Abstract
Infections lead to substantial morbidity during treatment of acute lymphoblastic leukemia (ALL) in which the adaptive immune system gets severely affected, leading to declining serum immunoglobulin levels. The aim of this trial was to investigate whether intravenous immunoglobulin (IVIG) prophylaxis in pediatric patients with ALL prevents admissions for fever.
This randomized controlled trial was a subtrial of the national Dutch multicenter ALL study. Patients aged 1-19 years with medium risk (MR) ALL were randomized into two groups receiving either IVIG prophylaxis (0.7 g/kg IVIG given every three weeks, starting day 22 after diagnosis) or well defined standard of care (control group).
Between October 2012 until March 2019, 91 (51%) patients were randomly assigned to IVIG prophylaxis and 86 (49%) to the control arm. In the IVIG prophylaxis group there were 206 admissions for fever versus 271 in the control group (p=0.011). IVIG prophylaxis was not associated with bacteremia. However, IVIG prophylaxis was associated with significantly less admissions for fever with negative blood cultures compared to the control group (N=113 versus 200, p<0.001). The difference in number of admissions for fever was observed specifically during maintenance treatment (N=100 versus 166, p<0.001); resulting in less antibiotic treatments (N=78 versus 137, p<0.001) and less chemotherapy adaptation (N=72 versus 134, p<0.001).
To conclude, in pediatric patients with MR ALL, IVIG prophylaxis was associated with significantly less admissions for fever with negative blood cultures during maintenance treatment, resulting in less antibiotic treatments and chemotherapy adaptations.
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