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Omrani et al.| Journal of Clinical and Translational Research 2024; 10(5): 291-295 293
against diphtheria and tetanus, respectively. In contrast, results lymphocytes decreased by 0.01% after 6 months following
indicated that the mean IgG antibody level against hepatitis B chemotherapy cessation. The relationship between the levels
increased by 7.09 units compared to the immediate time after of WBCs, neutrophils, and lymphocytes within the age group
cessation of therapy (Table 3). was not significant (p > 0.05). Changes in WBC number
Our raw data analyses revealed that 6 months after were significant (p = 0.001), but neutrophil (p = 0.516) and
chemotherapy cessation, one patient had the highest changes lymphocyte (p = 0.262) levels did not change significantly
in IgG antibody levels against diphtheria (from 0.05 to 71), after 6 months compared to the immediate period following
two patients had the highest changes in IgG antibody levels chemotherapy cessation (Table 4). Six months following
against tetanus (from 0.35 to 22.9; from 0.27 to >5), and four chemotherapy cessation, all patients enrolled in the analysis
patients had the highest changes in IgG antibody levels against responded well to the treatment.
hepatitis B (from 12 to 6; from 14 to 9.35; from 1 to >200; 4. Discussion
from 15 to 10).
Our analyses revealed that the changes in antibody levels The present study aimed to investigate the humoral immunity
against diphtheria, tetanus, or hepatitis B were not significant against diphtheria, tetanus, and hepatitis B in children with
after 6 months compared to the immediate period following leukemia both immediately after chemotherapy and 6 months
chemotherapy cessation (p = 0.157, 0.179, and 0.249, respectively; later. The mean of IgM, IgE, and IgA IgG, the total number of
Table 3). No significant relationship was found between the WBC significantly increased after 6 months; the mean level
antibody level against diphtheria, tetanus, or hepatitis B and the of antibodies against diphtheria, tetanus, and hepatitis B, as
patient’s gender (Table 3). In contrast, a significant relationship well as the lymphocyte and neutrophil levels, did not change
was found between the antibody level against diphtheria and the significantly after 6 months in comparison to the immediate
age group of the patients (p = 0.003; Table 3). period following chemotherapy cessation.
Immunosuppression is a significant side effect of many
3.3. Levels of immune system-related factors antineoplastic drugs. The rebuilding of the immune system can

Six months after the completion of chemotherapy, the differ depending on the nature of the disease, drug type and
average levels of WBCs and neutrophils increased by dosage, and the patient’s age [16]. In a cross-sectional study
1121 n/mm and 1.77%, respectively. The average level of performed by Ek et al. [17], involving 31 children with ALL, it
3
was revealed that the levels of IgG and IgM increased, whereas
Table 3. Changes in antibody levels against diphtheria, tetanus, and the level of IgA decreased at 6 months compared to 1 month
hepatitis B following treatment cessation; contrary to our findings, these
Parameter Antibody levels changes were not significant. An increase in IgG, IgM, IgE, and
Immediately after 6 months after p‑value IgA levels after treatment cessation indicates immune system
chemotherapy chemotherapy restoration, as demonstrated in various studies [8].
Anti-diphtheria (unit) 0.25±0.46 3.68±15.43 0.157 The findings of our study revealed that the levels of
Male 0.22±0.28 6.67±19.62 0.123 antibodies against hepatitis B and tetanus, IgG, IgM, IgE, IgA,
and WBCs were not significantly different in the two age groups
Female 0.30±0.68 0.44±0.83 0.358 of patients (≤8 or >8). In line with our findings, Williams et al.
p 0.383 0.138 studied 116 ALL patients with a median age of 6 years (range:
Age (years) 2–17 years) at intervals of 6 months after chemotherapy up to
≤8 (n=10) 0.24±0.26 3.65±15.76 0.244 18 months; no significant relationship was found between age
>8 (n=11) 0.27±0.35 0.98±0.43 0.003* and immune system reconstruction [18]. Our study was limited
Anti-tetanus (unit) 1.15±1.18 2.18±4.94 0.179 only to leukemia, and no categorization was performed based
Male 1.04±1.08 1.26±1.71 0.349 on the type of leukemia.
Female 1.34±1.38 3.37±7.42 0.229 Our study investigated the relationship between gender,
p 0.306 0.234 antibodies against diphtheria, tetanus, and hepatitis B, and IgG,
Age (years) IgM, IgE, and IgA levels 6 months after treatment cessation. In
≤8 (n=10) 0.98±1.32 1.6±1.43 0.163
>8 (n=11) 1.29±1.15 2.98±8.4 0.258 Table 4. Changes in white blood cell (WBC), neutrophils, and
Anti-hepatitis B (unit) 10.76±16.75 17.85±44.61 0.249 lymphocyte levels
Male 12.37±21.09 10.39±19.99 0.404 Parameter Leukocyte count p‑value
Female 8.13±5.21 30.10±69.12 0.192 Immediately after 6 months after
p 0.252 0.239 chemotherapy chemotherapy
Age (years) WBC (n/mm ) 5439±1619 6560±2089 0.001
3
≤8 (n=10) 10.87±18.88 13.46±43.61 0.432 Neutrophil (%) 49.19±14.93 50.96±8.84 0.516
>8 (n=11) 9.97±7.23 16.64±23.54 0.189 Lymphocyte (%) 42.07±14.08 42.08±10.50 0.262
Note: Antibody levels are presented as mean±standard deviation. *p<0.05 indicates Note: WBC, neutrophil, and lymphocyte levels are presented as mean±standard
statistical significance. deviation.
DOI: http://doi.org/10.36922/jctr.24.00050