Bochennek Konrad, Allwinn Regina, Langer Rebecca, Becker Martina, Keppler Oliver T, Klingebiel Thomas, Lehrnbecher Thomas
Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt, Germany.
Institute of Medical Virology, University of Frankfurt, Germany.
Vaccine. 2014 Jun 5;32(27):3357-61. doi: 10.1016/j.vaccine.2014.04.042. Epub 2014 Apr 29.
Intensive chemotherapy in children with cancer results in long-term impairment of humoral immunity. Whereas most studies to date focused on children with acute lymphoblastic leukemia (ALL), little data have been published on patients suffering from Hodgkin disease or from solid tumors. We therefore analyzed the loss of protective immunity (defined as immunity at the time of diagnosis and lack of immunity after completion of therapy) against vaccine-preventable diseases in children treated for various malignancies.
Children and adolescents <21 years of age at diagnosis and treated between 2001 and 2010 for various malignancies in the Department of Pediatric Hematology and Oncology, University of Frankfurt, were included in the retrospective chart review. Antibody levels against measles, mumps, rubella and varicella-zoster-virus (VZV) were routinely assessed at the time of diagnosis and within 12 months after completion of therapy.
The study population consisted of 195 children (122 male); 80 patients had ALL, 15 acute myelogenous leukemia (AML), 18 non-Hodgkin lymphoma (NHL), 22 Hodgkin disease, and 60 various solid tumors. Overall, 27%, 47%, 19%, and 17% of the patients lost their humoral immunity against measles, mumps, rubella, and VZV, respectively. The risk of losing protective antibody titers depended on age with a higher risk in younger children. The loss of protective humoral immunity occurred significantly more often in patients with ALL compared to patients with any other underlying malignant disease (hematological malignancies such AML and NHL, Hodgkin disease or solid tumors).
Our data demonstrate that a significant number of children lose pre-existing humoral immunity against measles, mumps, rubella, and VZV after completion of chemotherapy. This loss occurs more often in children with ALL than in children with AML, solid tumors and Hodgkin disease. Our results underline the need for post-chemotherapy revaccination of childhood cancer survivors.
对患癌儿童进行强化化疗会导致体液免疫长期受损。尽管迄今为止大多数研究聚焦于急性淋巴细胞白血病（ALL）患儿，但关于霍奇金病或实体瘤患者的数据报道较少。因此，我们分析了接受各种恶性肿瘤治疗的儿童针对疫苗可预防疾病的保护性免疫丧失情况（定义为诊断时具有免疫力而治疗结束后缺乏免疫力）。
对2001年至2010年间在法兰克福大学儿科血液学和肿瘤学系诊断时年龄小于21岁且因各种恶性肿瘤接受治疗的儿童和青少年进行回顾性病历审查。在诊断时以及治疗结束后12个月内常规评估针对麻疹、腮腺炎、风疹和水痘 - 带状疱疹病毒（VZV）的抗体水平。
研究人群包括195名儿童（122名男性）；80例患有ALL，15例急性髓性白血病（AML），18例非霍奇金淋巴瘤（NHL），22例霍奇金病，以及60例各种实体瘤。总体而言，分别有27%、47%、19%和17%的患者对麻疹、腮腺炎、风疹和VZV失去了体液免疫。失去保护性抗体滴度风险取决于年龄，年幼儿童风险更高。与患有任何其他潜在恶性疾病（血液系统恶性肿瘤如AML和NHL、霍奇金病或实体瘤）的患者相比，ALL患者中保护性体液免疫丧失的情况明显更常见。
我们的数据表明，大量儿童在化疗结束后失去了针对麻疹、腮腺炎、风疹和VZV的既往体液免疫。这种丧失在ALL儿童中比在AML、实体瘤和霍奇金病儿童中更常见。我们的结果强调了对儿童癌症幸存者进行化疗后再接种疫苗的必要性。
