Abstract
<title>Abstract</title> <p>Background Pediatric B-cell acute lymphoblastic leukemia (B-ALL) remains a major childhood malignancy in which interactions between leukemic cells and the immune microenvironment influence disease progression and clinical outcomes. However, the temporal dynamics of soluble immune mediators during remission chemotherapy and their prognostic value remain incompletely understood. Methods Here, we profiled 48 soluble immune mediators in peripheral blood (PB) and bone marrow (BM) from 36 pediatric B-ALL patients at diagnosis (D0) and during remission chemotherapy (D15, D35, and D84) using multiplex assays. Mediator profiles were also compared between patients who achieved remission (RG) and those who died during induction therapy (DG). Results At D0, pediatric B-ALL patients exhibited a broadly dysregulated immune landscape, followed by progressive remodeling throughout remission chemotherapy, with only partial normalization of mediator levels and persistent disruption of immune interaction networks over time. Patients in the DG displayed a more exacerbated immune profile at diagnosis than those in the RG. Decision tree models identified small panels of soluble immune mediators at D0 (PB: CCL5, IL-6, CXCL9, and IL-2Rα; BM: CXCL12 and CCL4) that discriminated clinical outcome with high internally resampled performance (PB: AUC = 0.996, 95% CI 0.987–1.000; BM: AUC = 0.910, 95% CI 0.790–1.000). Conclusions Together, these findings provide a comprehensive characterization of longitudinal immune remodeling in pediatric B-ALL and identify candidate immune mediator panels associated with adverse clinical outcomes. These results support the further evaluation of immune profiling as a candidate approach for early risk stratification in pediatric B-ALL.</p>