title: 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.
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.
authors.affiliation: Department of Pediatrics and.
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.affiliation: University Children's Hospital, Zurich, Switzerland;
authors.forename: Nicole
authors.initials: N
authors.lastname: Bodmer
authors.affiliation: Department of Pediatrics, University of Bonn, and Pediatric Oncology, Saarland University Hospital, Homburg, Germany;
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.affiliation: Department of Pediatrics and Institute for Infectious Diseases, University of Bern, and.
authors.forename: Philipp
authors.initials: P
authors.lastname: Agyeman
authors.affiliation: Department of Pediatrics and.
authors.forename: Kurt
authors.initials: K
authors.lastname: Leibundgut
authors.affiliation: Department of Pediatrics and Pediatric Critical Care Research Group, Pediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, Australia.
authors.forename: Luregn J
authors.initials: LJ
authors.lastname: Schlapbach
authors.affiliation: University Children's Hospital, Zurich, Switzerland;
authors.forename: Felix K
authors.initials: FK
authors.lastname: Niggli
keywords: Adverse Event; Bacteremia; Fever in Neutropenia; Lectin Pathway; Pediatric Oncology; Risk Prediction