Immunologic monitoring of maintenance therapy for acute lymphoblastic leukaemia in children - Preliminary report

Background. In the study we evaluated immune reconstitution during maintenance therapy for acute lymphoblastic leukaemia (ALL) in relation to different treatment protocols and response of the immune system to the accompanying infections. Procedure. The study group consisted of 40 children. The BFM protocol'90 was used in the standard risk group, while the New York protocol-in the high risk group. Assessment of the immune system was based on the analysis of peripheral blood mononuclear cells by flow cytometry and concentrations of immunoglobulins: G, M, A and IgE. Each patient was examined at 1-3 months' intervals. Results. Following cessation of intensive therapy, the successive months of maintenance treatment showed: (1) a considerable depletion of B lymphocytes, a durable decrease in IgM, IgA and gradually increasing IgG; (2) a correlation between the time passing from the cessation of intensive therapy and increased numbers and percentage of B cells, and the helper/suppressor cell ratio. In the group of children treated according to the high risk protocol, compared to the low-risk group patients, we found lower levels of the following parameters: IgG, lymphocytes: B and T lymphocytes (including CD4/CD8 ratio and "naive"/"memory" ratio) and NK cells (% and count). During infection: (1) a significant increase was noted in the percentage of T cells with HLA co-expression and monocytes with ICAM-1 co-expression, (2) the percentage of CD3(+)CD45RO(+) "memory" T cells was found to increase. Conclusions. Our findings indicate quantitative and qualitative changes of the immunity in children with ALL during maintenance therapy.