IMMUNOGLOBULIN DEFICIENCY AND INFECTIONS DURING AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN CHILDREN - A STUDY OF 127 PATIENTS SEEN IN A SINGLE INSTITUTION

Background. - Children with malignant diseases are frequently given hi gh dose chemotherapy plus autologous bone marrow transplants. Infectio us complications can lead to morbidity and mortality in this type of t reatment This study was designed to determine whether immunoglobulin d eficiency is an additional risk factor for infections. Patients and me thods. - One hundred and twenty seven children with solid malignant tu mors were treated between November 1987 and April 1992 in our Departme nt by chemotherapy followed by autologous bone marrow transplantation. Their serum IgA, IgG and IgM concentrations were measured by nephelom etry before chemotherapy, on the day of transplantation and every week thereafter. The frequency and severity of infectious episodes in all the children were recorded using a standard scale. The patients were d ivided into two subgroups, defined according to their serum IgG concen trations before the transplantation and 7 and 21 days later. Results. - Ig deficiency during transplantation was not associated with the occ urrence of septicemia or focal infections. It was associated with the course of infection (P = 0.003) and with the occurrence of tester viru s infection during the first 6 months after transplantation (P = 0.003 ). Conclusions. - Immune replacement during bone marrow transplantatio n may be indicated in children at risk of Ig deficiency. Fifty percent of the children with solid tumors treated in our institution were at risk of this deficiency.