DKK3 as a novel biomarker for risk stratification in pediatric acute lymphoblastic leukemia

Aberrant Wnt signaling drives oncogenesis. DKK proteins, key extracellular regulators of Wnt pathway, play critical roles in tumor suppression or promotion.
This study enrolled 66 newly diagnosed acute lymphoblastic leukemia (ALL) patients, stratified into low-risk (LR) and intermediate/high-risk (IR/HR) groups, alongside 39 children with immune thrombocytopenia (ITP) as controls. Bone marrow samples were collected at diagnosis and remission (day 46). DKK3 expression was measured using qRT – PCR and ELISA. Predictive performance was evaluated via ROC analysis and logistic regression.
DKK3 mRNA and protein levels were significantly lower at diagnosis than in remission and control groups (P < 0.001). LR patients showed higher DKK3 expression than IR/HR patients (P < 0.001). ROC analysis indicated that DKK3 mRNA and protein effectively predicted IR/HR status; combined AUC reached 0.889. No significant difference was found between B-ALL and T-ALL subgroups. Low DKK3 protein was an independent risk factor for event-free survival (P = 0.024).
DKK3 shows promise as a biomarker for early risk stratification and prognosis prediction in pediatric ALL, potentially supporting personalized treatment strategies.