Intensified
chemotherapy regimens resulting in improved survival of children with
acute lymphocytic leukemia (ALL) lead to concerns about
therapy-induced immune damage reflected by the loss of protection of previous immunizations and the efficacy of (re-)vaccination. The severity of secondary immunodeficiency, however, is not clear and knowledge is based on a limited number of studies. We performed a systematic review on literature concerning vaccination data of children with ALL published since 1980. Eight studies fulfilled the inclusion criteria. Regarding antibody titers
after treatment, the number of children who had preserved the defined protection level for
antibodies differed widely, ranging from 17 to 98% for
diphtheria, 27 to 82% for Bordetella pertussis, 20 to 98% for
tetanus, 62 to 100% for
poliomyelitis, 35 to 100% for Haemophilus influenzae type B (HiB), 29 to 92% for
mumps, 29 to 60% for
measles and 72 to 92% for
rubella. Most patients however responded to revaccination, demonstrating immunological recovery. Although the designs and results of the included studies varied widely, it can be concluded that
cytostatic therapy for ALL in children results in a temporarily reduction of specific antibody levels. Memory is preserved but revaccination may be warranted. This is the first systematic review and the best possible current approximation of
chemotherapy-induced immune damage in children after ALL treatment.