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Waning Vaccine Immunity and Vaccination Responses in Children Treated for Acute Lymphoblastic Leukemia: A Canadian
Karina A Top1, Wendy Vaudry2, Shaun K Morris3
1Departments of Pediatrics and Community Health & Epidemiology, and the Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada.
Insights
Children treated for acute lymphoblastic leukemia (ALL) have diminished immunity. Postchemotherapy vaccination with DTaP-IPV-Hib, PCV13, and PPV23 effectively restores antibody levels and is well-tolerated, indicating a need for systematic revaccination.
Area of Science:
- Pediatric Oncology
- Immunology
- Vaccinology
Background:
- Children with acute lymphoblastic leukemia (ALL) often experience waning immunity post-treatment.
- There is a lack of standardized guidelines for post-chemotherapy vaccination in pediatric ALL survivors.
Purpose of the Study:
- To evaluate waning immunity to specific antigens in children treated for ALL.
- To assess the immunogenicity and safety of post-chemotherapy vaccination regimens in pediatric ALL survivors.
Main Methods:
- A multicenter trial involving children with ALL 4-12 months post-chemotherapy and immunocompetent controls.
- Participants received diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib), 13-valent pneumococcal conjugate vaccine (PCV13), and 23-valent pneumococcal polysaccharide vaccine (PPV23).
- Serological measurements were taken at baseline, 2 months, and 12 months post-vaccination; adverse events were monitored.
Main Results:
- Post-chemotherapy participants showed lower baseline immunization rates and antibody levels compared to controls.
- Vaccination with DTaP-IPV-Hib, PCV13, and PPV23 significantly increased antibody levels to tetanus toxoid, pertussis toxin, pneumococcal serotypes, and varicella.
- Antibody levels remained elevated at 12 months post-vaccination, with no serious adverse events reported.
Conclusions:
- Children treated for ALL exhibit reduced immunity to key vaccine-preventable diseases.
- Post-chemotherapy vaccination strategies utilizing DTaP-IPV-Hib, PCV13, and PPV23 are immunogenic and safe for pediatric ALL survivors.
- Systematic revaccination protocols are recommended to improve immune protection in children who have undergone ALL treatment.
Background:
There is no uniform guideline for postchemotherapy vaccination of children with acute lymphoblastic leukemia (ALL). We evaluated waning immunity to 14 pneumococcal serotypes, pertussis toxin (PT), tetanus toxoid (TT) and varicella, and immunogenicity of postchemotherapy diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) and pneumococcal vaccination among previously vaccinated children treated for ALL.
Methods:
This was a multicenter trial of children with ALL enrolled 4-12 months postchemotherapy completion. Exclusion criteria included: infant ALL, relapsed ALL, and stem cell transplant recipients. Immunocompetent children were recruited as controls. Postchemotherapy participants received DTaP-IPV-Hib and 13-valent pneumococcal conjugate vaccine (PCV13) concurrently, followed by 23-valent pneumococcal polysaccharide vaccine (PPV23) 2 months later. Serology was measured at baseline, 2 and 12 months postvaccination. Adverse events were captured via surveys.
Results:
At enrollment, postchemotherapy participants (n = 74) were less likely than controls (n = 78) to be age-appropriately immunized with DTaP (41% vs 89%, P < .001) and PCV (59% vs 79%, P = .008). Geometric mean concentrations (GMCs) to TT, PT, PCV serotypes, and varicella were lower in postchemotherapy participants than controls after adjusting for previous vaccine doses (P < .001). Two months postvaccination, GMCs to TT, PT, and PCV serotypes increased from baseline (P < .001 for all antigens) and remained elevated at 12 months postvaccination. Antibody levels to PPV23 serotypes also increased postvaccination (P < .001). No serious adverse events were reported.
Conclusions:
Children treated for ALL had lower antibody levels than controls against pneumococcal serotypes, tetanus, pertussis, and varicella despite previous vaccination. Postchemotherapy vaccination with DTaP-IPV-Hib, PCV13, and PPV23 was immunogenic and well tolerated. Children with ALL would benefit from systematic revaccination postchemotherapy.
Clinical Trials Registration:
NCT02447718.
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