Clinical role of bone marrow angiogenesis in childhood acute lymphocytic leukemia

Purpose: Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are associated with increased angiogenesis, growth, and metastasis in solid tumors. But, until today, the importance of theses factors on leukemia, especially childhood acute lymphocytic leukemia (ALL) has received limited attention. Therefore, this study examined the bone marrow plasma VEGF and bFGF levels in ALL patients and normal controls. Patients and Methods: Bone marrow plasmas at diagnosis from 33 ALL patients (median age 5.9 years; range 1.8-13.9 years) were used for analysis. The bone marrow levels of bFGF and VEGF were determined by enzyme-linked immunosorbent assay (R & D Systems) and compared with the bone marrow levels of 7 healthy control subjects (median age 11.98 years; 6 months -13.6 years). Results: Average VEGF was higher in relapse ALL (N = 7, 216.6 ± 79.9 pg/ mL) compared to standard (N = 9, 36.8 ± 12.1 pg/mL) (p = 0.013) or high risk ALL (N = 17, 80.0 + 12.2 pg/mL) (p = 0.023). bFGF levels were also significantly higher in relapse than standard-, or high-risk ALL patients (relapse ALL; 48.6 ± 15.4 pg/mL, standard risk ALL; 18.9 + 5.5 pg/mL, high risk ALL; 19.0 ± 3.5 pg/mL, normal control; 18.6 ± 4.0 pg/ mL) (p = 0.003). Three patients with refractory relapse and death had much higher VEGF and bFGF values (VEGF; 420.0 ± 81.6 pg/mL, bFGF; 85.6 ± 3.2 pg/mL). Conclusion: Our data suggest that the increased levels of VEGF and bFGF in bone marrow may play an important role in prognosis of childhood ALL.