PRETREATMENT LABORATORY PARAMETERS AS POTENTIAL EARLY BIOMARKERS FOR DISEASE AGGRESSIVENESS IN ACUTE LEUKEMIA

Background: In acute leukemia, early identification of aggressive disease is crucial for risk-adapted therapy. Pretreatment laboratory parameters, readily available at diagnosis, may reflect underlying tumor burden and metabolic stress. Objective: To evaluate a panel of routine hematological and biochemical parameters as potential biomarkers of disease aggressiveness in patients with acute leukemia prior to induction chemotherapy. Methods: We conducted a retrospective analysis of 30 patients with newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Data included complete blood counts and liver function tests. A simple "High-Risk Presentation Score" (HRPS) was devised, assigning one point each for: leukocytosis (WBC >50 × 10⁶/L), severe thrombocytopenia (platelets <50 × 10⁶/L), hypoalbuminemia (albumin <3.5 g/dL), and transaminitis (ALT or AST >40 U/L). A score ≥2 defined a high-risk phenotypic cluster. Results: The cohort comprised 18 AML and 12 ALL patients, with a median age of 24 years (range: 1–85). Abnormalities were common: severe thrombocytopenia in 20 (66.7%), transaminitis in 13 (43.3%), leukocytosis >50 in 9 (30%), and hypoalbuminemia in 12 (40%). Based on the HRPS, 14 patients (46.7%) were classified as high-risk (score ≥2). This high-risk group exhibited a higher median WBC count (68 vs. 16 × 10⁶/L) and lower median platelet count (18.5 vs. 71 × 10⁶/L) compared to the low-risk group. Conclusion: A composite score integrating easily available pretreatment lab values can identify a distinct subgroup of acute leukemia patients with features suggestive of high disease burden and metabolic derangement. This pragmatic tool may aid in early risk stratification and warrants prospective validation against clinical outcomes such as chemotherapy tolerance and early mortality.