Serum Concentrations of Mannan-Binding Lectin (MBL) and MBL-Associated Serine Protease-2 and the Risk of Adverse Events in Pediatric Patients With Cancer and Fever in Neutropenia

Roland A Ammann; Nicole Bodmer; Arne Simon; Philipp Agyeman; Kurt Leibundgut; Luregn J Schlapbach; Felix K Niggli

doi:10.1093/jpids/pit005

Serum Concentrations of Mannan-Binding Lectin (MBL) and MBL-Associated Serine Protease-2 and the Risk of Adverse Events in Pediatric Patients With Cancer and Fever in Neutropenia

J Pediatric Infect Dis Soc. 2013 Jun;2(2):155-61. doi: 10.1093/jpids/pit005. Epub 2013 Feb 13.

Authors

Roland A Ammann¹, Nicole Bodmer², Arne Simon³, Philipp Agyeman⁴, Kurt Leibundgut¹, Luregn J Schlapbach⁵, Felix K Niggli²

Affiliations

¹ Department of Pediatrics and.
² University Children's Hospital, Zurich, Switzerland;
³ Department of Pediatrics, University of Bonn, and Pediatric Oncology, Saarland University Hospital, Homburg, Germany;
⁴ Department of Pediatrics and Institute for Infectious Diseases, University of Bern, and.
⁵ Department of Pediatrics and Pediatric Critical Care Research Group, Pediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, Australia.

PMID: 26619462
DOI: 10.1093/jpids/pit005

Abstract

Background: It is unknown whether serum concentrations of mannan-binding lectin (MBL) and MBL-associated serine protease-2 (MASP-2) influence the risk of adverse events (AEs) in children with cancer presenting with fever in neutropenia (FN).

Methods: Pediatric patients with cancer presenting with FN after non-myeloablative chemotherapy were observed in a prospective multicenter study. Mannan-binding lectin and MASP-2 were measured using commercially available enzyme-linked immunosorbent assay in serum taken at cancer diagnosis. Multiple FN episodes per patient were allowed. Associations of MBL and MASP-2 with AE in general, with bacteremia, and with serious medical complications (SMC) during FN were analyzed using mixed logistic regression.

Results: Of 278 FN episodes, AE was reported in 84 (30%), bacteremia was reported in 42 (15%), and SMC was reported in 16 (5.8%). Median MBL was 2152 ng/mL (range, 7-10 060). It was very low (<100) in 11 (9%) patients, low (100-999) in 36 (29%) patients, and normal (≥1000) in 79 (63%) patients. Median MASP-2 was 410 ng/mL (range, 68-2771). It was low (<200) in 18 (14%) patients and normal in the remaining 108 (86%) patients. Mannan-binding lectin and MASP-2 were not significantly associated with AE or bacteremia. Normal versus low MBL was independently associated with a significantly higher risk of SMC (multivariate odds ratio, 12.8; 95% confidence interval, 1.01-163; P = .050).

Conclusions: Mannan-binding lectin and MASP-2 serum concentrations were not found to predict the risk to develop AEs or bacteremia during FN. Normal MBL was associated with an increased risk of SMC during FN. This finding, in line with earlier studies, does not support the concept of MBL supplementation in MBL-deficient children with cancer presenting with FN.

Keywords: Adverse Event; Bacteremia; Fever in Neutropenia; Lectin Pathway; Pediatric Oncology; Risk Prediction.