Oxidative Stress Biomarkers Predict Clinical Consequence in Pediatric Bcell Acute Lymphoblastic Leukemia
Year: 2026
Type: article
Study design: Observational Study
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.
Institution: Universidade Estadual do Oeste do Paraná
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223110503