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Abstract
Over the last few years, the factors that have both a positive (angiogenic) and negative (antiangiogenic) influence on tumour growth have been identified. The potential use of of natural and synthetic factors that suppress vasculature formation as anti-cancer drugs is under intense investigation.
The importance of angiogenic factors such as VEGF, although clearly established in solid tumours, has not been fully elucidated in human haematopoietic neoplasms.
It was suggested that VEGF is the major tumour angiogenesis factor, promoting tumour growth, invasion and metastasis. Conversly, blocking of VEGF function inhibits angiogenesis and suppresses tumour growth in vivo.
The aim of this study was to evaluate VEGF in patients with myeloid leukaemia in relation to clinical activity and allogeneic stem cell transplantation.
The study was carried out on the following groups of patients: 15 patients with newly diagnosed acute myeloid leukaemia, 20 patients with acute myeloid leukaemia post allogeneic stem cell transplantation; 15 patients with newly diagnosed chronic myeloid leukaemia, 20 patients with chronic myeloid leukaemia post allogeneic stem cell transplantation. Patients were compared to 15 healthy subjects as control. In all subjects the plasma VEGF was measured using ELISA technique.
As regards patients with newly diagnosed AML, the mean plasma level of VEGF was low (67.2+/-17.3pg/ml) compared to control (126+/-56.1 pg/ml) with high significance (p<0.001), and compared to AML patient group post-transplantation (380+/-649 pg/ml).
There was no significant difference in mean VEGF levels of AML patients presenting with or without extramedullary infiltration. The infiltration was in form of splenomegaly (7 patients), and hepatosplenomegaly (one patient). The mean serum LDH level was significantly high in patients with AML compared to control.
As regards haematological parameters, AML patients pre-transplantation had significantly lower mean RBC count and platelet count, and high mean WBC count compared to control. The mean haemoglobin levels were low in both groups with AML. The mean RBC count was low in patients with AML post-transplantation.
In newly diagnosed CML patients, the mean plasma VEGF level was significantly increased (344+/-369pg/ml) compared to control (126+/-56.1 pg/ml). The mean serum LDH and uric acid levels were high compared to control.
In the CML pre-transplantation group, the mean levels of hepatic enzymes were high compared to control. This may be attributed to disease activity, as other causes of hepatitis have been excluded.We found also highly significantly low mean haemoglobin level compared to control, all patients had negative Coomb’s test. Their mean WBC and platelet counts highly significantly increased compared to control. All patients had high basophil count and low neutrophil alkaline phosphatase level. The mean RBC count was low compared to control. In CML patients post-transplantation, The mean plasma VEGF level was significantly low (102+/-74.2 pg/ml) compared to control and to CML patient group before transplantation.
We found that there was a significant positive correlation of plasma VEGF level with haemoglobin .in CML patients post-transplantation.
As regards allogeneic stem cell transplantation, patients with AML before transplantation, the mean plasma level of VEGF was low compared to AML patient group post-transplantation.
In CML patients post-transplantation, the mean plasma VEGF level was significantly low compared to control and to CML patient group before transplantation.
There was no significant difference in the mean plasma VEGF levels between each of AML and CML patient groups who received full conditioning and reduced conditioning regimens. Patient subgroups receiving different full conditioning regimens (Bu/Cy and TBI/Cy ) was too small to be interpreted statistically.
We found that the mean plasma VEGF level was significantly high in AML patients with GVHD compared those who did not develop GVHD .