Konte Elif Kilic, Yozgat Ayca Koca, Uzun Aysun Kara, Cakir Bahar Cuhaci, Yarali Husniye Nese
Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Division of Pediatric Rheumatology, Istanbul, Turkey.
Ankara, Bilkent City Hospital, Division of Pediatric Hematology and Oncology, Ankara, Turkey.
Mediterr J Hematol Infect Dis. 2025 Jul 1;17(1):e2025049. doi: 10.4084/MJHID.2025.049. eCollection 2025.
Emerging treatment strategies have enhanced life expectancy for cancer patients, but late complications, including vaccine-preventable infections from diminished antibody titers, are common. This study evaluates viral vaccine immunity in children post-leukemia treatment and examines the need for additional vaccine doses and their effectiveness.
Our cohort included 62 children diagnosed with acute leukemia. We recorded patients' sex, age at diagnosis, type of leukemia, risk groups, vaccination status prior to chemotherapy, and serology results for hepatitis A, hepatitis B, varicella, measles, rubella, and mumps (MMR) both at the end of chemotherapy and after vaccination following chemotherapy.
Post-treatment, patients exhibited a loss of protective antibody responses: hepatitis A (44.4%), hepatitis B (67.7%), varicella (62.5%), measles (46.9%), rubella (43.5%), and mumps (50%). Notably, high-risk group acute lymphoblastic leukemia (HRG ALL) patients had a marked decrease in protective antibodies for hepatitis B, measles, rubella, and mumps compared to standard/intermediate risk group (SRG/IRG) ALL patients (p<0.05). Among the seronegative patients, following vaccination, five (15.2%) remained seronegative for varicella, one (2.2%) for hepatitis A, one (3.5%) for measles, one (3.8%) for rubella, and two (6.5%) for mumps.
Our study highlights a significant loss of vaccine-protective antibody responses after acute leukemia treatment, particularly among HRG. The increased vulnerability to vaccine-preventable infections, particularly hepatitis B, measles, rubella, mumps, and varicella, in HRG ALL patients highlights the importance of ongoing monitoring of immunization status and potential revaccination strategies to ensure adequate protection against infectious diseases.
新兴的治疗策略提高了癌症患者的预期寿命，但包括因抗体滴度降低导致的疫苗可预防感染在内的晚期并发症很常见。本研究评估白血病治疗后儿童的病毒疫苗免疫力，并探讨额外接种疫苗剂量的必要性及其有效性。
我们的队列包括62名诊断为急性白血病的儿童。我们记录了患者的性别、诊断时的年龄、白血病类型、风险组、化疗前的疫苗接种状况，以及化疗结束时和化疗后接种疫苗后的甲型肝炎、乙型肝炎、水痘、麻疹、风疹和腮腺炎（MMR）的血清学结果。
治疗后，患者出现保护性抗体反应丧失：甲型肝炎（44.4%）、乙型肝炎（67.7%）、水痘（62.5%）、麻疹（46.9%）、风疹（43.5%）和腮腺炎（50%）。值得注意的是，与标准/中度风险组（SRG/IRG）急性淋巴细胞白血病（ALL）患者相比，高危组急性淋巴细胞白血病（HRG ALL）患者的乙型肝炎、麻疹、风疹和腮腺炎保护性抗体明显下降（p<0.05）。在血清阴性患者中，接种疫苗后，5名（15.2%）水痘仍为血清阴性，1名（2.2%）甲型肝炎为血清阴性，1名（3.5%）麻疹为血清阴性，1名（3.8%）风疹为血清阴性，2名（6.5%）腮腺炎为血清阴性。
我们的研究强调急性白血病治疗后疫苗保护性抗体反应显著丧失，尤其是在HRG中。HRG ALL患者对疫苗可预防感染，特别是乙型肝炎、麻疹、风疹、腮腺炎和水痘的易感性增加，凸显了持续监测免疫状态和潜在再接种策略以确保充分预防传染病的重要性。
