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In the M.R.C. UKALL VIII study, 35 of 199 (17.6%) patients on protocol developed interstitial pneumonitis within the first 44 weeks of treatment (median 10 weeks). These episodes were carefully documented, and serological investigation for Pneumocystis carinii infection was performed in 33 cases. These 35 patients were divided into two groups, one having either histological or serological evidence of P. carinii infection and the other without such evidence. We saw no false positive serological tests in the nine cases with histological confirmation, but the P. carinii immunofluorescence test was of most help in retrospectively confirming P. carinii infection. High dose trimethoprim-sulphamethoxazole was successful in treating 26 of 33 cases (78%). We did note an improvement in survival in children given steroids and we suggest they may have a role in anti-pneumonitis therapy.

Early studies indicated that low immunoglobulin (Ig) concentrations at diagnosis predict a worse outlook for children with acute lymphoblastic leukemia (ALL). We re-examined this suggestion in the light of immunophenotypic disease subtyping and more modern therapy. The concentrations of Ig, IgA, and IgM at diagnosis of ALL in 199 children were reviewed. One hundred forty-one (71%) had normal values and 58 (29%) had at least one abnormal value. No obvious pattern of abnormality relating to disease immunophenotype emerged. Disease-free survival (DFS) was not significantly different when simply comparing children with normal and abnormal values. Those with a white blood cell count lower than 20 × 109/L (n = 106) included 22 with at least one low Ig whose 5-year DFS was inferior to the "normal" group (56% vs 83%; P < 0.005). The 140 children with CD10 + B precursor ALL included 31 with one or more low Ig concentrations who also showed an inferior 5-year DFS to the remainder (55% vs 77%; P < 0.02). Minor abnormalities in Ig concentrations are seen in approximately one third of children with ALL regardless of immunologic subtype. Low values may relate to poor outcome in patients with the disease at otherwise good risk.