Role of pretreatment inflammatory indicators in pediatric acute leukemias; where do we stand? A prospective cohort study

Article type: Research Article

Authors: Zahran, Asmaa M.^a | Riad, Khalid F.^b | Elsayh, Khalid I.^c | Elmasry, Heba M.^a | Rayan, Amal^{d; *}

Affiliations: [a] Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt | [b] Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt | [c] Pediatric Department, Assiut University Hospital, Assiut University, Assiut, Egypt | [d] Clinical Oncology Department, Assiut University Hospital, Assiut University, Assiut, Egypt

Correspondence: [*] Corresponding author: Amal Rayan, Clinical Oncology Department, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut, 71515, Egypt. E-mail: [email protected].

Abstract: BACKGROUND AND AIM: There is a limited data at the moment regarding the clinical value of inflammatory indices and malnutrition markers in children with acute leukemias. We have examined the usefulness of prognostic nutritional index (PNI), Glasgow prognostic score (GPS), Prognostic Index (PI), monocyte to lymphocyte (MLR), neutrophil to lymphocyte (NLR), and platelet to lymphocyte (PLR) ratios to stratify patients as regards the response to induction therapy correlating them to different prognostic factors. PATIENTS AND METHODS: Children with acute leukemia and without microbial-induced inflammation at the time of diagnosis were prospectively recruited. Preliminary total and differential CBC, c-reactive protein (CRP), serum albumin (ALB) were used to calculate different inflammatory indicators including NLR, MLR, PLR, PNI, GPS, and PI. RESULTS: Higher PNI was significantly more associated to children who achieved remission as compared to those without remission (p< 0.0001). Patients without remission had GPS 1 or 2 compared to GPS 0 or 1 in those who entered remission (p= 0.001). NLR was significantly lower in patients in remission than in those without remission (p= 0.005). Similarly, complete remission was significantly associated to MLR ⩽ 0.45 as compared to MLR > 0.45 (p< 0.0001). CONCLUSION: Pretreatment PNI, GPS, CRP, serum albumin, NLR, MLR, and PLR are remission promising prognostic markers in pediatric acute leukemias, which deserve to be further investigated in large-scale studies.

Keywords: Prognostic nutritional index, Glasgow prognostic score, prognostic index, monocyte to lymphocyte, neutrophil to lymphocyte, platelet to lymphocyte ratios, AML, ALL

DOI: 10.3233/CBM-201790

Journal: Cancer Biomarkers, vol. 29, no. 4, pp. 553-564, 2020