Dynamic Variation and Clinical Significance of the Cytokine Level Changes in Children with Acute Leukemia during Chemotherapy

Background:

Cytokines and infection are closely related. One of the hot spots is the indexes which can early diagnose and predict prognosis of febrile neutropenia patients with acute leukemia. It is importment to find predictors of infection in febrile neutropenia patients.

Aim:

To investigate the variation of CRP(C-reactive protein), IL-6(interleukin 6), IL-8(interleukin 8) and IFN-γ (interferon γ) in children with acute leukemia before and after febrile neutropenia, and evaluate the reliability of plasma interleukin (IL) and CRP levels as indicators of febrile neutropenia patient.

Methods:

We selected 40 cases of children with acute leukemia from Pediatric department of Nanfang Hospital,Southern Medical University,including 27 cases of acute lymphoblastic leukemia(67.5%),13 cases of acute myeloid leukemia(32.5%). The mean age was 7 years(range:1-14).We used Luminex immunoassay to detected levels of cytokines, which include CRP, IL-6, IL -8 and IFN-γ. Serum samples were collected before chemotherapy(T₀),3 days after chemotherapy(T₁), 1 day after confirmation of febrile neutropenia, (T₂), 3 days after febrile neutropenia (T₃), 7 days after febrile neutropenia (i.e. the use of antibiotics 7 days,T₄), recovery after chemotherapy(T₅).

Results: Compared T₁、T₅ to T₀, the levels of CRP, IL-6 were no statistically significant(P>0.05). Compared T₁ to T₀, the levels of IFN-γ and IL -8 were statistically significant(P=0.005 and P=0.002); Compared T₅ to T₀ and T₅ to T₁, the levels of IFN-γ and IL-8 were no statistically significant(P>0.05). In T₀, T₁ and T₅ phase, the levels of IL-6, IL-8, IFN-γ and CRP were not correlated (P>0.05). Compared T₂, T₃ to T₀, the level of CRP increased significantly after infection early in the fever, and the level of CRP increased in 24 hours.Compared T₂, T₃ to T₀, the levels of IL-6, IL-8 were statistically significant, the level of IL-8 decreased after infection, but the level of IL-6 level increased in 24 hours.There were significant positive correlation between CRP and IL-6 in T₂, T₃ and T₄ phase.

Conclusions.

The level of CRP increased significantly after infection early in the fever, and the level of CRP increased in 24 hours. the level of IL-8 decreased after infection,but the level of IL-6 level increased in 24 hours.The levels of CRP, IL-8 and IL-6 can be useful markers to identify febrile neutropenia in children with acute leukemia.