Department of Pediatric Hematology and Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMC Pediatr. 2024 Aug 30;24(1):557. doi: 10.1186/s12887-024-05030-4.
The aim of this retrospective study was to investigate the influence of chemotherapy on the immune status of individual patients diagnosed with acute lymphoblastic leukemia (ALL) and to elucidate the clinical characteristics of immune reconstitution in ALL patients following chemotherapy.
Clinical data of children with ALL were gathered, including information on the number of lymphocyte subsets prior to chemotherapy, at the end of therapy, six months, and one year after the end of the treatment.
A total of 146 children with ALL were included, and T cells, B cells, and NK cells all decreased to various degrees prior to treatment. The abnormal CD3 + T cell numbers group experienced a considerably higher mortality (21.9% vs. 6.1%) and recurrence rate (31.3% vs. 11.4%) compared to the normal group (P < 0.05). T cells, B cells, and NK cells were all significantly compromised at the end of therapy compared to the beginning of chemotherapy, with B cells being more severely compromised (P < 0.001). At the end of treatment, levels of B cells, CD4 + T cells, CD4/CD8, IgG and IgM in low risk (LR) group were significantly higher than those in intermediate risk (IR) group (P < 0.01), and levels of NK cells in LR group were evidently lower than those in IR group (P < 0.001). Six months after the end of therapy, all the above indicators recovered (P < 0.001) except CD4/CD8 ratio (P = 0.451).
The immune systems of the ALL patients were severely compromised upon therapy withdrawal, particularly the B cells. At six months after the therapy ended, the B cells were basically restored to normal level, while the T-cell compartment was not. The impaired numbers of CD3 + T cell may contribute to a weakened anti-tumor response, potentially leading to a poorer prognosis.
本回顾性研究旨在探讨化疗对急性淋巴细胞白血病（ALL）患者免疫状态的影响，并阐明化疗后 ALL 患者免疫重建的临床特征。
收集 ALL 患儿的临床资料，包括化疗前、治疗结束时、治疗结束后 6 个月和 1 年时淋巴细胞亚群的数量信息。
共纳入 146 例 ALL 患儿，治疗前 T 细胞、B 细胞和 NK 细胞均不同程度减少。异常 CD3+T 细胞计数组的死亡率（21.9%比 6.1%）和复发率（31.3%比 11.4%）明显高于正常组（P<0.05）。与化疗开始时相比，治疗结束时 T 细胞、B 细胞和 NK 细胞均明显受损，B 细胞受损更为严重（P<0.001）。治疗结束时，低危（LR）组 B 细胞、CD4+T 细胞、CD4/CD8、IgG 和 IgM 水平明显高于中危（IR）组（P<0.01），LR 组 NK 细胞水平明显低于 IR 组（P<0.001）。治疗结束后 6 个月，除 CD4/CD8 比值（P=0.451）外，上述指标均恢复（P<0.001）。
ALL 患者的免疫系统在停药后受到严重损害，尤其是 B 细胞。治疗结束后 6 个月，B 细胞基本恢复正常水平，而 T 细胞亚群未恢复。CD3+T 细胞计数减少可能导致抗肿瘤反应减弱，从而导致预后较差。
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