# Insights into the Prognostic Value of Telomere Length in Childhood Acute Lymphoblastic Leukemia

## TL;DR

This study explores how telomere length in children with leukemia may predict their risk of relapse and treatment response.

## Contribution

The study introduces a novel approach to assess telomere length in ALL patients for potential prognostic use.

## Key findings

- Telomere shortening was observed in ALL lymphoblasts but not in post-treatment lymphocytes.
- Shorter telomeres were significantly linked to a higher risk of relapse.
- B-ALL showed a trend of more pronounced telomere shortening compared to T-ALL, though not statistically significant.

## Abstract

Background: Although telomere length maintenance is a common characteristic of hematological malignancies, the role of telomere length as a prognostic factor to stratify acute lymphoblastic leukemia (ALL) patients depending on their risk of relapse remains elusive. Methods: This knowledge gap motivated us to examine telomere length values in children with ALL at the time of diagnosis and after treatment using quantitative polymerase chain reaction (qPCR) (n = 35). To achieve high-resolution precision and cell specificity, a quantitative fluorescence in situ hybridization (qFISH) technique was developed (n = 5). Results: The results demonstrated statistically significant evidence of telomere shortening in the lymphoblasts of children with ALL but not in the lymphocytes of children after remission following treatment. Our findings also suggested a significant association between telomere shortening and a high risk of relapse disease. Last but not least, our preliminary results showed a trend that telomere shortening was more pronounced in children with B-ALL compared to those with T-ALL in a non-significant manner. Conclusions: Consequently, the current study provides preliminary insights into the potentially substantial prognostic value of telomere length in the progression of pediatric ALL, with the possibility of predicting treatment response. To clarify the application of telomere length as a possible biomarker for disease progression and treatment response in children with ALL, the telomere length values of additional participants need to be examined in further studies.