OXIDATIVE STRESS BIOMARKERS PREDICT CLINICAL CONSEQUENCE IN PEDIATRIC BCELL ACUTE LYMPHOBLASTIC LEUKEMIA
- 1Universidade Estadual do Oeste do Paraná (UNIOESTE) - Francisco Beltrão - PR - Brazil
Abstract
Background: B-cell acute lymphoblastic leukemia (B-ALL) is the most common childhood malignancy. Although survival has improved substantially, chemoresistance and relapse remain major determinants of poor prognosis. Oxidative stress plays an important role in leukemia biology and in the mechanism of action of chemotherapy; however, the clinical significance of redox biomarkers during treatment remains incompletely understood. This study investigated whether circulating markers of oxidative damage and antioxidant defense are associated with treatment response and clinical outcomes in pediatric B-ALL. Methods: Thirty-four pediatric patients with B-ALL were prospectively evaluated throughout chemotherapy. Peripheral blood samples were collected at diagnosis and during the induction, consolidation, and maintenance phases. Total antioxidant capacity (TRAP) and circulating lipoperoxide levels were quantified by high-sensitivity chemiluminescence. Associations with clinical characteristics, prognostic factors, treatment response, relapse, mortality, and receiver operating characteristic (ROC) curve performance were analyzed. Results: TRAP levels were significantly higher at diagnosis than during early induction chemotherapy (Day 7; p = 0.0178) and were also increased in high-risk patients (p = 0.0314). Reduced antioxidant capacity was associated with mortality (p = 0.0278). During consolidation and maintenance, TRAP progressively declined to levels comparable to those observed in cured patients outside treatment (p < 0.0001). In contrast, elevated lipoperoxide concentrations were associated with relapse, death, and platelet counts above 50,000/mm³, whereas lower levels were observed in patients achieving remission and hospital discharge. Lipoperoxide measurements discriminated patients undergoing induction chemotherapy from untreated patients with 92.31% sensitivity and 71.43% specificity. Together, these findings demonstrate a dynamic modulation of systemic redox balance throughout chemotherapy, with antioxidant depletion accompanying treatment progression and increased lipid peroxidation identifying patients with poorer clinical outcomes. Conclusions: Dynamic changes in antioxidant capacity and lipid peroxidation are closely associated with prognosis in pediatric B-ALL. While TRAP reflects the evolution of the systemic antioxidant response during chemotherapy, elevated circulating lipoperoxides identify patients at increased risk of relapse and mortality. Combined assessment of these complementary biomarkers may provide a practical strategy for monitoring treatment response and improving risk stratification during pediatric B-ALL therapy.
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BibTeX
@article{prazeres2026oxidative,
title = {{OXIDATIVE STRESS BIOMARKERS PREDICT CLINICAL CONSEQUENCE IN PEDIATRIC BCELL ACUTE LYMPHOBLASTIC LEUKEMIA}},
author = {Gustavo Schroll DOS PRAZERES and Bruna Yukie KOIZUMI and Matheus Ricardo GARBIM and Ana Luiza Goulart STARCK and Laura Gabriela CARDOSO and Micael Dangui MENEZES and Stefania Tagliari LONGO and Geise Ellen BROTO and André Cherubini CECCHINEL and Fausto Celso TRIGO and Carolina PANIS},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.108416},
url = {https://doi.org/10.1016/j.htct.2026.108416},
note = {CC BY},
}
RIS
TY - JOUR
TI - OXIDATIVE STRESS BIOMARKERS PREDICT CLINICAL CONSEQUENCE IN PEDIATRIC BCELL ACUTE LYMPHOBLASTIC LEUKEMIA
AU - Gustavo Schroll DOS PRAZERES
AU - Bruna Yukie KOIZUMI
AU - Matheus Ricardo GARBIM
AU - Ana Luiza Goulart STARCK
AU - Laura Gabriela CARDOSO
AU - Micael Dangui MENEZES
AU - Stefania Tagliari LONGO
AU - Geise Ellen BROTO
AU - André Cherubini CECCHINEL
AU - Fausto Celso TRIGO
AU - Carolina PANIS
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.108416
UR - https://doi.org/10.1016/j.htct.2026.108416
AB - Background: B-cell acute lymphoblastic leukemia (B-ALL) is the most common childhood malignancy. Although survival has improved substantially, chemoresistance and relapse remain major determinants of poor prognosis. Oxidative stress plays an important role in leukemia biology and in the mechanism of action of chemotherapy; however, the clinical significance of redox biomarkers during treatment remains incompletely understood. This study investigated whether circulating markers of oxidative damage and antioxidant defense are associated with treatment response and clinical outcomes in pediatric B-ALL. Methods: Thirty-four pediatric patients with B-ALL were prospectively evaluated throughout chemotherapy. Peripheral blood samples were collected at diagnosis and during the induction, consolidation, and maintenance phases. Total antioxidant capacity (TRAP) and circulating lipoperoxide levels were quantified by high-sensitivity chemiluminescence. Associations with clinical characteristics, prognostic factors, treatment response, relapse, mortality, and receiver operating characteristic (ROC) curve performance were analyzed. Results: TRAP levels were significantly higher at diagnosis than during early induction chemotherapy (Day 7; p = 0.0178) and were also increased in high-risk patients (p = 0.0314). Reduced antioxidant capacity was associated with mortality (p = 0.0278). During consolidation and maintenance, TRAP progressively declined to levels comparable to those observed in cured patients outside treatment (p < 0.0001). In contrast, elevated lipoperoxide concentrations were associated with relapse, death, and platelet counts above 50,000/mm³, whereas lower levels were observed in patients achieving remission and hospital discharge. Lipoperoxide measurements discriminated patients undergoing induction chemotherapy from untreated patients with 92.31% sensitivity and 71.43% specificity. Together, these findings demonstrate a dynamic modulation of systemic redox balance throughout chemotherapy, with antioxidant depletion accompanying treatment progression and increased lipid peroxidation identifying patients with poorer clinical outcomes. Conclusions: Dynamic changes in antioxidant capacity and lipid peroxidation are closely associated with prognosis in pediatric B-ALL. While TRAP reflects the evolution of the systemic antioxidant response during chemotherapy, elevated circulating lipoperoxides identify patients at increased risk of relapse and mortality. Combined assessment of these complementary biomarkers may provide a practical strategy for monitoring treatment response and improving risk stratification during pediatric B-ALL therapy.
SN - 2531-1379
SN - 2531-1387
ER -