Trivedi Maharshi, Thankamony Priyakumari, Nair Manjusha, Rajeswari Binitha, Sojamani Guruprasad Chellappan, Seetharam Shwetha, Rajendran Prasanth Varikkattu, Krishna Jagathnath
Departments of Pediatric and Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, 695011, India.
Indian Pediatr. 2025 Jul;62(7):482-488. doi: 10.1007/s13312-025-00034-4. Epub 2025 Apr 15.
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.
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.
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.
Hypoglobulinemia was not found to be an independent risk factor for severe febrile illnesses in children with ALL receiving maintenance chemotherapy.
确定急性淋巴细胞白血病（ALL）患儿在维持化疗期间低球蛋白血症的比例，并确定其与严重发热性疾病的关联。
前瞻性招募接受维持化疗的ALL患儿，采用比浊法测量血清免疫球蛋白水平（IgG、IgM、IgA）。对患儿进行6个月的严重发热性疾病随访或直至治疗结束。
我们纳入了199名平均（标准差）年龄为82.03（39.34）个月的儿童；58、52、47和42名儿童分别接受了0 - 6、7 - 12、13 - 18和19 - 24个月的维持化疗。56.8%、80.4%和86.4%的儿童出现低IgG、低IgA和低IgM。91名（45.7%）儿童发生了147次严重发热性疾病发作。年龄较大（>5岁）与低IgG [优势比95%置信区间] [0.540（0.297，0.982），P = 0.044]、低IgA [0.030（0.011，0.088），P = 0.001]和低IgM [0.323（0.117，0.894），P = 0.030]风险降低相关，女性性别与低IgG风险降低相关（0.539（0.305，0.953），P = 0.033）。年龄较大降低了严重发热性疾病的风险[0.585（0.328，1.041），P = 0.014]，而女孩发生严重发热性疾病的风险增加[（1.118，3.488），P = 0.019]。低球蛋白血症并未增加严重发热性疾病的风险。
在接受维持化疗的ALL患儿中，未发现低球蛋白血症是严重发热性疾病的独立危险因素。
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