Serum IGF-1 and IGFBP-3 Levels Before and After Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia
Abstract
Background: The growth hormone–insulin-like growth factor (GH–IGF) axis is suppressed by systemic inflammation and catabolism. We assessed the dynamics of Insulin-like Growth Factor-1 (IGF-1) and Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) in children with acute lymphoblastic leukemia (ALL) at presentation and after induction chemotherapy, and we examined their relationships with disease metrics and nutritional status. Materials and Methods: In a prospective cohort with a healthy control group, we enrolled 27 pediatric ALL patients and 95 healthy children. After 2 deaths and 2 withdrawals, paired pre/post-induction analyses were performed in 23 patients. IGF-1 and IGFBP-3 were measured using a chemiluminescent immunoassay on the Immulite 2000 system at baseline and on day 33. Anthropometrics and routine disease indices (WBC, cytogenetics, DNA index, measurable residual disease (MRD) were recorded. Data were analyzed using SPSS version 26 using chi-square, Fisher’s exact test, T-test, Wilcoxon signed-rank, and Mann–Whitney U. P-value<0.05 was considered significant. Results: At diagnosis, patients had significantly lower IGF-1 (53 [34–111] vs. 168 [107.5–288] ng/mL; p < 0.001) and IGFBP-3 (1650 [1325–2890] vs. 3306 [2476–4149.5] ng/mL; p < 0.001) than controls. Following induction, IGF-1 increased from 53 [34–111] to 98 [79–138] ng/mL (p < 0.001), and IGFBP-3 from 1650 [1325–2890] to 2190 [1764–3799] ng/mL (p = 0.001). MRD status was not associated with IGF-1 (pre-induction: p = 0.459; post-induction: p = 1.000) or IGFBP-3 (pre-induction: p = 0.312; post-induction: p = 0.825) levels, or with their changes during induction (IGF-1: p = 1.000; IGFBP-3: p = 0.923). Conclusion: IGF-1 and IGFBP-3 are suppressed at diagnosis and rebound after induction in pediatric ALL. These findings demonstrate dynamic changes in IGF-1 and IGFBP-3 during induction therapy. Further longitudinal studies are needed to determine whether these biomarkers have clinical utility.