Salivary immunoglobulin A level during steroids and chemotherapy treatment administered in remission induction phase among pediatric patients with acute lymphoblastic leukemia

The agents used in the treatment of acute lymphoblastic leukaemia (ALL) might affect the oral health of cancer patients. The study aims to assess the changes in the levels of immunoglobulin A (IgA) in saliva and blood, during first 22 days of intensive chemotherapy of ALL in children. Saliva and blood samples were taken from 24 patients, including 13 boys and 11 girls (age range: 4 – 17 years) on days 1, 8 and 22 of treatment. The levels of immunoglobulin A and total protein were estimated in samples at each time-point. The distribution of the quantitative variables was assessed using the Shapiro-Wilk test. Non-parametric statistics were used to compare the levels of repeated measurements and post hoc non-parametric analysis was applied for between time-point comparisons. A constant relationship was found between the levels of Ig A in blood and saliva (r = 0.28; P = .031). No change in salivary IgA level was observed in the prednisone-only prephase, but it dropped significantly on day 22 (10.7+/−4.8 vs 9.6+/−6.4 vs 5.7+/−3.9 ng/mL; P = .04), when chemotherapy was given (anthracycline, vincristine, L-asparaginase). In blood, the total protein level decreased significantly between day 1 and 22 (6.2+/−0.4 vs 5.1+/−0.3 g/dL; P = .001). Lymphocyte count (per microliter) also decreased (2.12+/−0.8 vs 0.41+/−0.1 vs 1.08+/−0.5; P = .002). Four children suffered from oral mucositis graded 1 or higher between days 8 and 22. Chemotherapy given during the treatment of childhood ALL is associated with a reduction in the level of salivary immunoglobulin A. Prevention of the drop of salivary IgA may diminish the risk of occurrence of acute mucosal complications.