Immune recovery in children with malignancy after cessation of chemotherapy

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.