الفهرس 
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Abstract
Chronic lymphocytic leukemia, is a chronic lymphoproliferative disorder characterized by increased accumulation of long lived B lymphocytes with a clinical course that progresses from an indolent lymphocytosis without other evident disease to generalized lymphatic enlargement.
chronic lymphocytic leukemia is the most common form of leukemia in Western countries. The risk of developing B-CLL increases progressively with age and is two times higher in males than females. It occurs primarily in middle age and elderly individuals with increasing frequencies in successive decades. The etiology of CLL remains unknown, though a genetic or familial susceptibility has been suggested. Staging of CLL is mainly done by either one of the two main systems which are the Rai and the Binet classifications. However, these two systems fail to predict the outcome of the cases. Some cases have a bad prognosis despite of early aggressive courses of treatment and others have a better prognosis even with less aggressive treatment. So other prognostic factors are considered such as lymphocyte doubling time, β-2 microglobulin, immunoglobulin variable heavy chain gene mutations, CD38, ZAP70 and serum thymidine kinase.
Certain diseases, especially of autoimmune nature, are associated more frequently with particular HLA types. The association level however, varies among diseases and there is generally a lack of a strong concordance between the HLA phenotype and the disease.
The aim of the present study was to report the association of CLL with specific alleles of HLA DRB1 in some Egyptian patients.
The present study included two groups: patient group and control group.
The patients group was 50 in number. They were subjected to the following:
1. Thorough history taking with special emphasis on the disease presentation, past history and family history.
2. Complete clinical examination laying stress on the extent and distribution of lymph node enlargement, visceromegaly, pallor, bleeding, skin nodules and purpuric eruption.
3. Diagnostic laboratory investigations included:
• Complete blood picture and bone marrow aspiration.
• Immunophenotyping analysis by flow cytometery for expression of CD5, CD10, CD19, CD20, CD23, CD24, SmIg and CD38.
The control group included 57 individuals with matched age and sex.
All the patients and control group were subjected to:
Molecular typing of HLA class II DRB1 using Inno LiPA HLA DRB1, from Murex Innogenetics. Molecular typing was performed on DNA purified from peripheral blood samples. Generation Capture Column kit, from Gentra systems was used for purification of DNA from the blood samples.
Our stastical analysis of the results have shown that the age for the patient’s group ranged form 48 years to 81 years with a mean of 61.54±8.22 years. Also we found that 41 were males with a percentage of 82% and 9 were females with a percentage of 18%. According to Rai staging system the studied patients were classified into: 10 patients in stage 0 (20%), 7 patients in stage I (14%), 21 patients in stage II (42%), 6 patients in stage III (12%) and 6 patients in stage IV (12%).
The white blood cell count ranged between 18 X109 /l to 145 X109 /l with a mean of 53.22 X109 /l ±27.44.
The absolute lymphocytic count has a range of 14.58 X109/l to 111.65 X109/l with mean of 40.81±21.12.
The red blood cell count ranged between 2.6 X1012 /l to 5.0 X1012 /l with a mean of 3.97 X1012/l ±0.65.
The hemoglobin ranged between 7.5g/dl to 14.2g/dl with a mean of 11.55 g/dl ±1.74.
Hematocrit ranged between 22% to 42% with a mean of 34.92 ±5.32.
Platelets ranged between 68 Xl09/l to 363 X109/l with a mean of 148.52 X109/l ±51.77.
Immunophenotyping was carried out for all cases, it included CD5, CD 10, CD 19, CD20, CD23, CD24, CD25, Smlg and CD38.
CD5, CD 19, and CD23 were positive in all cases. CD 10 and CD25 were negative in all studied cases, while Smlg was weak positive in all cases.
CD20 was positive in 22 cases with a percentage of 44%.
CD24 was positive in 28 cases with a percentage of 56%.
CD38 was positive in 20 cases with a percentage of 40%. 30% of patients in stage 0 expressed the CD38 antigen, 38.1% of patients in stage I and II were CD38 positive, 50% of patients in stage III were also CD38 positive compared to 66.7% of those in stage IV. This might reflect the prognostic importance of CD38 in patients with CLL. Patients in early stages of the disease have a better prognosis than those in late stages.
HLA-DRB1 findings:
In the present study, HLA typing for DRB1 revealed that the allele 04 was predominant in the control group. There was also increased frequency of HLA-DRB1*04 among our Egyptian patients. In addition HLA-DRB1*07 was the second most common allele in the patients group. Moreover, HLA-DRB1*011 had average frequency in Egyptian patients.