Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, İzmir, Türkiye
Dokuz Eylül University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, İzmir, Türkiye
Turk J Haematol. 2024 Aug 28;41(3):160-166. doi: 10.4274/tjh.galenos.2024.2024.0150. Epub 2024 May 27.
The survival rates of children with acute lymphoblastic leukemia (ALL) have improved over the years, but infections remain a significant cause of morbidity and mortality. Chemotherapy has a range of harmful side effects including the loss of protective antibodies against vaccine-preventable diseases. The objective of this study was to evaluate the serological status of pediatric ALL cases before and after intensive chemotherapy.
Children treated and followed for ALL at Dokuz Eylül University were included in this retrospective cross-sectional study. Antibody levels against hepatitis A, hepatitis B, and rubella were routinely assessed at both the time of diagnosis and 6 months after completion of chemotherapy. Measles, mumps, and varicella antibody levels were evaluated at only 6 months after treatment.
Seventy-eight children who completed chemotherapy for ALL were enrolled in the study. All participants had non-protective antibody levels for at least one of the diseases. The highest seropositivity rate was found for hepatitis A (55.1%) and the lowest for measles (17.9%) after chemotherapy. Overall, 50.7%, 30.6%, and 45.7% of the patients significantly lost their humoral immunity against hepatitis B, hepatitis A, and rubella, respectively. Patients in the higher-risk group for ALL had lower seropositivity rates than patients of the other risk groups. There were statistically significant relationships between the protective antibody rates for hepatitis A and varicella and the ages of the patients. Except for hepatitis A vaccination, pre-chemotherapy vaccination did not affect post-chemotherapy serology. On the other hand, all children with a history of varicella before diagnosis showed immunity after chemotherapy.
Patients with ALL, including those previously fully vaccinated, are at great risk of infection due to the decrease in protective antibody levels after chemotherapy. There is a need for routine post-chemotherapy serological testing and re-vaccination based on the results obtained.
近年来，儿童急性淋巴细胞白血病（ALL）的生存率有所提高，但感染仍是发病率和死亡率的重要原因。化疗具有一系列有害的副作用，包括对疫苗可预防疾病的保护性抗体的丧失。本研究的目的是评估强化化疗前后小儿 ALL 病例的血清学状态。
本回顾性横断面研究纳入了在多泽大学接受 ALL 治疗和随访的儿童。在诊断时和化疗完成后 6 个月常规评估针对甲型肝炎、乙型肝炎和风疹的抗体水平。仅在治疗后 6 个月评估麻疹、腮腺炎和风疹的抗体水平。
本研究纳入了 78 名完成 ALL 化疗的儿童。所有参与者至少有一种疾病的非保护性抗体水平。化疗后血清阳性率最高的是甲型肝炎（55.1%），最低的是麻疹（17.9%）。总体而言，分别有 50.7%、30.6%和 45.7%的患者对乙型肝炎、甲型肝炎和风疹的体液免疫显著丧失。ALL 高危组患者的血清阳性率低于其他风险组患者。患者对甲型肝炎和水痘的保护性抗体率与年龄之间存在统计学显著关系。除甲型肝炎疫苗接种外，化疗前的疫苗接种并不影响化疗后的血清学。另一方面，所有在诊断前有过水痘病史的儿童在化疗后均显示出免疫力。
ALL 患者，包括那些以前已完全接种疫苗的患者，由于化疗后保护性抗体水平下降，存在严重感染的风险。需要根据获得的结果进行常规化疗后血清学检测和重新接种疫苗。
