Original ArticleImmunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens
Section snippets
Patient Selection and Study Design
We performed a chart review to identify children with precursor T- or precursor B-cell ALL who had been treated and observed at the Schneider Children's Hospital. Classification of ALL phenotype was made on the basis of a multiparameter flow cytometric analysis.23 The children had been treated with either the modified BFM1, 22 or another MACR, including the risk-defined Pediatric Oncology Group (POG 9201, 9405, 9605, and 9406), and the NY I24 and NY II25 protocols. These other MACR protocols
Patient Population
All children were treated at the time of initial diagnosis of ALL; 77 children were treated with a modified BFM protocol,1, 22 and 23 others were treated with MACR. Eight-nine percent of the children had precursor B-cell ALL, and 11% had precursor T-cell ALL. Of the patients (n = 65) who had genotype data available, 7 had T-cell ALL, whereas the remainder of patients had pre-B-cell ALL. We categorized the pre-B-cell genotypes into 3 groups: normal chromosome number (17/58), hyperdiploidy (27/58),
Discussion
A large number of these children persistently failed to make and maintain protective antibody responses to viral vaccines, bacterial vaccines, or both. Furthermore, an even larger number of children showed fluctuation in their ability to express and maintain protective antibody responses. This indicates that children, after chemotherapy, are more likely to be at risk of serious infection than would be predicted when only children who persistently fail to make protective antibodies are
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