Mustafa M M, Buchanan G R, Winick N J, McCracken G H, Tkaczewski I, Lipscomb M, Ansari Q, Agopian M S
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, USA.
J Pediatr Hematol Oncol. 1998 Sep-Oct;20(5):451-7. doi: 10.1097/00043426-199809000-00008.
To study longitudinally the extent and recovery of cellular and humoral immune alterations in children with cancer after completion of their therapy.
Using standard immune assays, cellular and humoral immunity was measured in 43 infants and children with cancer at completion of therapy and every 3 months thereafter for 1 year. There were 17 patients with acute lymphoblastic leukemia, 9 with Hodgkin disease, and 17 with solid nonhematopoietic tumors. All children had received standard childhood immunizations before diagnosis of cancer. Immune assays performed included circulating lymphocyte subpopulations, in vitro antigen-induced responses, and total concentrations of serum immunoglobulin G (IgG), IgM, IgA, and IgG subclasses, and specific antibodies against diphtheria, tetanus, pertussis, and poliovirus types I, II, and III.
At completion of therapy, the majority of patients had low circulating lymphocyte subpopulations and antigen-induced responses. Serum antibody concentrations were low in up to 89% of patients regardless of the underlying malignancy. Although improvement occurred during the year of follow-up, 35 of 43 (81%) patients continued to exhibit one or more immune abnormalities 9 to 12 months after cessation of chemotherapy. Younger patients had more persistent alterations. Other risk factors studied (including gender, duration of therapy, and underlying malignancy) did not correlate with the severity of the immune defects. With the exception of poliovirus antibodies, specific antibody titers against common childhood vaccine antigens were deficient at completion of therapy and 9 to 12 months later in a substantial proportion of patients.
Children with malignancy have persistent specific and nonspecific immune alterations 9 to 12 months after cessation of chemotherapy. The clinical implications of these in vitro observations are unclear and require further evaluation.
纵向研究癌症患儿治疗结束后细胞免疫和体液免疫改变的程度及恢复情况。
采用标准免疫检测方法，对43例癌症婴幼儿及儿童在治疗结束时及之后每3个月进行为期1年的细胞免疫和体液免疫检测。其中急性淋巴细胞白血病患者17例，霍奇金病患者9例，实体非造血系统肿瘤患者17例。所有患儿在癌症诊断前均接受过标准的儿童免疫接种。进行的免疫检测包括循环淋巴细胞亚群、体外抗原诱导反应、血清免疫球蛋白G（IgG）、IgM、IgA及IgG亚类的总浓度，以及针对白喉、破伤风、百日咳和脊髓灰质炎病毒I、II、III型的特异性抗体。
治疗结束时，大多数患者循环淋巴细胞亚群及抗原诱导反应水平较低。无论潜在恶性肿瘤类型如何，高达89%的患者血清抗体浓度较低。尽管在随访的一年中有所改善，但43例患者中有35例（81%）在化疗停止9至12个月后仍表现出一种或多种免疫异常。年龄较小的患者免疫改变持续时间更长。研究的其他危险因素（包括性别、治疗持续时间和潜在恶性肿瘤）与免疫缺陷的严重程度无关。除脊髓灰质炎病毒抗体外，在治疗结束时以及9至12个月后，相当一部分患者针对常见儿童疫苗抗原的特异性抗体滴度不足。
恶性肿瘤患儿在化疗停止9至12个月后存在持续的特异性和非特异性免疫改变。这些体外观察结果的临床意义尚不清楚，需要进一步评估。
