Psychological intervention based on psychoneuroimmunology improves clinical evolution, quality of life, and immunity of children with leukemia: A preliminary study

Abstract

We conducted a non-randomized, open-label clinical trial to assess whether a psychoneuroimmunology-based intervention enhanced immunity in children with acute lymphoblastic leukemia undergoing chemotherapy. In total, 16 children (44% female) received psychoneuroimmunology-based intervention, whereas 12 (50% female) received health psychoeducation (controls). The primary outcome was immunity markers, being clinical conditions the secondary outcome. Psychoneuroimmunology-based intervention increased immune markers (CD8+ T, B, and natural killer cells, serum immunoglobulin A, and immunoglobulin M) and quality of life, whereas it shortens the duration of fever and use of antipyretics, antibiotics, analgesics, and respiratory therapy. Immunity markers correlated with clinical conditions. Thus, psychoneuroimmunology-based intervention could reduce hospital cost and increase patient well-being.

Keywords: children; hematology; leukemia; psychological intervention; psychoneuroimmunology.

Figure 1.

TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) flowchart of the study.

Figure 2.

Comparison of the average number of circulating lymphocytes and NK cells between control and PNI patients before (day 1) and during (days 33 and 64) the induction chemotherapy. Each point represents mean ± s.e.m. Horizontal dotted lines depict normal reference ranges: total lymphocytes = 2000–2700 per μL; NK cells = 200–300 per μL. (a) Total circulating lymphocytes (includes all subtypes; *significant difference of PNI respect to controls (p < 0.05, Student’s t-test)). (b) Circulating NK cells (*significant difference of PNI respect to controls (p < 0.05, two-way ANOVA followed by Newman–Keuls test)).

Figure 3.

Comparison between the time course of the number of all T lymphocytes, subpopulations of T lymphocytes, and B lymphocytes. Each point represents mean ± s.e.m. Horizontal dotted lines depict normal reference ranges: (a) T lymphocytes range = 1400–2000 per μL. (b) CD4+ T lymphocyte range = 700–1100 per μL (*significantly higher in the PNI group than in the controls (p < 0.0001, unpaired t-test)). (c) CD8+ T lymphocytes range = 600–900 per μL (*significantly higher in the PNI than in the controls (p < 0.0001; unpaired t-test)). (d) B lymphocytes range = 300–800 per μL (*significantly higher in the PNI group than in the controls (p < 0.001; Mann–Whitney U test)).

Figure 4.

Average serum antibody subtypes during chemotherapeutic induction in controls and patients undergoing PNI. Each point represents mean ± s.e.m. Horizontal dotted lines depict normal reference range (IgG = 700–1600 mg/dL; IgM = 40–260 mg/dL; IgA = 70–400 mg/dL). (a) IgG antibodies. (b) IgM antibodies (*significantly overall higher serum IgM concentrations in PNI group respect to controls (F(1, 57) = 7.348, p = 0.0089, two-way ANOVA)). (c) IgA antibodies (*significantly overall higher serum IgA concentrations in PNI group respect to controls: F(1, 71) = 6.981, p = 0.0101, two-way ANOVA and significant intervention × time interaction: F(2, 71) = 3.151, p = 0.0489, two-way ANOVA).

Figure 5.

Quality of life at day 64 of induction chemotherapy in ALL pediatric patients subjected to PNI and conventional (control) interventions. (a) Quality of life index. Each point represents mean ± s.e.m. (*significant difference with respect to controls (p < 0.01; two-way ANOVA); **significantly higher than day 1 (for PNI) or day 33 (for controls) (PNI: p < 0.01; controls: p < 0.05; one-way ANOVA)). (b) Percentage by category of quality of life at day 64 (*significant difference (p < 0.05, Fisher’s exact test)).