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Immunologic status in children with brain tumors and the effect of therapy
R Kebudi1, I Ayan, E Darendeliler
1University of Istanbul, Department of Clinical Oncology, Turkey.
Insights
The UIOI-PBT-91 protocol for pediatric brain tumors caused significant immunosuppression after chemotherapy and radiotherapy. While generally tolerable, it impacted cellular immunity and some humoral immunity markers.
Area of Science:
- Immunology
- Pediatric Oncology
- Cancer Treatment
Background:
- Pediatric brain tumors require intensive treatment protocols.
- Chemotherapy and radiotherapy can significantly impact the immune system.
- Understanding treatment-induced immunosuppression is crucial for patient management.
Purpose of the Study:
- To investigate the immunological effects of the UIOI-PBT-91 protocol in pediatric brain tumor patients.
- To assess changes in cellular and humoral immunity before and after treatment.
- To evaluate the tolerability of the protocol regarding acute immunological side effects.
Main Methods:
- Assessed immunological parameters including lymphocyte subsets, lymphoproliferative response, natural killer cell activity, and immunoglobulin levels.
- Compared pre- and post-treatment values in 20 pediatric brain tumor patients.
- Analyzed data from patients receiving chemotherapy (CT), radiotherapy (RT), or both.
Main Results:
- Pre-treatment T4/T8 cell percentages and lymphoproliferative response were lower than in healthy children.
- Chemotherapy significantly decreased cellular immunity (except T8 and NKCA) and IgG/IgA levels.
- Radiotherapy caused a depression in all cellular immunity parameters.
- Combined CT and RT showed a non-significant decrease in immune parameters.
Conclusions:
- The UIOI-PBT-91 protocol induces cellular immunosuppression following both CT and RT.
- Some humoral immunosuppression was observed after CT.
- The protocol was found to be tolerable concerning acute immunological side effects.
- Infectious episodes were mild and did not cause mortality.
Abstract:
The cellular and humoral immunological parameters (leucocyte, granulocyte, lymphocyte, total T, T4, T8 lymphocyte counts, lymphoproliferative response to PHA [LP-PHA], natural killer cell activity [NKCA], IgG, IgM and IgA levels) of 20 pediatric brain tumor patients were investigated before and after chemo-(CT) and radiotherapy (RT) administered according to the UIOI-PBT-91 protocol. The T4 and T8 cell percentages and the LP-PHA values before therapy were found to be significantly diminished in comparison to values obtained from 12 healthy children (p < 0.05). In patients receiving postoperative CT, all cellular immunity parameters except T8 cell number and NKCA; IgG and IgA levels were significantly decreased after two courses of CT (p < 0.05). In 7 patients given postoperative RT, a depression in all cellular immunity parameters was observed (p < 0.05). In 6 patients treated with 2 courses of postoperative CT followed by RT administered concomitantly with low dose CDDP, there was a decrease in all cellular and humoral immunity parameters, which was not found to be significant. In 5/18 patients infectious episodes in mild to moderate severity were observed, none causing mortality. It was concluded that the UIOI-PBT-91 protocol caused cellular immunosuppression both after CT and after RT and some humoral immunosuppression after CT, but was found to be tolerable in regard to acute immunological side effects.
