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Fibronectin concentration in cerebrospinal fluid reflects early central nervous system involvement in children with
M Koskiniemi1, J Rajantie, J Rautonen
1Children's Hospital, Helsinki, Finland.
Insights
Elevated cerebrospinal fluid fibronectin (CSF-FN) levels at diagnosis may predict central nervous system (CNS) leukemia in acute lymphoblastic leukemia (ALL) patients. This CSF-FN test could serve as a novel early marker for neuroleukemia.
Area of Science:
- Oncology
- Neurology
- Biochemistry
Background:
- Acute lymphoblastic leukemia (ALL) can involve the central nervous system (CNS), leading to neuroleukemia.
- Early detection of CNS involvement is crucial for effective treatment and improved patient outcomes.
- Fibronectin (FN) is a glycoprotein found in various bodily fluids, and its role in neuroleukemia is under investigation.
Purpose of the Study:
- To investigate the diagnostic and prognostic value of cerebrospinal fluid fibronectin (CSF-FN) concentrations in patients with ALL.
- To determine if CSF-FN levels can serve as an early marker for the development of neuroleukemia.
Main Methods:
- Measurement of CSF-FN concentrations in long-term follow-up patients with ALL, including those with and without neuroleukemia.
- Comparison of CSF-FN levels at diagnosis, during therapy, and at the time of blast cell detection.
- Statistical analysis, including regression analysis, to identify factors associated with CSF-FN levels and CNS involvement.
Main Results:
- Patients who developed neuroleukemia had significantly higher CSF-FN levels at diagnosis compared to those who did not.
- Elevated initial CSF-FN levels (>2 mg/l) were strongly associated with a higher incidence of neuroleukemia (43% vs. 5%).
- CSF-FN levels increased during therapy in patients with neuroleukemia.
Conclusions:
- The CSF-FN test shows significant differences between patients with and without CNS leukemia at the time of ALL diagnosis.
- CSF-FN may represent a novel and valuable early marker for predicting neuroleukemia in ALL patients.
- While total protein concentration in CSF correlates with CSF-FN, it does not correlate with CNS involvement.
Abstract:
We measured concentrations of fibronectin (FN) in the cerebrospinal fluid (CSF) in long-term follow-up patients with acute lymphoblastic leukemia (ALL). In 11 patients with neuroleukemia the CSF-FN level was elevated already at the time of diagnosis of ALL, 3.8 +/- 0.6 mg/l, increased during therapy to 4.7 +/- 0.5 mg/l, and at the time of concurrent blast cell finding it was 5.5 +/- 1.0 mg/l. In 11 patients with no subsequent CNS leukemia, the mean CSF-FN level was 2.4 +/- 0.6 mg/l at the time of diagnosis of ALL and 2.8 +/- 0.6 mg/l during therapy, and increased to 3.2 +/- 0.8 mg/l. The neuroleukemia rate was 43% in patients with initial CSF-FN levels greater than 2 mg/l, compared with 5% in patients with CSF-FN levels less than or equal to 2 mg/l (p less than 0.005) in a group of 45 long-term follow-up patients with ALL. Regression analysis on the 21 clinical or laboratory parameters studied showed that the only variable independently associated with CSF-FN was the total protein concentration in the CSF; this, however, explained only 14% of the observed variation in the CSF-FN concentration and did not show any correlation with CNS involvement. We conclude that the CSF-FN test at diagnosis of ALL showed significant differences between groups of patients with and without CNS leukemia, and may prove to be a new early marker for neuroleukemia.