Abstract
9551 Background: Humoral immunity has been evaluated in pediatric ALL; data in pediatric AML is lacking. The objectives of this study were to assess humoral immunity on follow-up in pediatric AML patients. Methods: From April 2010-May 2011, 45 consecutive AML patients 1-18 years old were prospectively enrolled with 7 healthy controls. Immunoglobulin (Ig) levels in 45 patients and B-lymphocytes (CD19+) in 29 patients were assessed at diagnosis, post-induction, post-consolidation, 3 and 6 months follow-up and relapse. Results: At diagnosis, Ig levels were higher in patients as compared to healthy controls (IgG, p=0.041; IgA, p=0.07; IgM, p=0.16) while B-cells were lower (p=0.001). Patients with gum hypertrophy had low Ig levels (IgG, p=0.007; IgA, p=0.003; IgM, p=0.06). CR rate was 84.4% (38/45); EFS 40% and OS 58% at 20 months follow-up. Post-induction, there was reduction in IgM (p<0.001) and IgA (p=0.048) levels and increase in B cells (p<0.001). Using generalized estimating equation regression model, average reduction from post-induction till 3 month follow-up was 36.9 units/visit (IgG); 10.3 units/visit (IgA); 0.32 units/visit (IgM) in those with continuous CR (group-1, n=24) and 91 units/visit (IgG); 8.9 units/visit (IgA); 1.5 units/visit (IgM) in those who relapsed (group-2, n=14). Difference between these two groups was significant for IgA (p=0.017). There was increase in IgG (p=0.52) and IgA levels (0.21) at relapse when compared with post-consolidation values. B-cells had an average increase of 3.6 units/visit (p=0.012) in group 1 and decrease of 0.58 units/visit (p=0.82) in group 2; (group-1 vs group-2, p=0.10). There was no significant correlation of baseline Ig and B cells with CR rate, EFS and OS. Conclusions: This is the first study to evaluate humoral immunity serially in pediatric AML. AML patients with gum hypertrophy have low IgG and IgA at diagnosis. On serial monitoring, B cells show an increase in patients who are in continuous CR while those who relapse tend to show a reduction on follow-up. Further, on follow-up, although all Ig decrease, but the reduction in IgA is significantly lower in patients who relapse suggesting their possible role in disease biology.
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