{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T10:12:47Z","timestamp":1778148767936,"version":"3.51.4"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Acute lymphoblastic leukemia is the most prevalent childhood cancer and the leading cause of cancer mortality before the age of 20. Although therapeutic advances have significantly improved survival, children and adolescents treated for acute lymphoblastic leukemia remain vulnerable to infections, largely preventable by vaccination, due to humoral and cellular immune dysfunction induced by disease and treatment. Materials and Methods: This systematic review, based on electronic databases, aims to evaluate antibody levels associated with potential protective immunity against vaccine antigens for diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, influenza, varicella-zoster virus, yellow fever, pneumococcal, and meningococcal diseases in children and adolescents treated for acute lymphoblastic leukemia after completion of chemotherapy. Results: A total of twenty-four studies published between 1981 and 2023 were included, comprising 1110 children and adolescents. Protective antibody levels ranged from 11% to 97% for diphtheria, 0% to 90% for pertussis, 20% to 100% for tetanus, and 11% to 95% for poliomyelitis. Haemophilus influenzae type b, protection ranged from 16.7% to 100%. Viral vaccines also showed heterogeneous responses, with protection rates of 25\u201379% for mumps, 16\u201386% for measles, 35\u201398% for rubella, and 23\u201375% for varicella-zoster virus. Antibody responses to pneumococcal and meningococcal vaccines were consistently low, with protection rates of 5\u201338% for pneumococcal studies and 12% in a single meningococcal study. Conclusions: This review found a consistent and clinically relevant loss of vaccine-induced immunity in children and adolescents treated for acute lymphoblastic leukemia. The recommendation of vaccine booster doses for this vulnerable population, irrespective of serological status, may represent a more practical approach to ensuring adequate post-chemotherapy treatment protection.<\/jats:p>","DOI":"10.3390\/vaccines14050419","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:03:37Z","timestamp":1778144617000},"page":"419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaccine-Induced Immunity in Children and Adolescents After Chemotherapy for Acute Lymphoblastic Leukemia: A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0515-6971","authenticated-orcid":false,"given":"Cl\u00e1udia F. C.","family":"Valente","sequence":"first","affiliation":[{"name":"Hospital da Crian\u00e7a de Bras\u00edlia Jos\u00e9 Alencar, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6638-6642","authenticated-orcid":false,"given":"Heloisa Ihle Garcia","family":"Giamberardino","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Pr\u00edncipe, Curitiba 80250-060, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T\u00e2nia Cristina de Mattos Barros","family":"Petraglia","sequence":"additional","affiliation":[{"name":"Sa\u00fade da Crian\u00e7a e do Adolescente, Faculdade de Medicina Est\u00e1cio de S\u00e1, Rio de Janeiro 20071-004, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-6011","authenticated-orcid":false,"given":"Cristiane Feitosa","family":"Salviano","sequence":"additional","affiliation":[{"name":"Hospital da Crian\u00e7a de Bras\u00edlia Jos\u00e9 Alencar, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla Lemos","family":"Gomes","sequence":"additional","affiliation":[{"name":"Hospital Materno-Infantil de Bras\u00edlia, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberia Mendon\u00e7a de","family":"Pontes","sequence":"additional","affiliation":[{"name":"Hospital da Crian\u00e7a de Bras\u00edlia Jos\u00e9 Alencar, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Eduarda","family":"Canellas de Castro","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade de Bras\u00edlia, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lis R. V.","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Instituto Ren\u00e9 Rachou, Funda\u00e7\u00e3o Oswaldo Cruz\u2014FIOCRUZ-Minas, Belo Horizonte 30190-003, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-4889","authenticated-orcid":false,"given":"Olindo Assis","family":"Martins-Filho","sequence":"additional","affiliation":[{"name":"Instituto Ren\u00e9 Rachou, Funda\u00e7\u00e3o Oswaldo Cruz\u2014FIOCRUZ-Minas, Belo Horizonte 30190-003, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9245-7504","authenticated-orcid":false,"given":"Cleandro Pires de","family":"Albuquerque","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias M\u00e9dicas, Universidade de Bras\u00edlia, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-5121","authenticated-orcid":false,"given":"Licia Maria Henrique da","family":"Mota","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias M\u00e9dicas, Universidade de Bras\u00edlia, Bras\u00edlia 70684-831, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1056\/NEJMra1400972","article-title":"Acute Lymphoblastic Leukemia in Children","volume":"373","author":"Hunger","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1053\/j.seminhematol.2013.06.007","article-title":"A 50-Year Journey to Cure Childhood Acute Lymphoblastic Leukemia","volume":"50","author":"Pui","year":"2013","journal-title":"Semin. Hematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e188","DOI":"10.1016\/S1473-3099(18)30601-7","article-title":"Vaccination of Patients with Haematological Malignancies Who Did Not Have Transplantations: Guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7)","volume":"19","author":"Mikulska","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/00043426-200411000-00008","article-title":"Intensive Treatment for Childhood Acute Lymphoblastic Leukemia Reduces Immune Responses to Diphtheria, Tetanus, and Haemophilus influenzae Type b","volume":"26","author":"Ek","year":"2004","journal-title":"J. Pediatr. Hematol.\/Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3109\/08880019409141671","article-title":"Recovery of Blood T-Cell Subsets after Chemotherapy for Childhood Acute Lymphoblastic Leukemia","volume":"11","author":"Alanko","year":"1994","journal-title":"Pediatr. Hematol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"707691","DOI":"10.1155\/2014\/707691","article-title":"Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients","volume":"2014","author":"Cesaro","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2509472","DOI":"10.1080\/21645515.2025.2509472","article-title":"Immunization Coverage for Children with Cancer in Latin America and the Caribbean Can Be Improved through Strategic Coordination of Existing Global Agendas","volume":"21","author":"Homsi","year":"2025","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A Web and Mobile App for Systematic Reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/XEB.0000000000000054","article-title":"Methodological Guidance for Systematic Reviews of Observational Epidemiological Studies Reporting Prevalence and Cumulative Incidence Data","volume":"13","author":"Munn","year":"2015","journal-title":"Int. J. Evid.-Based Healthc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1542\/peds.67.2.222","article-title":"Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy","volume":"67","author":"Hermans","year":"1981","journal-title":"Pediatrics"},{"key":"ref_12","first-page":"5116","article-title":"Immunity to Measles and Rubella Impaired after Chemotherapy","volume":"97","author":"Nilsson","year":"2000","journal-title":"L\u00e4kartidningen"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/01.mph.0000163214.37147.5a","article-title":"Antibody Titers and Immune Response to Diphtheria-Tetanus-Pertussis and Measles-Mumps-Rubella Vaccination in Children Treated for Acute Lymphoblastic Leukemia","volume":"27","author":"Ercan","year":"2005","journal-title":"J. Pediatr. Hematol.\/Oncol."},{"key":"ref_14","first-page":"481","article-title":"Measles and Rubella Antibody Status in Children After Treatment for Acute Lymphoblastic Leukemia","volume":"82","author":"Volc","year":"2006","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1086\/511636","article-title":"Revaccination of Children After Completion of Standard Chemotherapy for Acute Leukemia","volume":"44","author":"Patel","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1055\/s-2007-990290","article-title":"Diphtheria (D) and Tetanus (T) Antibody Values in Children with Acute Lymphoblastic Leukaemia (ALL) after Treatment According to Co-ALL 05\/92","volume":"219","author":"Calaminus","year":"2007","journal-title":"Klin. Padiatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1002\/pbc.21327","article-title":"Longitudinal Assessment of Immunological Status and Rate of Immune Recovery Following Treatment in Children with ALL","volume":"50","author":"Kosmidis","year":"2008","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1002\/pbc.22135","article-title":"Humoral Immunity to Diphtheria, Tetanus, Measles, and Hemophilus influenzae Type b in Children with Acute Lymphoblastic Leukemia and Response to Re-Vaccination","volume":"53","author":"Zengin","year":"2009","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_19","first-page":"701","article-title":"Viral Vaccine Antibodies in Children After Acute Lymphoblastic Leukemia Chemotherapy","volume":"53","author":"Cipolotti","year":"2009","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1365-2141.2010.08522.x","article-title":"Revaccination of Children After Completion of Standard Chemotherapy for Acute Lymphoblastic Leukaemia: A Pilot Study Comparing Different Schedules","volume":"152","author":"Lehrnbecher","year":"2010","journal-title":"Br. J. Haematol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.5581\/1516-8484.20120071","article-title":"Antibody Responses to Hepatitis B and Measles-Mumps-Rubella Vaccines in Children Who Received Chemotherapy for Acute Lymphoblastic Leukemia","volume":"34","author":"Viana","year":"2012","journal-title":"Rev. Bras. Hematol. Hemoter."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1002\/pbc.25086","article-title":"Varicella Zoster Immune Status in Children Treated for Acute Leukemia","volume":"61","author":"Patel","year":"2014","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1002\/pbc.25685","article-title":"Vaccine-Derived Immunity in Children with Cancer\u2014Analysis of Anti-Tetanus and Anti-Diphtheria Antibodies Changes After Completion of Antineoplastic Therapy","volume":"62","author":"Gowin","year":"2015","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_24","first-page":"549","article-title":"Humoral Immunity to Tetanus, Measles and Rubella in Children with Acute Lymphoblastic Leukemia After Chemotherapy","volume":"114","author":"Onoratelli","year":"2016","journal-title":"Arch. Argent. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/pbc.26187","article-title":"Protection Against Vaccine Preventable Diseases in Children Treated for Acute Lymphoblastic Leukemia","volume":"64","author":"Leclerc","year":"2017","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e99","DOI":"10.1097\/MPH.0000000000001072","article-title":"Assessment of Humoral Immunity to Hepatitis B, Measles, Rubella, and Mumps in Children After Chemotherapy","volume":"40","author":"Buyukavci","year":"2018","journal-title":"J. Pediatr. Hematol.\/Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1080\/10245332.2018.1460035","article-title":"Humoral Immune Response of Childhood Acute Lymphoblastic Leukemia Survivors Against the Measles, Mumps, and Rubella Vaccination","volume":"23","author":"Fouda","year":"2018","journal-title":"Hematology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e439","DOI":"10.1093\/cid\/ciaa163","article-title":"Waning Vaccine Immunity and Vaccination Responses in Children Treated for Acute Lymphoblastic Leukemia: A Canadian Immunization Research Network Study","volume":"71","author":"Top","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1080\/21645515.2020.1802975","article-title":"Immunization Status and Re-Immunization of Childhood Acute Lymphoblastic Leukemia Survivors","volume":"17","author":"Toret","year":"2021","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e28944","DOI":"10.1002\/pbc.28944","article-title":"Pneumococcal Vaccination During Chemotherapy in Children Treated for Acute Lymphoblastic Leukemia","volume":"68","author":"Dorval","year":"2021","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_31","first-page":"e1907","article-title":"Loss of Humoral Immunity in Childhood Cancer Survivors Not Having Undergone Hematopoietic Stem Cell Transplantation","volume":"6","author":"Pearson","year":"2023","journal-title":"Cancer Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e30133","DOI":"10.1002\/pbc.30133","article-title":"MMR Vaccination Timing and Long-Term Immunity among Childhood Cancer Survivors","volume":"70","author":"Speckhart","year":"2023","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e30321","DOI":"10.1002\/pbc.30321","article-title":"Revaccination of Children with Acute Lymphoblastic Leukemia Following Completion of Chemotherapy","volume":"70","author":"Anafy","year":"2023","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/S0140-6736(19)33018-1","article-title":"Acute Lymphoblastic Leukaemia","volume":"395","author":"Malard","year":"2020","journal-title":"Lancet"},{"key":"ref_35","unstructured":"Plotkin, S.A., Orenstein, W.A., Offit, P.A., and Edwards, K.A. (2018). Plotkin\u2019s Vaccines, Elsevier. [7th ed.]. Chapter 2."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1038\/sj.leu.2404326","article-title":"Loss of Antibodies and Response to (Re-)Vaccination in Children After Treatment for Acute Lymphocytic Leukemia: A Systematic Review","volume":"20","author":"Sanders","year":"2006","journal-title":"Leukemia"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zeng, Y., Yang, C., Li, X., An, Q., Zhou, B., Niu, W., Tian, Y., Cheng, Y., and Wang, L. (2025). Impact of Chemotherapy on Vaccine Immunogenicity and Revaccination Response of Acute Lymphoblastic Leukemia\u2014A Systematic Review and Meta-Analysis. Vaccines, 13.","DOI":"10.3390\/vaccines13060605"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1093\/cid\/cit684","article-title":"2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host","volume":"58","author":"Rubin","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","unstructured":"(2026, March 19). Please change for \u201c Brazil. Ministery of Health. Manual of Reference Centers for Special Immunobiologics, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/manual_centros_referencia_imunobiologicos_6ed.pdf."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/5\/419\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:41:42Z","timestamp":1778146902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/5\/419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["vaccines14050419"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14050419","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]}}}