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Serum levels of mannose‐binding lectin and the risk of fever in neutropenia pediatric cancer patients
Author(s) -
Schlapbach L.J.,
Aebi C.,
Otth M.,
Luethy A. Ridolfi,
Leibundgut K.,
Hirt A.,
Ammann R.A.
Publication year - 2007
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21097
Subject(s) - mannan binding lectin , medicine , neutropenia , bacteremia , etiology , pediatric cancer , immunology , pneumonia , gastroenterology , poisson regression , cancer , lectin , chemotherapy , antibiotics , biology , population , environmental health , microbiology and biotechnology
Background Fever in neutropenia (FN) is a frequent complication in pediatric oncology. Deficiency of mannose‐binding lectin (MBL), an important component of innate immunity, is common due to genetic polymorphisms, but its impact on infections in oncologic patients is controversial. This study investigated whether MBL serum levels at cancer diagnosis are associated with the development of FN in pediatric cancer patients. Procedure Serum MBL was measured using ELISA. Frequency, duration, and cause of FN were assessed retrospectively. Association with MBL level was analyzed using uni‐ and multivariate Poisson regression taking into account both intensity and duration of chemotherapy. Results In 94 children, with a cumulative follow‐up time of 81.7 years, 177 FN episodes were recorded. Patients with both very low MBL levels (<100 µg/L; risk ratio (RR), 1.93; 95% CI, 1.14–3.28; P = 0.014) and normal MBL levels (≥1,000 µg/L; RR, P = 0.011) had significantly more frequent FN episodes than patients with low MBL levels (100–999 µg/L). Patients with very low MBL levels had significantly more episodes of FN with severe bacterial infection (bacteremia or pneumonia; RR, 4.49; 1.69 = 11.8; P = 0.003), while those with normal MBL levels had more FN episodes with no microbial etiology identified (RR, 1.85; 1.14 = 3.03; P = 0.014). Conclusions Very low MBL levels are associated with more frequent FN episodes, mainly due to severe bacterial infections. The surprising finding that children with normal MBL levels had more frequent FN episodes than those with low MBL levels needs testing in prospective studies. Pediatr Blood Cancer 2007;49:11–16. © 2006 Wiley‐Liss, Inc.