Lymphocyte Subsets Changes in Children with Acute Lymphoblastic Leukemia during Chemotherapy

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with chemotherapy significantly impacting immune cell populations. This study evaluates changes in lymphocyte subsets in children with ALL during treatment. Methods: A retrospective-prospective study analyzed 17 pediatric patients (aged 2-12 years) treated at the University Clinic for Children's Disease- Skopje following the BFM ALL-IC 2002 protocol. Lymphocyte subsets (CD3, CD4, CD19, CD45) were assessed before chemotherapy, after induction, and after reinduction using flow cytometry. Results: Children with ALL exhibited reduced cellular immunity at the end of therapy. Lymphocyte depletion was observed in all patients following the induction phase. A statistically significant difference in CD19+ cell values across the three time points was confirmed (p=0.017). Post-hoc analysis revealed significantly lower CD19+ cell values after induction compared to baseline (1.22 vs. 15.3, p=0.008) and significantly lower values at the end of therapy compared to pre-therapy levels (2.5 vs. 15.3, p=0.021). Conclusion: Intensive chemotherapy induces profound immunosuppression in pediatric ALL patients, primarily affecting B cells. These findings highlight the necessity for immune function assessment and consideration of supportive immunotherapy.