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292 Omrani et al.| Journal of Clinical and Translational Research 2024; 10(5): 291-295
lymphoid organs, and the BM [5,6]. In addition, immune system Data were analyzed using Statistical Package for Social Sciences
dysfunction is an inevitable side effect of chemotherapy, which (SPSS) V19 software (SPSS Inc., USA). The Kolmogorov–Smirnov
is used in the treatment of leukemia. test evaluated the normal distribution of continuous variables.
Chemotherapy uses potent cytotoxic and immune-suppressing Parametric data are expressed as mean ± standard deviation. The
agents to eliminate cancerous cells, but these drugs also affect Chi-square test and Spearman correlation were used to analyze
normal BM cells, leading to a reduction in blood cells [7] and data. For all analyses, a p < 0.05 is considered significant.
defects in the humoral immune system. The abnormality in
the immune system after chemotherapy in leukemia patients 3. Results
lasts for a general period of 6–12 months after stopping the 3.1. Total IgA, IgE, IgG, and IgM
treatment [8]; however, long-term abnormalities have also been
reported [9], and B lymphocytes are mainly sensitive to this side The mean age of the patients was 8.6 ± 2.5 years old. In general,
effect of chemotherapy [10,11]. Therefore, these patients appear 6 months after chemotherapy, the mean level of IgG, IgM, IgE,
to be highly susceptible to infection, even diseases they have and IgA exhibited an increase of 563.1 units in IgG level, 11 units
been vaccinated for, such as diphtheria, tetanus, or hepatitis B. in IgM, 11.3 units in IgE, and 5 units in IgA levels (Table 1).
Post-chemotherapy immune system dysfunction has been Changes in study variables 6 months after the completion of
reported, but previous findings are not consistent [12,13]. The chemotherapy are presented in Table 2. Our analyses revealed
probability of vaccination failure and the need for revaccination that the IgM, IgE, and IgA levels were significantly increased
remain challenging for these patients [14]. In this regard, the after 6 months of chemotherapy compared to the immediate
behavior of the immune system in leukemia patients following time after chemotherapy (p = 0.001), but the increment in IgG
chemotherapy is not yet clearly defined. In the present study, level was not significant (p = 0.336). Moreover, no statistically
we aimed to evaluate the humoral immunity against diphtheria, significant relationship was observed between the level of these
tetanus, and hepatitis B in pediatrics with leukemia immediately IgG, IgM, IgE, and IgA and gender (Table 3).
and 6 months after chemotherapy. 3.2. IgG antibody levels against diphtheria, tetanus, and
2. Materials and Methods hepatitis B
The present prospective cohort study included 21 children In total, 6 months after chemotherapy, the mean level of
(13 males and 8 females) with acute lymphocytic leukemia IgG antibodies exhibited an increase of 3.43 and 1.03 units
(ALL). The patients were assessed at 1 and 6 months after
therapy termination. The treatment process of all enrolled Table 1. Changes in antibody levels
patients was performed based on the Acute Lymphoblastic Antibody Antibody levels (unit) p‑value
Leukaemia: BFM 20001 Schema protocol [15]. Briefly, all Immediately after 6 months after
patients were treated with a combination of vincristine sulfate, chemotherapy chemotherapy
adriamycin, and methotrexate. IgG 665.6±509.9 1228.7±1815.2 0.366
Patients with a history of stem cell transplantation or primary IgM 46.9±56.9 57.9±44.3 <0.001
immune deficiency disease were excluded from this study. IgE 29.3±80.5 40.6±77.7 <0.001
All participants provided written informed consent, and the IgA 84.9±85.4 89.9±69.3 <0.001
Institutional Review Board approved the protocol and consent Note: Antibody levels are presented by mean±standard deviation.
forms at Shahid Beheshti University of Medical Sciences
(approval number: IRSBMU.MSP.REC.1399.473). Table 2. Changes in study variables 6 months after the completion
The following data were collected immediately after and of chemotherapy
6 months after the end of the chemotherapy: quantitative level of Variables Changes in variables
total immunoglobulins (IgG, IgM, IgE, and IgA), IgG antibody
levels against diphtheria, tetanus, and hepatitis B, white blood Increase, Constant, Decrease,
n (%)
n (%)
n (%)
cell (WBC) number, and neutrophil and lymphocyte percentages.
Serum samples were screened for IgG antibodies against Serum levels of immunoglobulins
diphtheria and tetanus using the commercial Human IgG 10 (47.6) 0 (0) 11 (52.4)
Diphtheria Antibody enzyme-linked immunosorbent assay IgM 9 (42.85) 3 (14.3) 9 (42.85)
(ELISA) Kit and Tetanus Toxoid IgG ELISA Kit, respectively IgE 12 (57.1) 3 (14.3) 6 (28.6)
(MyBioSource, United States of America [USA]). Furthermore, IgA 8 (38) 3 (14.3) 10 (47.6)
a hepatitis B antibody rapid test kit was used to identify the IgG Antibody titer against diphtheria 11 (52.4) 4 (19) 6 (28.6)
antibody against the hepatitis B virus. All ELISA reactions were Antibody titer against tetanus 3 (14.3) 5 (23.8) 13 (61.9)
performed according to the manufacturer’s instructions. Antibody titer against hepatitis B 1 (4.8) 5 (23.8) 15 (71.4)
The patients were categorized into two groups based on age: WBC count 16 (76.2) 1 (4.8) 4 (19)
group 1: ≤8 years old; group 2: >8 years old. The relationship Neutrophil count 12 (57.1) 0 (0) 9 (42.8)
between the immune system-related factors and the age group Lymphocyte count 10 (47.6) 0 (0) 11 (52.4)
and gender of the patients was evaluated. Abbreviations: n: Number of patients; WBC: White blood cell.

DOI: http://doi.org/10.36922/jctr.24.00050