Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy

Sharmin Nahar(1), Md. Anwarul Karim(2), A T M Atikur Rahman(3), Md. Abu Hasan Rubel(4), Sharmin Akter(5), Mst. Arafatara Khatun(6)
(1) Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh, Bangladesh
(2) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, Bangladesh
(3) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, Bangladesh
(4) Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh, Bangladesh
(5) Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh, Bangladesh
(6) National Institute of Cancer and Research Hospital, Dhaka, Bangladesh, Bangladesh

Abstract

Background: Immunosuppression in children with Acute Lymphoblastic Leukaemia (ALL) escalates vulnerability to severe infectious complications which leads to higher morbidity and mortality rates among patients. Immunoglobulins are important part of defence mechanism of the body contributing to the humoral immunity. Of all the immunoglobulins, IgG and IgA represents most common type of antibody in blood circulation and provides most long-lived antibody-based immunity against invading pathogens. In earlier years, studies have shown that, serum immunoglobulins are found to be decreased during chemotherapy and this reduction is related with severe sepsis and death in patients. Early identification of immune status can be much useful for assessment of severity and better risk stratification of the patients. Objective: Evaluation of serum IgG and IgA levels in children with ALL and its relationship with sepsis in induction phase of chemotherapy. Method: This prospective observational study was conducted in the Departments of Paediatric Haematology & Oncology and Department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka. During January 2022 to December 2022, a total 60 paediatric patients of newly diagnosed ALL were included as study population. As control, 30 patients were included in this study from General paediatrics and Paediatric Haematology & Oncology, BSMMU to compare baseline immunoglobulin levels with the study group. Complete history and physical examination of all patients were undertaken, and all prior reports were collected. Serum IgG and IgA level assay was done before starting chemotherapy and at the end of induction chemotherapy in the study group. Patients diagnosed with ALL received chemotherapy modified UK-ALL 2003 protocol. History and data of any event of sepsis, along with the symptoms of complications were taken from all patients during the course of induction chemotherapy. Results: The mean age of the cases were 5.49±3.15 (mean ± SD) years, which ranged from 1.9 to 15 years. Among the cases, 41 patients (68.3%) were male and 19 (31.7%) females. Seven (11.7%) subjects expired during induction chemotherapy. In comparison to the control group the mean IgG level in the study group was lower at baseline and even lower at the end of induction and it was statistically significant (p<0.05). The mean IgG level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgG between septic and aseptic patients was significant only at the end of induction chemotherapy (p<0.05). The mean IgA level was low in study group in comparison with the control group and it was statistically significant (p<0.05) only at the end of induction chemotherapy. The mean IgA level was low in patients with septic events in comparison with the patients with no septic events. Difference of mean of IgA between septic and aseptic patients was significant (p<0.05).  Based on the receiver-operator characteristic (ROC) curves of change of S. IgG, with a cut off value 50% decreased from baseline having 68.8% sensitivity and 29.7% specificity for prediction of sepsis. Considering change of S. IgA with a cut off value 50% decreased from baseline having 67.6% sensitivity and 27.5% specificity for prediction of sepsis. Conclusion: In our study, the mean IgG and IgA level of the cases were low in comparison to the control group. The mean IgG and IgA level of the patients were lower who had infectious complications, and it was more marked after induction chemotherapy. Therefore, evaluation of immunoglobulin profiles is recommended to be considered in patients with ALL in further studies.

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Authors

Sharmin Nahar
naharnabila@gmail.com (Primary Contact)
Md. Anwarul Karim
A T M Atikur Rahman
Md. Abu Hasan Rubel
Sharmin Akter
Mst. Arafatara Khatun
Author Biographies

Sharmin Nahar, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Clinical staff, Department of Haematology, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Md. Anwarul Karim, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Professor, Department of Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh

A T M Atikur Rahman, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Professor and Chairman, Department of Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh

Md. Abu Hasan Rubel, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Specialist, Department of Haematology, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Sharmin Akter, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Clinical staff, Department of Haematology, Asgar Ali Hospital, Gandaria, Dhaka, Bangladesh

Mst. Arafatara Khatun, National Institute of Cancer and Research Hospital, Dhaka, Bangladesh

Medical Officer, Department of Pediatric Hematology and Oncology, National Institute of Cancer and Research Hospital, Dhaka, Bangladesh

1.
Nahar S, Karim MA, Rahman ATMA, Rubel MAH, Akter S, Khatun MA. Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy . Haematol J Bangladesh [Internet]. 2024 Feb. 20 [cited 2024 Apr. 17];8(1):14-20. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/119

Article Details

How to Cite

1.
Nahar S, Karim MA, Rahman ATMA, Rubel MAH, Akter S, Khatun MA. Serum IgG and IgA level in children with acute lymphoblastic leukaemia and its relation with outcome in induction chemotherapy . Haematol J Bangladesh [Internet]. 2024 Feb. 20 [cited 2024 Apr. 17];8(1):14-20. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/119