Abstract
Background: Approximately all systemic therapies for childhood affect the immune system. The
behavior of the immune system in leukemia patients following chemotherapy is not yet clearly
defined. The probability of vaccination failure and the need for revaccination remain challenging
for these patients.
Aim: To evaluate the humoral immunity against diphtheria, tetanus, and hepatitis B in children
with acute lymphocytic leukemia (ALL) immediately and 6 months after chemotherapy.
Materials and Methods: In the present prospective cohort study, 21 patients with ALL referred
to Mofid Children’s Hospital were studied immediately and 6 months after chemotherapy. Serum
samples were collected from patients, and the levels of immunoglobulins (IgG, IgM, IgE, and IgA)
antibodies against diphtheria, tetanus, and hepatitis B were determined using specific enzymelinked
immunosorbent assay kits. The obtained data were analyzed using Statistical Package for
Social Sciences 21 software.
Results: A total of 13 males and 8 females with an average age of 8.6 ± 2.5 years were included
in the present study. Six months after chemotherapy, the mean level of IgG, IgM, IgE, and IgA
displayed an increase of 563.1 units in IgG, 11 units in IgM, 11.3 units in IgE, and 5 units in IgA
levels. Moreover, data revealed that 6 months after chemotherapy, the mean level of IgG antibodies
displayed an increase of 7.09, 3.43, and 1.03 units against hepatitis B, diphtheria, and tetanus,
respectively. A significant relationship was found between the antibody level against diphtheria and
the age group of the patients (p = 0.003).
Conclusion: Humoral immune status was boosted after 6 months of chemotherapy, though all
patients had some extent of lasting immune dysfunction. We indicate that survivors of childhood
cancer have ongoing humoral immunological defects and may remain at risk for infectious
complications after completion of therapy.
Relevance for Patients: The present study indicated that systemic therapies for pediatrics with
leukemia affect the immune system. Pediatrics with leukemia may remain at risk for infectious
complications after completion of therapy.
DOI: http://doi.org/10.36922/jctr.24.00050
Author affiliation
1Department of Pediatric Medicine, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
2Pediatric Congenital
Hematologic Disorders Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4Pediatrics and Child Health, Department of
Allergy and Clinical Immunology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
*Corresponding authors:
Dr. Shiva Nazari
Pediatric Congenital Hematologic Disorders
Research Center, Research Institute
for Children’s Health, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Email: shnazari2000@gmail.com
Dr. Fatemeh Malek
Pediatric Congenital Hematologic Disorders
Research Center, Research Institute
for Children’s Health, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
Email: Fmalek7721@gmail.com
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