“…The fact that some soluble factors (CCL2, IL-6, IL8, CXCL1, and RANTES) are synergistically increased in the LN argues in favor that the phenotypic and functional alterations observed in the CD34+ cells is either directly through soluble factors secreted from the REH cell and/or indirectly through REH-CM-induced secretion by MSC. In particular the role of CCL2, IL-6, and IL-8 merits further study; the fact that IL-8 and CCL2 are upregulated in MSC from ALL patients [23], and that plasma levels of CCL2, IL-8, and IL-6 are increased in children at ALL diagnosis [23,31], show their relevance in vivo and validates in part our in vitro LN. The leukemic-induced alterations of the HSPC found here could be equated with the observed reduced hematopoiesis, increased progenitors and differentiated cells, and, in general, bone marrow failure in patients with ALL [6,20,32].…”