الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute myeloid leukemia (AML) is heterogeneous hematological malignancy characterized by accumulation of abnormal myeloblasts, most commonly in the bone marrow, leading to bone marrow failure and death.
In Egypt, leukemia comprises 10% of all malignancies, with AML representing 16.9%. The incidence is approximately 1.03/100000/year with 1023 new AML cases in 2013.
Over the years several different classification systems for AML have been presented based on etiology, morphology, immunophenotyping and genetics.
Pathogenesis of AML is a complex multistep process that results from the interaction of two different classes of mutations. The first class of mutation impairs cell differentiation resulting in clonal expansion of myeloid progenitors. The second class causes abnormal cell proliferation by constitutive activation of cellular proto-oncogenes including FLT3 tyrosine kinase, RAS, c-KIT, and others. Patients with AML usually present with bone marrow failure that causes symptoms of anemia, bleeding from thrombocytopenia, and neutropenic infections. Striking bruising and life threatening hemorrhage should raise suspicion of disseminated intravascular coagulation frequently seen in acute promyelocytic leukemia. Since 1970, the backbone of intensive induction chemotherapy remains unchanged. For young adults (age < 60 years) and fit elderly patients (especially those harboring NPM1 mutations and CBF leukemia) the intensive anthracycline and cytarabine regimen, “7 + 3”, induction therapy is thestandard of care. Patients with suspected acute promyelocytic leukemia (APL) should be treated with all-trans retinoic acid (ATRA) even before the diagnosis is confirmed. Consolidation or post-induction therapy is given to prevent relapse and eradicate minimal residual leukemia (MRD) in the bone marrow after induction as a bridge to transplant or to achieve cure. There are two main strategies for consolidation; chemotherapy (including targeted agents) and hematopoietic stem cell transplantation. Both strategies could be used alone or most commonly in combination depending on the type of leukemia, the fitness of the patient and the availability of a stem cell donor. Febrile neutropenia is a medical emergency that requires urgent evaluation, the timely administration of empiric broad-spectrum antimicrobials, and careful monitoring to optimize patient outcomes and mitigate the risk of complications. The most popular tool used to predict the risk of complications associated with a febrile neutropenia episode is the Multinational Association of Supportive Care in Cancer (MASCC) score. Survival from infections can be influenced by the capacity of the host immune system in identified microbial pathogens and triggering an immediate and effective response. This mechanism is divided into an innate and an adaptive system. Presepsin is a newly investigated sepsis marker that has been shown to have potential as an early marker of sepsis recognition, for antimicrobial therapy monitoring and as a prognostic marker. Presepsin could be detected as early as one hour after the exposure, with maximum concentration in the third hour. This finding may confirm that presepsin can be a useful marker of host response to bacteria and can be both a specific marker of infection as well as an early indicator, compared to cur-rent markers. the aim of this study is to evaluate the role of soluble CD14 (plasma Presepsin) as a biomarker of sepsis in febrile neutropenic acute myeloid leukemia (AML) patients receiving induction chemotherapy in relation to other biomarkers of sepsis like CRP and blood culture results and to assess the relation between Presepsin level with quick sofa score and MASCC score in febrile neutropenic patients for prognostication of these patients.
All patients were subjected to history taking, physical examination, imaging studies and laboratory investigations including blood culture, C-reactive protein,and presepsin which is measured on day 1,2 and 7 of neutropenic fever . Also, MASSC score and quick sofa score were calculated to all patients.
We found that 13% of patients have gram positive blood culture results, 36.7% have gram negative blood culture results and 50% have no growth results. Plasma presepsin showed significant diagnostic ability with sensitivity 80% and specificity 73.33.in relation to blood culture results .also it showed significant diagnostic ability in relation to CRP with sensitivity 95.42 and specificity 88.89. MASSC score had significant prognostic ability with sensitivity 100 and specificity 66 in contrast to quick sofa score which had sensitivity 53.33 and specificity 66.7. There was a positive correlation between plasma presepsin level and gram positive blood cultures and no growth results. There was positive correlation between presepsin level and gram negative blood cultures and no growth results. There was positive significant correlation between plasma presepsin level and quick sofa score. There was negative significant correlation between plasma presepsin and MASCC score results. We concluded that plasma presepsin is a good diagnostic tool in detection of sepsis in relation CRP and blood culture results; it also has a prognostic ability as marker of poor prognosis alone or in combination with MASCC sore.