الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
In leukemia, multiple acquired genetic changes must occur in order to convert a normal haematopoietic stem cell (HSC) to leukemic stem cell (LSC). It is characterized by the accumulation of large numbers of blasts arrested at varying stages of differentiation; thus, a perturbation of the normal differentiation program with maturation arrest is a key event in leukemogenesis.
Acute myeloid leukemia (AML; also known as acute non lyrmphocytic leukemia) is a heterogeneous group of disease characterized by an increase in the number of myeloid cells in the marrow and an arrest in their maturation, frequently resulting in hematopoietic insufficiency (granulocytopenia, thrombocytopenia, or anemia), with or without leukocytosis.
AML is the most common type of leukemia in adults, yet it continues to have the lowest survival rate of all leukemia’s. While results of treatment have improved steadily in younger adults over the past 20 years, there have been limited changes in survival among individuals of age >60 years.
The development of AML has been associated with several risk factors. Remarkably though, as of yet defined risk factors account for only a small number of observed cases. These include age, antecedent hematological disease, genetic disorders as well as exposures to radiation, viruses, chemical or other occupational hazards, and previous chemotherapy.
The clinical signs and symptoms of AML are diverse and nonspecific, but they are usually directly attributable to the leukemic infiltration of the bone marrow, with resultant cytopenia. Typically, patients presented with signs and symptoms of fatigue, hemorrhage, or infections and fever due to decreases in red cells, platelets, or white cells, respectively.
The primary diagnosis of AML rests on the morphologic identification of leukemic myeloblasts in preparations of peripheral blood and bone marrow stained with Wright-Giemsa. These cells have round to irregular nuclei, distinct nucleoli, and very little cytoplasrn. The cytoplasm frequently contains fine azurophilic granules and a variable number of Auer bodies, or rods. The presence of more than 30 percent leukemic blasts in a bone marrow aspirate is required for a definitive diagnosis of acute leukemia; before therapy is initiated
This study aimed to investigate the serum estrogen and its soluble receptor levels in patients with acute leukemia in order to extrapolate its possible clinical significance.
Individuals submitted to this study were divided into three groups:
group I: Involved 20 healthy volunteers (10 males and 10 females) clinically free from any disease (control group), their mean age was 41.30 ± 3.46 years and were chosen from the stuff members of MRI, Alexandria University, and Hematology unit, Faculty of Medicine, Alexandria University and their relatives.
group II: Involved 28 patients (18 males and 10 females) of newly diagnosed AML.
group III: Involved 19 patients (9 males and 10 females) of newly diagnosed ALL.
Patients in group II and III were of matched age as the control group and were recruited from Hematological department, MRI, Alexandria University and Hematology unit, Faculty of Medicine, Alexandria University. An informed consent was taken from all contributors in this study.
Patients with AML received 3 + 7 protocol of induction including: Daunomycin 45 mg/m2 for 3 days, Cytosine arabinoside 100 mg/ m2 x2 / day for 7 days.
Patients with ALL received induction protocol as follows: Vincristine 1.4 mg/ m2 days 1, 8, 15, 22, Prednisolone 1 mg / kg / day x 28 days, Doxorubicin 25 mg/ m2 days 1, 2, 3.
After completion of the cycles and restoration of bone marrow cellularity, bone marrow aspiration was done. Patients who achieved complete remission had a BM blasts less than 5%. Those who did not achieve complete remission received a 2nd induction cycle.
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. The results showed that the levels of both serum estrogen (pg/ml) and its soluble receptor level ER (ng/ml) in both male and female patient groups with either AMLor ALL were significantly lower than in control group.
Moreover, the mean values of SGOT (U/l), SGPT (U/l). Urea (mg/dl) and creatinine (mg/dl) in both groups of patients with leukemia were significantly higher than the control group.
On the other hand, the mean value of albumin (mg/dl) in both groups of patients with leukemia was significantly lower than the control group.
Also, the mean value of WBCs (×10³/μl) count in AML and ALL patients were higher than in control group. On the other hand, Platelets count (×10³/μl) and Hb concentration (g/dl) in both groups of patients were significantly less than in control subjects.
Level of ER (ng/ml) in serum of male AML patients showed a significant positive correlation with E2 (pg/ml) and Hb concentration (g/dl) and was inversly correlated with WBCs count (×10³/μl) and age (years).
Level of ER (ng/ml) in serum of female AML patients showed a positive significant correlation with E2 (pg/ml).
Also, Level of E2 (pg/ml) in serum of female AML patients showed a positive significant correlation with Hb (g/dl).
It was also noticed that, level of ER (ng/ml) in serum of female ALL patients showed a negative significant correlation with Blast cells.
Also, Level of E2 (pg/ml) in serum of female ALL patients showed a negative significant correlation with albumin (mg/dl).
The ROC curve analysis was used to compare the diagnostic values of serum ER (ng/ml) and E2 (pg/ml) in both males and females depending on the area under the curve (AUC). The higher AUC corresponds to a better diagnostic test. The curve showed that both parameters were excellent diagnostic markers of acute leukemia as was indicated by asymptomatic significance and very high area under the curve.