Baseline Extracellular HMGB-1 Levels Associated with Induction Chemotherapy Response in Adult Acute Myeloid Leukemia

<ns5:p>Background Treatment response in acute myeloid leukemia (AML) is influenced by multiple biological and molecular mechanisms. High Mobility Group Box-1 (HMGB-1) is a multifunctional protein involved in inflammation, autophagy, apoptosis, and immunogenic cell death (ICD). Extracellular HMGB-1 released following chemotherapy-induced leukemia cell death may enhance anti-tumor immune responses. This study aimed to evaluate the association between baseline extracellular HMGB-1 protein levels and achievement of complete remission following induction chemotherapy in adult AML patients. Methods A prospective cohort study was conducted at Dharmais National Cancer Center, Jakarta, Indonesia. Adult patients with newly diagnosed AML who received standard D3A7 induction chemotherapy were enrolled consecutively. Baseline extracellular HMGB-1 protein levels were measured using enzyme-linked immunosorbent assay (ELISA) before chemotherapy initiation. Complete remission was assessed by bone marrow examination after induction chemotherapy. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal HMGB-1 cut-off value. Associations between HMGB-1 levels and complete remission were evaluated using relative risks (RRs) with 95% confidence intervals (CIs). Results Seventy-one AML patients were included in the final analysis. The median age at diagnosis was 39 years, and 52.1% were female. Complete remission was achieved in 40 patients (56.3%). Patients with low baseline extracellular HMGB-1 protein levels had a significantly lower probability of achieving complete remission than those with high HMGB-1 levels (RR 0.620; 95% CI 0.394–0.975; p = 0.038), corresponding to an approximately 38% reduction in remission likelihood. Among the evaluated biomolecular markers, extracellular HMGB-1 was the only biomarker significantly associated with complete remission. Conclusion Low baseline extracellular HMGB-1 protein levels are associated with a lower probability of achieving complete remission following induction chemotherapy in adult AML patients. Extracellular HMGB-1 may serve as a potential biomolecular marker of treatment response in AML.</ns5:p>