β-adrenergic receptors (β-AR) have been closely associated with the occurrence and progression of certain tumors. However, the expression of β-AR in acute T-cell lymphoblastic leukemia (T-ALL) and its correlation with the prognosis and risk stratification of T-ALL have not been reported domestically or internationally.

To clarify the expression of β-AR on the leukemic cells of pediatric T-ALL patients and to analyze the impact of β-AR on the risk stratification and prognosis of T-ALL patients.

Database searches were conducted to determine the expression levels of β1-AR, β2-AR, and β3-AR in leukemia and other malignant tumors, as well as the influence of their expression levels on tumor prognosis, with data summarized accordingly. Clinical data and bone marrow specimens were collected from 40 pediatric T-ALL patients treated at the Affiliated Hospital of Zunyi Medical University from 2019 to 2022, divided into newly diagnosed T-ALL group and T-ALL remission group based on diagnosis and therapeutic outcomes, with 23 and 17 cases respectively; 15 cases of clinical data and bone marrow specimens from pediatric patients with non-hematological diseases were collected as a control group. The newly diagnosed T-ALL group was further divided into intermediate-risk subgroup (9 cases) and high-risk subgroup (14 cases). Additionally, the newly diagnosed T-ALL group was categorized based on prognosis outcomes into a poor prognosis subgroup (10 cases) with death and relapse, and a good prognosis subgroup (13 cases) with good therapeutic effect and complete remission. Clinical data of the pediatric patients were collected. β-AR expression in T-ALL cells was detected using Western blot. Pearson correlation analysis or Spearman rank correlation test was used to explore the correlation between β-AR and the degree of risk in T-ALL pediatric patients. Multifactorial Logistic regression analysis was used to explore the risk factors for high risk in T-ALL pediatric patients.

Database search results revealed that β1-AR has a higher expression level in prostate cancer, β2-AR has a higher expression level in hematological and prostate-related malignant tumors, and β3-AR has a very low expression level in malignant tumors. Compared with normal blood tissue, the expression of β-AR genes in acute myeloid leukemia blood tissue is higher, mainly dominated by β2-AR gene expression, followed by β1-AR gene, while the expression level of β3-AR gene is lower. The β1-AR gene can affect the survival rate of patients with cervical cancer, squamous cell carcinoma of the lung, pancreatic cancer, sarcoma, and melanoma; the β2-AR gene can affect the survival rate of patients with renal cell carcinoma, adenocarcinoma of the lung, and thymic carcinoma; the β3-AR gene can affect the survival rate of patients with renal clear cell carcinoma. Western blot results showed that the protein expression levels of β1-AR, β2-AR, and β3-AR in the newly diagnosed T-ALL group were higher than those in the control group and T-ALL remission group (P<0.05). The β3-AR in the high-risk subgroup was higher than that in the intermediate-risk subgroup (P<0.05). Multifactorial Logistic regression analysis showed that an increase in β3-AR (OR=7.036, 95%CI=1.244-39.783, P=0.027) and the presence of leukemic cells in the bone marrow after 15 days of chemotherapy (OR=10.667, 95%CI=1.035-109.941, P=0.047) are risk factors for high risk in T-ALL pediatric patients, and an increase in β3-AR (OR=8.447, 95%CI=1.557-45.819, P=0.013) is a risk factor for poor prognosis in T-ALL pediatric patients. Correlation analysis results showed that β2-AR is positively correlated with white blood cell count, the proportion of leukemic cells in the bone marrow at the first diagnosis, and the bone marrow leukemic cells after 15 days of chemotherapy, and β3-AR is positively correlated with the risk and prognosis of T-ALL pediatric patients (P<0.05) .

There is an abnormally high expression of β-AR on the leukemic cells of T-ALL pediatric patients, and the decrease in the expression level of β-AR can be used as an indicator of remission in T-ALL pediatric patients. In addition, the abnormally high expression of β3-AR is an independent risk factor for the occurrence of high risk and poor prognosis in T-ALL pediatric patients.