Related Experiment Video
Updated: Jun 20, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Immune function in children under chemotherapy for standard risk acute lymphoblastic leukaemia - a prospective study
Matthias Eyrich1, Verena Wiegering, Annick Lim
1Department of Paediatric Haematology/Oncology and Stem Cell Transplantation, Children's Hospital, University of Würzburg, Würzburg, Germany. eyrich_m@klinik.uni-wuerzburg.de
Insights
Chemotherapy for paediatric acute lymphoblastic leukaemia (ALL) severely impacts B-cells but largely preserves T-cell immunity. Immune recovery in ALL patients highlights potential for immunotherapy integration.
Area of Science:
- Immunology
- Paediatric Oncology
- Cancer Therapy
Background:
- Multidrug chemotherapy is crucial for treating paediatric acute lymphoblastic leukaemia (ALL).
- Chemotherapy significantly compromises patient immune function, increasing infection risk.
- Understanding immune system changes during ALL treatment is vital for optimizing care.
Purpose of the Study:
- To analyze the impact of multidrug chemotherapy on immune cell populations and function in children with standard- and intermediate-risk ALL.
- To investigate the recovery patterns of B-cells, T-cells, and Natural Killer (NK) cells during and after ALL treatment.
- To assess T-cell receptor (TCR) repertoire diversity, cytokine production, and thymic function in paediatric ALL patients undergoing chemotherapy.
Main Methods:
- Immunophenotyping to analyze immune cell populations.
- Intracellular cytokine staining to assess T-cell function.
- Serum cytokine concentration measurement.
- T-cell receptor (TCR) repertoire diversity analysis.
- Thymic function assessment.
Main Results:
- B-cells were most severely affected, declining during induction and recovering only after maintenance therapy cessation, with naive B-cell generation being key.
- T-cells and NK cells showed numerical reduction but partial recovery by the end of induction.
- CD4:CD8 ratio, T-cell subsets (naive vs. memory), cytokine production, TCR repertoire, and thymic function remained largely unaffected by chemotherapy.
- Patients receiving dexamethasone had lower IFNgamma-producing T-cells compared to those on prednisone.
Conclusions:
- The T-cell system in paediatric ALL patients with standard- and intermediate-risk disease is relatively well-preserved during chemotherapy.
- Chemotherapy's impact on immune cells varies, with B-cells being most vulnerable.
- The preserved T-cell function suggests potential for incorporating immunotherapy into standard ALL treatment protocols.
Abstract:
Multidrug chemotherapy is a highly effective treatment for paediatric acute lymphoblastic leukaemia (ALL), but at the same time compromises immunity of patients. Immune function in a homogenous cohort of 20 children with standard- and intermediate-risk ALL was analysed by immunophenotyping, intracellular cytokine staining, assessment of serum cytokine concentrations, T-cell receptor (TCR) repertoire diversity and thymic function. B-cells were most severely affected by chemotherapy, rapidly declined under induction and did not recover until the cessation of maintenance therapy. This recovery was paralleled by a relative increase in naive IgM(+)IgD(+)CD27(-) B-cells, indicating de novo B-cell generation as the major pathway for B-cell reconstitution. T- and Natural Killer-cells were less severely affected. Although numerically diminished by chemotherapy, they had partially recovered at the end of induction. Interestingly, CD4:CD8 ratio, distribution of naive versus memory T-cells, cytokine production, TCR-repertoire complexity and thymic function were all only marginally affected by chemotherapy. Patients receiving dexamethasone had significantly less IFNgamma(+) T-cells than those receiving prednisone. Our data show that during chemotherapy in standard- and intermediate-risk paediatric ALL patients the T-cell system remains relatively well preserved. Future studies will show if this effect can be exploited for inclusion of immunotherapy in standard ALL treatment protocols.
