الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
AML is a hematological cancer distinguished by the accumulation of immature blast cells in the bone marrow. Anemia, recurrent infections, easy bruising or bleeding tendency are the main manifestations of the disease. Those are primarily caused by disruption of the normal hematopoiesis by the infiltrating leukemic cells,
Acute myeloid leukemia is diagnosed with 20% or more blast cells in a patient’s bone marrow or by identification of the recurring genetic abnormalities: t(8;21) (q22;q22), inv(16)(p13q22), t(16;16)(p13;q22), and t(15;17)(q22;q12) regardless of the number of blast cells. Main stay treatment is the ‘7+3’ protocol as induction chemotherapy which consists of 7 days of cytarabine combined with 3 days of daunorubicin. All trans retinoic acid or arsenic trioxide are added in acute promyelocytic leukemia cases. Elder or more frail patients are subjected to reduced regimen or novel targeted therapy.
Infection is the most common manifestation of AML as well as the most common cause of mortality. AML patients are more prone to infections due to the decrease in number and functions of leukocytes. This is not only due to bone marrow infiltration but also due to the effect of treatment.
Febrile neutropenia occurs when a patient has an oral temperature of more than 38.5°C or two successive measurements greater than 38.0°C for 2 hours in addition to an absolute neutrophil count lower than 0.5 × 109/L, or a projected decrease under 0.5 × 109/L. It is common in most patients undergoing chemotherapy and is a precipitating factor for infection and sepsis.
Serum immunoglobulin levels are usually indicative of immunological status of an individual. IgA, IgG and IgM are the most commonly measured serum immunoglobulins and increase in their levels could be indicative of a response to infections.
The present study was carried out on 40 newly diagnosed adult AML patients admitted at Alexandria Main University Hospital, Alexandria, Egypt. All patients underwent routine hematological and biochemical tests as well as bone marrow aspiration and immunophenotyping to diagnose AML. Using ELISA technique, serum IgA, IgG and IgM levels for the patients were measured before initiation of induction chemotherapy and repeated either at the onset of the first neutropenic febrile episode or at the nadir of aplasia. The serum immunoglobulin levels of 20 healthy controls matched in terms of age and sex were also measured.
The results of the study revealed that IgA, IgG and IgM levels patients significantly decreased in sera of AML patients following induction chemotherapy. Serum IgG and IgM levels were significantly elevated in adult AML patients prior to induction chemotherapy compared to healthy controls and serum IgG level was significantly less at febrile neutropenia or aplasia when compared to controls.
Males had significantly higher IgG level than females at febrile neutropenia or aplasia. Also, IgA levels correlated positively with Hb and negatively with WBC in controls. Ig A level also significantly increased with procalcitonin level at time of febrile neutropenia. IgA were noted to be significantly highest in viral infections and lowest in fungal infections. However, no statistically significant difference in serum immunoglobulin levels between febrile and afebrile AML cases could be established. Our results showed that serum immunoglobulin levels had no prognostic value as regards treatment outcome and overall survival