Persistent Endothelial Activation Is Associated with An Increased Mortality During Therapy of Children with ALL – a Pilot Study

Activation of endothelial cells is associated with a worse prognosis in numerous disorders treated at intensive care units. The goal of this study was to analyze if an activation of vascular endothelium despite of the treatment with the ALLIC protocol in children with ALL might have a predictive value for the survival rate.

N=18 children at age of 4–18 years with ALL treated with the ALLIC protocol were investigated. Plasma levels of markers of endothelial activation (VCAM-1, ICAM-1, VEGF, E-selectin, P-selectin and PAI-1) were analyzed at baseline, during the 33^rd and 78^th day of therapy (beginning of the protocol M).

Higher baseline levels of ICAM-1 (467.1±72.8 vs. 206.3±21.7 ng/ml, p<0.05) and E-selectin (56.1±10.9 vs. 28.1±10.0 ng/ml, p<0.05) were observed in children treated unsuccessfully. Moreover, an increase in E-selectin levels and a non-decreasing trend in ICAM-1 levels within the first three days of the ALLIC protocol as well as significant increase in the PAI-1 levels were positive predictors for death in children with ALL.

In this pilot study, we have demonstrated for the first time that persistent pro-inflammatory and pro-aggreagatory activation of endothelium might be a positive predictor for death in children with ALL.

No relevant conflicts of interest to declare.