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.