#Leukemia #ALL #cancer #oncology #pediatrics #prophylaxis #immunoglobulin #fever
Acute lymphoblastic laukemia (ALL) is the
most common pediatric cancer.
Despite therapeutic advances, infections remain a
major cause of complications
and mortality. Approximately
20% of deaths related to pediatric hematologic
cancer treatment are due to infections, accounting for more than half of
non-disease-related deaths.
Intensive treatments, such as
chemotherapy, weaken the
immune system,
leading to a
decrease in immunoglobulins (IgG) and B lymphocytes, both
essential for infection defense. This immune deficiency exposes children to
frequent infections, often accompanied by fever requiring hospitalization.
These repeated hospitalizations can
interrupt chemotherapy, increasing the
risk
of relapse.
Prophylaxis with intravenous immunoglobulins (IVIG), successfully used
in patients with
primary immunodeficiencies, could be a solution to
reduce the
risk of infections in children with ALL. However, the efficacy and relevance of
such an approach in this population remain uncertain, particularly due to
the
potential risk of side effects.
This study evaluates the impact of IVIG prophylaxis on
reducing
hospitalizations for fever, antibiotic use, and
treatment interruptions in
children with intermediate-risk ALL.
Read next: ALL: a constantly evolving battle
IVIG: An Effective Shield Against Infections?
A total of
177 children with intermediate-risk ALL were included and
randomly assigned to two groups:
- One group
receiving IVIG prophylaxis (0.7 g/kg every 3 weeks, starting on day 22
after diagnosis);
- A control
group receiving standard care.
The impact of this prophylaxis was measured by analyzing the following
outcomes: the
number of hospitalizations for fever, antibiotic use, and
chemotherapy adjustments due to infections.
Children who received IVIG had
fewer hospitalizations for fever (206 vs.
271, p = 0.011), with a particularly marked reduction during the
maintenance
phase (100 vs. 166, p < 0.001).
Admissions for fever with negative blood
cultures, often associated with viral infections, were also less frequent (113
vs. 200, p < 0.001). These patients required
fewer antibiotic treatments (78
vs. 137, p < 0.001) and
fewer chemotherapy adjustments (72 vs. 134, p <
0.001).
However, IVIG prophylaxis had
no significant impact on relapse rates,
disease-free survival, or overall survival. Its main benefit lies in
reducing
infections and improving treatment tolerance.
Fewer Hospitalizations, but a Limited Overall Benefit?
Acute lymphoblastic leukemia is the
most common pediatric cancer. Its
treatment, based on intensive chemotherapy, weakens the immune system and
increases the risk of infections, which account for a significant share of
complications and hospitalizations.
Infections, besides being potentially severe, can
disrupt the
chemotherapy protocol, increasing the
risk of relapse. Currently, strategies to
reduce these infections remain limited. IVIG prophylaxis could be a promising
therapeutic avenue.
This study aimed to assess whether
prophylactic IVIG administration
could reduce the
number of hospitalizations for fever, limit
antibiotic use,
and prevent
chemotherapy interruptions in children with intermediate-risk ALL.
The results show that
IVIG significantly reduces hospitalizations for
fever, particularly during the
maintenance phase. Antibiotic use and treatment
interruptions are also reduced. However, IVIG did not improve survival rates or
reduce the risk of relapse.
Further research will help identify which patients could benefit most
from IVIG. The increased risk of thrombosis observed must be evaluated before
considering widespread prophylaxis. Future studies should focus on children
most vulnerable to infections, particularly those with immune deficiencies, to
optimize IVIG use and tailor it to high-risk profiles.
Read next: Weight at diagnosis: an ally or an obstacle?
