Introduction
Modern chemotherapy has increased the survival of childhood acute
lymphoblastic leukemia (ALL) upto 90%;1–4 but it
comes with the consequences of immune defence abnormalities and
increased susceptibility to infections.5 Infection is
an important cause of morbidity and mortality in children with ALL
during chemotherapy, especially in developing
countries.6 Reduction of intensity of chemotherapy for
ALL had resulted in a major reduction in infectious
morbidity,7 explaining the possibility that serum
immunoglobulin levels and specific antibody levels may be less affected
in children treated with reduced dose chemotherapy.8Few studies have focussed on the effect of chemotherapy on serum
immunoglobulin levels, and its effect on infective
complications.9–12 Many studies on infection and
immunosuppression in ALL are without stratification for the period and
intensity of chemotherapy. Maintenance chemotherapy bears the
accumulation of previous intensive chemotherapy and reduced reserve for
hematopoesis and is of the longest duration of continuation treatment.
Children are less intensively monitored during this period of
chemotherapy due to reduced intensity of chemotherapy and less frequent
use of parenteral chemotherapeutic agents. Continuation of maintenance
chemotherapy as outpatient treatment also poses significant risk of
exposure to infections via community contacts. There is scarcity of data
correlating immunosuppression especially hypoglobulinaemia with
occurrence of infections during maintenance chemotherapy. Most of such
studies in paediatric ALL are from developed countries, where infections
and related mortality are less. Role of intravenous immunoglobulin
(IVIG) in reducing infectious complications and improving outcome of
infections is still unclear, so is the timing of IVIG for prophylaxis or
treatment.9,13 This study aimed to monitor ALL
children for severe infections during maintenance chemotherapy in the
Indian setting and to find out the risk of severe infections with
hypoglobulinaemia.