Serum Immunoglobulin Levels in Children with Acute Lymphoblastic Leukemia During Maintenance Chemotherapy and its Association with Severe Febrile Illness.

OBJECTIVE

To determine the proportion of children with acute lymphoblastic leukemia (ALL) with hypoglobulinemia during maintenance chemotherapy and to determine its association with severe febrile illnesses.

METHODS

Children with ALL receiving maintenance chemotherapy were prospectively recruited and serum immunoglobulin levels (IgG, IgM, IgA) were measured by turbidimetric method. Children were followed up for severe febrile illnesses for 6 months or till the completion of treatment.

RESULTS

We enrolled 199 children with mean (SD) age 82.03 (39.34) months; 58, 52, 47, and 42 children had received 0-6, 7-12, 13-18 and 19-24 months of maintenance chemotherapy, respectively. Hypo-IgG, hypo-IgA, and hypo-IgM were seen in 56.8%, 80.4%, and 86.4% of children. 91 (45.7%) children developed 147 episodes of severe febrile illness. Older age (> 5 years) was associated with decreased risk [odds ratio 95% CI] of hypo-IgG [0.540 (0.297, 0.982), P = 0.044], hypo-IgA [0.030 (0.011, 0.088), P = 0.001], and hypo-IgM [0.323 (0.117, 0.894), P = 0.030] and female gender had decreased risk of hypo-IgG (0.539 (0.305, 0.953), P = 0.033). Older age decreased the risk [0.585 (0.328, 1.041), P = 0.014] and girls were at increased risk [(1.118, 3.488), P = 0.019] of severe febrile illness. Hypoglobulinemia did not increase the risk of severe febrile illness.

CONCLUSION

Hypoglobulinemia was not found to be an independent risk factor for severe febrile illnesses in children with ALL receiving maintenance chemotherapy.