Prognostic value of plasma levels of thrombomodulin and von Willebrand factor in Egyptian children with acute lymphoblastic leukemia

Background: Acute lymphoblastic leukemia is the most common childhood malignancies, representing nearly one-third of all pediatric cancers. Thrombomodulin is a membrane glycoprotein in the vascular endothelium. Its plasma level depends on the integrity of the endothelium. Soluble thrombomodulin is derived from injured endothelial cells or proteolytically cleaved from thrombomodulin by proteases. Von Willebrand factor is a blood glycoprotein involved in homeostasis. Its plasma level increases in neoplastic diseases and arises from adverse changes in the endothelium. Severe endothelial dysfunction is present during the acute phase of acute lymphoblastic leukemia. Plasma levels of von Willebrand factor and soluble thrombomodulin have been used as indexes of endothelial dysfunction. Objective: The aim of this study was to assess serum soluble thrombomodulin and von Willebrand factor levels in children with acute lymphoblastic leukemia during acute phase of the disease to assess their potential prognostic value. Patients and methods: Forty patients with acute lymphoblastic leukemia included 26 males and 14 females with their ages ranged from 2 to 10 years and 20 healthy children of matched age and sex were included in this study. We analyzed serum soluble thrombomodulin and von Willebrand factor levels by enzyme-linked immunosorbent assay. Results: In children with acute lymphoblastic leukemia, there was a significant increase in soluble thrombomodulin, and von Willebrand factor levels during the acute phase of the disease. Children with an unfavorable outcome had higher levels of thrombomodulin and von Willebrand factor levels. Conclusions: Serum thrombomodulin and von Willebrand factor levels as a parameter of endothelial dysfunction during the acute phase of acute lymphoblastic leukemia might represent an additional prognostic marker in childhood acute lymphoblastic leukemia.