Evaluation of Survivin and vegf expression as independent predictors of relapse in Egyptian children with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer. Overexpression of survivin is associated with increased risk of recurrence in a variety of cancers including hematologic malignancies. Vascular endothelial growth factor (VEGF) has been demonstrated to be a significant promoter of tumor neovascularity. The aim of the current study was to evaluate the prognostic significance of expression of survivin and VEGF in pediatric patients with acute lymphoblastic leukemia at induction and their correlation with minimal residual disease (MRD) following chemotherapy. This study was conducted on 100 patients with de novo ALL. Survivin and VEGF expression were analyzed before and after chemotherapy. Patients were examined for MRD by flow cytometry to determine those prone to relapse. Using real time polymerase chain reaction, there was an over expression of both survivin and VEGF in patients before induction chemotherapy. After induction, survivin expression declined significantly, while VEGF expression significantly increased. Patients with MRD had significantly higher expression of both genes with a significant positive correlation before and after induction chemotherapy. In conclusion, these data support the association between a high coexpression of survivin and VEGF and disease activation as well as their correlation with a higher tendency to relapse in pediatric ALL.