ERYTHROCYTE SPERMINE LEVELS - A PROGNOSTIC PARAMETER IN CHILDHOOD COMMON ACUTE LYMPHOBLASTIC-LEUKEMIA

Polyamines have been implicated to play a role in cell proliferation a nd in cancer development. Ninety percent of the circulating spermidine (Spd) and spermine (Spm) are transported by red blood cells (RBC). RB C Spd and Spm levels were prospectively determined in 63 unselected ch ildren with common acute lymphoblastic leukemia. The Spm and Spd level s were not correlated with white blood cell (WBC) count. On the basis of the polyamine levels it was possible to discriminate four groups wi th P<10(-3). In C1, C2, C3 and C4 group the Spm level was respectively 90 (39-597), 3.75 (1-7.45), 9.95 (2.9-12.6) and 17 (6.3-33.8). The pr obability of relapse-free survival (RFS) of the 58 children who entere d complete remission was 55% +/- 9. For the groups C1 (n = 6), C2 (n = 16), C3 (n = 21) and C4 (n = 15) groups, the RFS was 25% +/- 20, 73% +/- 12, 73% +/- 13 and 32% +/- 13 respectively. For children with Spm levels <13/greater than or equal to 13 nmol/8 x 10(9) RBC, event-free survival (EFS) was 54% +/- 11/33% +/- 10 and RFS was 64% +/- 12/38% +/ - 11 respectively (P < 0.03, P < 0.005). Our clinical study shows clea rly that an RBC spermine level could be used as parameter of prognosis at the time of diagnosis, particularly for patients with intermediary WBC count.