Immunoglobulin concentrations in untreated lymphoblastic leukemia

Early studies indicated that low immunoglobulin (Ig) concentrations at diagnosis predict a worse outlook for children with acute lymphoblastic leukemia (ALL). We re-examined this suggestion in the light of immunophenotypic disease subtyping and more modern therapy. The concentrations of Ig, IgA, and IgM at diagnosis of ALL in 199 children were reviewed. One hundred forty-one (71%) had normal values and 58 (29%) had at least one abnormal value. No obvious pattern of abnormality relating to disease immunophenotype emerged. Disease-free survival (DFS) was not significantly different when simply comparing children with normal and abnormal values. Those with a white blood cell count lower than 20 x 10(9)/L (n = 106) included 22 with at least one low Ig whose 5-year DFS was inferior to the "normal" group (56% vs 83%; P < 0.005). The 140 children with CD10 + B precursor ALL included 31 with one or more low Ig concentrations who also showed an inferior 5-year DFS to the remainder (55% vs 77%; P < 0.02). Minor abnormalities in Ig concentrations are seen in approximately one third of children with ALL regardless of immunologic subtype. Low values may relate to poor outcome in patients with the disease at otherwise good risk.