ALL-548 Assessment of Serum Hyaluronic Acid and Ferritin Levels in Children With Acute Lymphoblastic Leukemia

Abstract

Serum levels of hyaluronic acid (HA) and ferritin are high in newly diagnosed children with acute lymphoblastic leukemia. To evaluate the level of serum hyaluronic acid and ferritin in patients with ALL at diagnosis and in remission and investigate their impact on disease development and prognosis. A prospective cross-sectional study was conducted in the Central Teaching Hospital of Pediatrics, Baghdad, Iraq from January to October 2020. The study was conducted on hospitalized patients. For each patient, consent was obtained to take peripheral blood (PB) and/or bone marrow (BM) samples, and serum samples were analyzed in a private laboratory. 60 subjects were enrolled in this study, 40 ALL patients as cases (20 patients at diagnosis before starting chemotherapy and 20 patients in remission but still under therapy); and 20 age and sex-matched healthy subjects as controls. Both Band T-ALL subtypes were included. The age was less than 15 years. The patients were randomly collected in relation to gender. Patients on iron supplementation, with liver diseases, and those with other types of malignancy were excluded. The diagnosis of ALL was based on morphological assessments of the stained PB and BM smears according to the standard French-American-British criteria and confirmed by cytochemical stains and flow cytometric immunophenotyping. Patients with complete remission were also evaluated by morphological examination. Serum HA was measured using a commercially available sandwich ELISA kit while serum ferritin was measured by an immunoassay analyzer. Serum HA in newly diagnosed patients with ALL was significantly higher than either patients in remission (P-value 0.022) or controls (P-value 0.001). Both newly diagnosed patients and those in remission had elevated levels of serum ferritin with no significant difference. Serum levels of HA correlated positively with both serum ferritin and LDH (p<0.001). Our data suggest that serum level of hyaluronic acid could have a role in the malignant process of ALL and may serve as a possible marker for aggressiveness. Further studies on larger populations and on patients with relapse and follow-up of patients for a longer period of time are recommended.