Association between increased levels of TNF-alpha, decreased levels of prealbumin and retinol-binding protein, and disease outcome

We determined whether there is an association between tumor necrosis factor -alpha (TNF-alpha), undernutrition [prealbumin (PA) < 160 mg/L, retinol bin ding protein (RBP) < 30 mg/L], disease stage, outcome (death or survival), and race in children with leukemia. TNF-alpha, PA, and REP were measured in 52 patients (0.8 to 17 years old): 18 African Americans, 34 whites; 27 new ly diagnosed (ND), and 25 in clinical remission (CR). Mean levels of TNF-al pha were higher in patients than in 46 healthy children (p < 0.05), but wer e not different between ND and CR groups. Mean acute phase proteins (APP) w ere different among groups: ND > CR > controls (p < 0.05). Mean levels of P A and REP were lower in patients than in controls (p < 0.05), and tended to be higher in CR than in ND patients. African-American patients had lower c oncentrations of TNF-alpha, PA, and REP but higher APP than white patients (p < 0.05). CR patients and African-American patients who died tended to ha ve higher levels of TNF-alpha and APP, but lower PA and REP than those who survived. A higher percentage of ND African Americans (45%) than of ND whit es (13%) died. Results suggest that undernutrition and inflammation in CR p atients and African Americans were associated with poor survival, and that ND African Americans have a poorer outcome than whites independently of TNF -alpha levels.