Affiliations: Department of Pediatrics, Gazi University School of
Medicine, University of Pediatric Hematology, Ankara, Turkey
Note: [] Corresponding author: Fatma Burcu Belen, Department of
Pediatrics, Gazi University School of Medicine, University of Pediatric
Hematology, Ankara, Turkey. Tel.: +90 312 2026015/90 532 581 45 51; Fax: +90
312 2150143; E-mail: draida@yahoo.com
Abstract: Neopterin, a pteridine group compound that is secreted from
macrophages is shown to be increased in adult leukemia; however there are few
studies in childhood leukemia. This study aimed to investigate neopterin levels
during childhood leukemia treatment and neutropenic fever episodes for the
possibility of using as a marker for disease activity and differentiation of
infections. A total of 44 children with acute leukemia, 19 children with
infection (control group 1) and 21 healthy children (control group 2) were
studied. Median serum neopterin level before induction chemotherapy (day 0) in
25 children (patient group 1) was significantly higher (27.7 nmol/L) than those
at the beginning of 30 febrile episodes in 19 children in bone marrow remission
(2.2 nmol/L) (patient group 2) and in control group 2 (0.4 nmol/L) (p<
0.05). It was (27.7 nmol/L) also significantly higher in control group 1 than
in patient group 2 and control group 2 (p< 0.05). Serum neopterin levels at
day 15 (2.1 mmol/L) and day 33 (0.4 mmol/L) of induction were significantly
lower than day 0 of ALL subgroup at patient group 1. There were no significant
difference in neopterin levels between days 0, 3 and 5 of neutropenic fever as
well as between patients with microbiologically and/or clinically documented
infections and those with fever of unknown origin in patient group 2 (p>
0.05). Serum neopterin did not show significant correlation with absolute
neutrophil count and absolute monocyte count (p> 0.05). In conclusion,
elevated neopterin at diagnosis of leukemia with decrement during induction
therapy suggest that it might be an indicator of leukemic process; however
larger studies for its role in identifying infections are warranted.
