Prognostic significance of activin A in adult Egyptian patients with acute lymphoblastic leukemia

Abstract

Background Activin A belongs to the transforming growth factor-beta superfamily of cytokines that exert a plethora of biological functions, including developmental differentiation, sex determination, control of cellular proliferation, migration, and immune responses. Activins are dimeric glycoproteins that play a significant role in reproduction and in endocrine-active tumors, although inhibins and activins have primarily been described in human gonads and identified as modulators of follicle-stimulating hormone production of the pituitary gland, they have also been detected in several solid tumor types, including endocrine-responsive endometrial, ovarian, and breast carcinomas. Their differential expression has suggested their important role in malignant cell transformation, as well as possible roles in cancer differentiation, proliferation, and growth tumors. Aim The aim was to assess expression of activin A in the serum of adult patients with acute lymphoblastic leukemia (ALL) and its influence on remission and survival of ALL patients. Patients and methods Serum activin A was measured using enzyme-linked immunosorbent assay in 30 ALL patients recruited from Hematology and Bone Marrow Transplantation Unit, Ain Shams University Hospitals, and followed for 1 year in comparison with 15 healthy controls. Results Serum level of activin A was elevated in ALL patients in comparison with the control group with a statistically significant difference (P<0.001). A statistically significant negative correlation was detected between age of the patients and activing-A level (P=0.035). The comparison between different outcomes of the patients (remitted, relapsed, and died patients) above and below the mean level of activin A (265.667 ng/ml), was statistically significant (P<0.001). A statistically significant negative correlation was detected between activing-A level in ALL patients and overall survival (P<0.001), and by using the log-rank test, a statistically significant difference (P<0.001) was detected in ALL patients above and below the mean level of activin A. However, a statistically nonsignificant difference was detected between the mean activing-A level in Philadelphia chromosome-positive patients and Philadelphia chromosome-negative patients (P=0.839). Conclusion Activin A can be a useful poor prognostic biomarker in ALL patients, also, it can be used as a predictor for aggressiveness of the disease, resistance, and survival.