Studies on the immune status of children with acute lymphocytic leukaemia. I. Early phase before and after first remission.

Seventeen children of 2-15 years of age with newly diagnosed untreated acute lymphatic leukaemia (ALL) were evaluated with a number of immunological tests: for humoral immunity serum immunoglobulins and reactive antibody formation against three antigens (diphtheria, tetanus, KLH); for cell-mediated immunity in vitro response of blood lymphocytes against PHA; membrane characteristics of blood lymphocytes and lymphoid blasts for both B and T cells. The tests were repeated in thirteen patients who attained full remission. In the majority (twelve cases) no surface markers were detected (null-cell leukaemia), one patient fulfilled the criteria for a T-cell leukaemia with thymoma. Four patients had rather high absolute B-cell counts, but did not fulfill all the criteria for B-cell leukaemia; three of them died before remission. Immune globulin concentrations were only slightly changed, antibody formation, both primary and anamnestic, was possible. PHA response was extremely low in the initial phase, but normal immediately after remission. During remission all patients were markedly depleted in both their B- and T-cell compartment.

Studies on the immune status of children with acute lymphocytic leukaemia. II. In remission with and without cytostatic treatment.

In eleven children with acute lymphocytic leukaemia (ALL), cytostatic treatment was stopped after sustained remission lasting for 9 months--6 1/2 years. Their immunological status was monitored every 6--12 weeks during the first year after cessation of therapy. Rebound of depressed parameters was observed for absolute lymphocyte, B-cell and T-cell counts and for immunoglobulins. A simple follow-up scheme for such patients is proposed.

Normal values of immunoglobulins in premature and in full-term infants, calculated as percentiles.

Immunoglobulin values were determined in carefully selected healthy, normal children of different gestational and chronological ages. Criteria for "normality" were eutrophy (length, weight, head circumference) and absence of obvious malformation, infection or other disease. Immunoglobulin concentrations were measured in radial immunodiffusion, calibrated by a standard serum according to WHO recommendations. Since the distribution patterm of the individual values was found to be asymmetric in certain age groups, percentiles were calculated. They represent a physiologically more meaningful pattern than the arithmetic mean with standard deviation. Especially at the critical chronological age around 3 months the low values are closer together and the high values wider spaced than is the case with the standard deviations. In premature infants the transplacentally acquired IgG supplement is reduced in inverse relation to the duration of gestation. However, the IgG levels of all prematures equal those of term babies at the chronological age of 14 weeks. IgM can, in contrast, be adequately synthesized by all age groups within the first week of life.