vaccine. 2011 Feb 11;29(8):1565-8. doi: 10.1016/j.vaccine.2010.12.084. Epub 2011 Jan 8.
It is known that antineoplastic treatment may induce secondary immunodeficiency, but studies after childhood sarcoma are rare. Since 1998, the Late Effects Surveillance System (LESS) of the German Society for Paediatric Oncology and Haematology (GPOH) prospectively registers late effects in soft tissue-, osteo- and Ewing's sarcoma patients treated within the therapy trials EICESS-92/EURO-E.W.I.N.G.-99, CWS-96/CWS-2002P, COSS-96 in Austria, Germany and Switzerland.
Antibody levels (AL) against diphtheria and tetanus were used as markers for immunity and classified according to established guidelines for protective AL values. There were 47 eligible relapse-free patients<21 years of age (31 males; 10 osteosarcoma, 12 Ewing's and 25 soft tissue sarcoma patients). Median age at diagnosis was 9.6 (interquartile range: 4.4-14.7) years.
A median 7.2 (3.7-12.2) months after end of antineoplastic therapy, in 28% (13/47; 95% CI 16-43%) of patients there were no protective AL (<0.1 IU/ml) against diphtheria and/or tetanus. Diphtheria and tetanus AL were positively correlated (r=0.39; p=0.007). In multivariable analysis, the type of treatment had no effect on AL, similar to tumour type and time of examination after treatment end. Younger patients had significantly lower AL against tetanus (p=0.009) and girls had significantly lower AL against diphtheria than boys (p=0.015).
Lack of protective AL against tetanus and/or diphtheria is frequent after childhood sarcoma treatment. Prospective surveillance of immunity and, if indicated, re-immunization is warranted in patients treated for childhood cancer.
已知抗肿瘤治疗可能会导致继发性免疫缺陷，但针对儿童肉瘤的研究却很少。自 1998 年以来，德国儿科肿瘤学和血液学学会（GPOH）的晚期效应监测系统（LESS）前瞻性地登记了软组织肉瘤、骨肉瘤和尤文肉瘤患者在 EICESS-92/EURO-E.W.I.N.G.-99、CWS-96/CWS-2002P、COSS-96 治疗试验中的晚期效应，这些患者来自奥地利、德国和瑞士。
抗白喉和破伤风毒素的抗体水平（AL）被用作免疫的标志物，并根据保护性 AL 值的既定指南进行分类。共有 47 名无病生存且年龄<21 岁的患者符合条件（31 名男性；10 名骨肉瘤，12 名尤文肉瘤和 25 名软组织肉瘤患者）。诊断时的中位年龄为 9.6 岁（四分位距：4.4-14.7）。
在抗肿瘤治疗结束后 7.2 个月（中位数，3.7-12.2），28%（47 例中的 13 例；95%CI 16-43%）的患者对白喉和/或破伤风毒素没有保护性 AL（<0.1 IU/ml）。白喉和破伤风毒素的 AL 呈正相关（r=0.39；p=0.007）。多变量分析显示，治疗类型对 AL 没有影响，与肿瘤类型和治疗结束后检查时间相似。年龄较小的患者破伤风毒素的 AL 明显较低（p=0.009），女孩对白喉毒素的 AL 明显低于男孩（p=0.015）。
儿童肉瘤治疗后，破伤风和/或白喉缺乏保护性 AL 是很常见的。对儿童癌症患者进行免疫的前瞻性监测，如果需要，应进行再免疫。
