الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
B-cell chronic lymphocytic leukemia (B-CLL), also known as chronic lymphoid leukemia (CLL), is the most common type of leukemia. CLL is a disease of adults, but, in rare cases, it can occur in teenagers and occasionally in children (inherited). Most (>75%) people newly diagnosed with CLL are over the age of 50, and the majority are men. Most people are diagnosed without symptoms as the result of a routine blood test that returns a high white blood cell count, but, as it advances, CLL results in For the past ten years, there has been a dynamic development of new therapeutic compounds and prognostic parameters for chronic lymphocytic leukemia (CLL). Hematologists and oncologists are challenged to use these new possibilities for an optimized, risk- and fitness-adapted treatment strategy, with the goal of achieving long-term remissions and preserving a good quality of life. The last ten years have seen a dynamic development of new agents for the treatment of chronic lymphocytic leukemia (CLL). Fludarabine and a monoclonal antibody, alemtuzumab, have been approved by the European and American regulatory agencies. Additional monoclonal antibodies (anti-CD20, rituximab; anti-CD23; anti-MHC II) as well as many other drugs (flavopiridol, bendamustine) are currently being tested in clinical trials. In addition, the increased experience with autologous and allogeneic progenitor cell transplantation allows to offer these intensified treatment modalities to physically fit patients at very high risk of relapse or at the time of relapse. However, the optimal combination and treatment sequence of these different novel treatment modalities remain unclear. Similarly, rapid progress has been achieved with regard to new diagnostic tests to identify prognostic subgroups in CLL, and to assess their response to therapy. The survival period from the time of diagnosis of CLL varies between 2 and more than 10 years, depending on the stage. The staging systems of Rai , and Binet are used to estimate prognosis. Both are based on the extent of lymphadenopathy, splenomegaly, and hepatomegaly on physical exam and on the degree of anemia and thrombocytopenia in peripheral cell counts. These simple studies are inexpensive and can be applied to every patient without technical equipment. Both staging systems describe three major prognostic subgroups. However, it has long been recognized that the above clinical staging systems are not sufficient to predict the individual prognosis, especially in the early stages of disease. Therefore, additional parameters have been identified allowing a more accurate prediction of the prognosis of CLL patients. In this study we have studied the comparison between fludarabine single agent, and the combinations fludarabine, cyclophosphamide in new untreated CLL patients. Also we have studied the prognostic significance of soluble CD27, and β2 microglobulin, and their relation to other prognostic factors. Our patients collected from the outpatient clinic of the hematology& oncology unit, at Mansoura oncology center.50 patients (32 males, 18 females), where grouped into two arms. Arm A received Fludarabine 25 mg/m2 IV Daily for 5 days. Arm B received Fludarabine 20 mg/m2 IV Daily for 3 days plus, Cyclophosphamide 600 mg/m2 Day 1only. Both arms received 6 cycles of treatment. The serum level of soluble CD27, and β2 microglobulin were measured before and after the treatment, and compared to the clinical response of the patients, and to other prognostic factors. The result of this study revealed that the combination of fludarabine, cyclophosphamide yield improved CR, OR,OS, 3 year disease FS and PFS compared to fludarabine alone, but the difference was statistically insignificant, and this might be the small number of our patients. We compared the serum levels of β2microglobulin, and CD27, with other prognostic variables, and to the treatment response. We found that sCD27 has a predictive and prognostic significance in CLL . High values are associated with lower response rates, PFS, similar to the β2microglobulin, and both are considered bad prognostic indicators of CLL, reflecting high tumor burden, and lower response rate.