Department and Clinic of Pediatric Oncology, Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2014 Jan-Feb;23(1):97-102. doi: 10.17219/acem/37030.
Acute lymphoblastic leukemia (ALL) is the most common pediatric neoplasm. Long-term survival is achieved in approximately 80% of patients. One of the more common complications of ALL treatment is immunosuppression.
The aim of the study is to assess the reconstruction rate of the most important immune system parameters in children after ALL treatment.
The study included 47 children (22 boys, 25 girls) diagnosed and treated for ALL in Department of Pediatric Hematology and Oncology at Wroclaw Medical University. The study used peripheral blood collected at the time treatment was completed and in the first, second, third and sixth months following treatment, then at yearly intervals up to 10 years after treatment. In order to determine the immune status of the tested samples the following parameters were assessed: white blood cell count, absolute lymphocyte count, the proportions of individual subpopulations of lymphocytes - T (CD3 +), Th (CD4 +), Ts (CD8 +), B (CD19 +), NK (CD16 + 56 +), the concentration of immunoglobulins A, G and M, interleukin 10 activity, as well as the expression of ICAM-1 adhesion molecules.
At the end of anti-neoplastic therapy a reduction in both the absolute number leukocytes and various subpopulations of lymphocytes was observed. The lower limits of normal range were achieved about two years after the end of treatment. The concentrations of immunoglobulin IgA, IgG and IgM at the end of treatment were within low normal limits. Normal concentrations of immunoglobulin levels and stability were observed about two years after the end of treatment. There was a slow, steady increase in the production of interleukin-10 and the expression of ICAM-1 adhesion molecules. These results confirm previous observations that after ALL treatment children are in an immunocompromised state for up to 12 months, in terms of both humoral and cellular immunity.
Knowing the average growth trends for the main immune system parameters after ALL treatment can be important in clinical practice for children in whom immune reconstruction proceeds slowly. Predicting the expected time required to restore immune function could be of help, for example in combating infections and planning vaccinations.
急性淋巴细胞白血病（ALL）是最常见的儿科肿瘤。约 80%的患者实现了长期生存。ALL 治疗的常见并发症之一是免疫抑制。
本研究旨在评估 ALL 治疗后儿童最重要的免疫系统参数的重建率。
该研究纳入了在弗罗茨瓦夫医科大学儿科血液学和肿瘤学系诊断和治疗 ALL 的 47 名儿童（22 名男孩，25 名女孩）。该研究使用在治疗完成时以及治疗后第 1、2、3 和 6 个月以及治疗后 10 年内每年收集的外周血样。为了确定测试样本的免疫状态，评估了以下参数：白细胞计数、绝对淋巴细胞计数、淋巴细胞各亚群的比例 - T（CD3+）、Th（CD4+）、Ts（CD8+）、B（CD19+）、NK（CD16+56+）、免疫球蛋白 A、G 和 M 的浓度、白细胞介素 10 活性以及 ICAM-1 粘附分子的表达。
在抗肿瘤治疗结束时，白细胞和各种淋巴细胞亚群的绝对数量均减少。大约在治疗结束后两年达到正常范围的下限。治疗结束时免疫球蛋白 IgA、IgG 和 IgM 的浓度处于正常低值范围内。在治疗结束后两年左右，观察到免疫球蛋白水平的正常浓度和稳定性。白细胞介素-10 的产生和 ICAM-1 粘附分子的表达呈缓慢而稳定的增加。这些结果证实了之前的观察结果，即在 ALL 治疗后，儿童在体液和细胞免疫方面都处于免疫抑制状态长达 12 个月。
了解 ALL 治疗后主要免疫系统参数的平均增长趋势，对于免疫重建进展缓慢的儿童，在临床实践中可能非常重要。预测恢复免疫功能所需的预期时间可能有助于对抗感染和规划疫苗接种。
