IMMUNE STATUS AND IMMUNE RECOVERY IN CHILDREN WITH LYMPHOMA AT THE END OF THERAPY (CHEMOTHERAPY AND/OR RADIOTHERAPY) AND IN FOLLOW-UP EVALUATIONS
OBJECTIVE: We aimed to evaluate the immune status and immune recovery after completion of chemotherapy and/or radiotherapy in children with lymphoma.
METHODS: We prospectively evaluated humoral and cellular immunity in 22 children with lymphoma (11 with Hodgkin's disease [HD] and 11 with non-Hodgkin's lymphoma [NHL]) at the completion of therapy and every 6 months thereafter.
RESULTS: Immunoglobulin (Ig) levels were normal before the onset of therapy in all but 1 child. At the end of therapy, Ig levels decreased: IgM in 18, IgG in 12, and IgA in 7 children. In addition, 17 of 22 had decreased CD19 levels. In HD after radiotherapy, IgG and CD19 levels increased significantly (P = .013 and .004, respectively). IgM levels remained abnormally low in 16 of 22 children up to 18 months after therapy completion. At the end of therapy, helper T lymphocyte (CD4) levels were low in 20 of 22 children, and suppressor (CD8) levels were elevated in 13 of 22 children. (For those with HD before radiotherapy, the CD8 level was high in 10 of 11 children, and the CD4 level was low in 6 of 11 children.) The suppressor CD8 level remained elevated in 12 of 20 children, and helper CD4 level remained abnormally low in 18 of 20 children for a period of 6 to 18 months after therapy. Some immunized children became nonimmune to polio (15 of 22), mumps (6 of 22), rubella (5 of 22), and measles (1 of 22).
CONCLUSIONS: In children with lymphoma, IgM levels remained low for long periods. Helper T lymphocyte levels were low and suppressor levels were high at the end of therapy. Suppressor cells normalized faster, whereas helper cell levels remained abnormally low for a long period. Most children became nonimmune to polio, whereas the majority had antibodies to measles, mumps, and rubella. Despite depressed immunity, serious infections were not documented.
Submitted by Helen Kosmidis
- Copyright © 2008 by the American Academy of Pediatrics